By Ana Espino | Published on November 26, 2025 | 3 min read
Testicular cancer is the most common
solid tumor in young men and carries an
excellent prognosis thanks to current
treatments such as surgery, chemotherapy, and radiotherapy. However,
fertility
preservation remains a major concern, as these treatments can impair
spermatogenesis, either temporarily or permanently.
This study was initiated to
evaluate
the impact of anticancer treatments on the fertility of patients with
testicular cancer, by analyzing the likelihood of natural conception and the
birth of a live child after treatment, according to the different therapeutic
regimens received.
Intensive treatments, impossible
fatherhood?
In this study,
4,863 men aged 15 to
55, diagnosed with testicular cancer between 1995 and 2017, were selected and
randomly assigned to six groups based on their treatment: active surveillance,
surgery alone, radiotherapy, or chemotherapy (1, 2, or ≥3 cycles). The median
follow-up was 9.6 years.
The results show that the
probability of fathering a live child after treatment was high across all
groups—24% in the “surveillance” group and between 17% and 22% in groups that
received active treatment. The most notable difference was found in patients
who received ≥3 cycles of chemotherapy: they had a slightly reduced, but still
substantial, probability of becoming fathers. Adjusted multivariate analysis
showed that treatments (including chemotherapy and radiotherapy)
only modestly
affected long-term fertility, with a
moderate impact mainly for intensive
regimens.
The length of follow-up made it
possible to observe that most conceptions occurred within the first five years
after diagnosis. Notably, about
70% of men who had a child after cancer had not
yet had one at the time of diagnosis, highlighting a substantial preservation of
reproductive capacity despite treatment.
Preserved fertility: a reassuring
message
Although
testicular cancer is highly
curable, it raises major concerns regarding fertility preservation in young men
of reproductive age. A key challenge lies in
balancing oncological treatment
efficacy with the minimization of reproductive sequelae.
The objective of this study was to
assess the
real effect of treatments on male fertility, drawing on real-world
data and actual birth outcomes. The results are reassuring: the
majority of men
retain sufficient fertility to become fathers, even after chemotherapy or
radiotherapy. Only intensive treatments (≥3 cycles of chemotherapy) appear to
have a slightly unfavorable effect. These findings support personalized
treatment strategies and informed discussions about sperm cryopreservation.
These results could help clinicians
better inform patients, adapt treatments based on fertility goals, and
emphasize pre-treatment cryopreservation according to individual risk.
Read next: Prostate cancer: could physical exercise be the key to regaining an active sexual life?
About the author – Ana EspinoPhD in Immunology, specialized in Virology
