Semen quality in patients with testicular cancer is associated with age and with greatly elevated levels of beta human chorionic gonadotropin.

BACKGROUND

Poor semen quality is a well-known feature in patients with testicular germ cell tumours (GCTs) at the time of diagnosis but the underlying biological reasons are incompletely understood.

OBJECTIVES

This study aimed to identify GCT-specific clinical factors that are involved with poor semen quality in GCT patients.

MATERIALS AND METHODS

Pre-orchiectomy ejaculate volume (EV), total sperm count (TSC), and proportion of progressive motility (PPM) were retrospectively analysed in 163 consecutive GCT patients. Their possible associations with the following clinical factors were evaluated: patients age, GCT histology, clinical stages, tumour size, serum levels of tumour markers and of follicle stimulating hormone (FSH) and luteinizing hormone (LH). Statistical methods involved comparisons of various stratified subgroups of clinical characteristics by employing multivariable statistical analyses.

RESULTS

Patients > 40 years had significantly inferior results than patients < 30 years with respect to median EV (2 mL vs. 3.1 mL) and median PPM (25% vs. 40%). The median TSC was 75-80 million in mildly elevated levels of beta human chorionic gonadotropin (bHCG) opposed to only 22 million in greatly elevated levels. Elevated FSH indicated low sperm counts. GCT histology, tumour-size, and elevations of alpha fetoprotein levels were not associated with semen quality. The effect of clinical staging remained equivocal due to small numbers.

DISCUSSION AND CONCLUSION

Greatly elevated bHCG levels and age > 40 years are significantly associated with poor semen quality in GCT patients. The inverse association of age with semen quality is a novel finding in GCT patients that mirrors the physiological decline of male reproductive function with age but that still needs confirmation. As these two features are present in only a small proportion of patients, other factors such as the postulated testicular dysgenesis syndrome may be involved in the pathogenesis of poor semen quality in the majority of GCT patients.