Revisiting sperm cryopreservation timing in testicular cancer patients: pre- versus post-orchiectomy in the era of assisted reproductive technology

Revisando el momento de la criopreservación de esperma en pacientes con cáncer testicular: antes versus después de la orquiectomía en la era de la tecnología de reproducción asistida

Background: This study aims to evaluate the clinical importance of the timing of sperm cryopreservation in patients diagnosed with testicular cancer who did not receive adjuvant therapy. Methods: We conducted a retrospective analysis of medical records from patients who underwent orchiectomy and sperm cryopreservation due to testicular tumors between 2013 and 2023. Patients with a normal contralateral testis were included. Participants were divided into two groups based on the timing of sperm cryopreservation. Group I comprised patients whose sperm was frozen before orchiectomy, while Group II comprised those whose sperm was frozen after orchiectomy. The groups were compared regarding age, tumor characteristics, serum tumor markers and sperm parameters. Results: A total of 160 patients met the inclusion criteria and had complete data, with 33 (20.6%) in Group I and 127 (79.4%) in Group II. Group I had a significantly higher prevalence of multiple tumors, while Group II had larger tumor diameters. Sperm concentration and total sperm count were higher in Group I. Conclusions: Sperm cryopreservation before orchiectomy is recommended for testicular cancer patients. Our findings particularly highlight the negative effects of orchiectomy on sperm motility. However, considering advancements in assisted reproductive technologies such as intracytoplasmic sperm injection, the timing of sperm cryopreservation—whether performed before or after orchiectomy—may not result in significant clinical changes in patient management.

Resumen

Antecedentes: Este estudio tiene como objetivo evaluar la importancia clínica del momento de la criopreservación de esperma en pacientes diagnosticados con cáncer testicular que no recibieron terapia adyuvante. Métodos: Realizamos un análisis retrospectivo de los registros médicos de pacientes que se sometieron a orquiectomía y criopreservación de esperma debido a tumores testiculares entre 2013 y 2023. Se incluyeron pacientes con un testículo contralateral normal. Los participantes se dividieron en dos grupos según el momento de la criopreservación de esperma. El Grupo I comprendió a los pacientes cuyo esperma se congeló antes de la orquiectomía, mientras que el Grupo II comprendió a aquellos cuyo esperma se congeló después de la orquiectomía. Se compararon los grupos en relación con la edad, las características del tumor, los marcadores tumorales en suero y los parámetros del esperma. Resultados: Un total de 160 pacientes cumplieron con los criterios de inclusión y tenían datos completos, con 33 (20.6%) en el Grupo I y 127 (79.4%) en el Grupo II. El Grupo I presentó una prevalencia significativamente mayor de tumores múltiples, mientras que el Grupo II tuvo tumores de mayor diámetro. La concentración de esperma y el recuento total de esperma fueron más altos en el Grupo I. Conclusións: Se recomienda la criopreservación de esperma antes de la orquiectomía para los pacientes con cáncer testicular. Nuestros hallazgos destacan especialmente los efectos negativos de la orquiectomía sobre la motilidad espermática. Sin embargo, teniendo en cuenta los avances en tecnologías de reproducción asistida, como la inyección intracito plasmática de esperma, el momento de la criopreservación de esperma, ya sea antes o después de la orquiectomía, puede no tener implicaciones clínicas significativas en la gestión del paciente.

Testicular cancer; Orchiectomy; Fertility preservation; Sperm cryopreservation; Infertility

Palabras Clave

Cáncer testicular; Orquiectomía; Preservación de la fertilidad; Criopreservación de esperma; Infertilidad

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