Effect of cisplatin-based chemotherapy on gonadal function in men with advanced germ cell tumors

Cisplatin-based chemotherapy has improved the survival of men with metastatic germ cell tumors. Fertility could be a matter of concern for young patients with long survival. In this study we investigated gonadal function in men with advanced germ cell tumors after cisplatin-based chemotherapy. The serum levels of follicle-stimulating hormone (FSH) and testosterone were measured in 55 men with advanced germ cell tumors treated with cisplatin-based chemotherapy. Semen analysis was performed in 26 of these patients. The patients treated with more than 400 mg/m² of cisplatin had the higher level of FSH than the patients treated with 400 mg/m² or less of cisplatin did (35.6 versus 19.9 mIU/ml). Of 20 men treated with 400 mg/m² or less of cisplatin 14 (70%) had the sperm count of >20×10⁶/ml at a mean interval of 2.8 years after cessation of therapy whereas none of 6 men treated with more than 400 mg/m² did. Of 14 men with improved sperm counts 7 men fathered children. Cisplatin had no effect on the serum level of testosterone. Our results demonstrated that more than 4 cycles of standard chemotherapy for advanced germ cell tumors might induce irreversible spermatogenesis.