Pre-orchiectomy semen analysis in patients with testicular germ cell tumours and comparison with healthy men and with patients with other malignancies.

Purpose Subfertility is a well-known aftermath of treatment of testicular germ cell tumours (GCTs). Growing evidence suggests reduced semen quality also before therapy. The present study aimed to evaluate pre-orchiectomy semen parameters in GCT patients and to compare the results with controls. Methods GCT patients providing semen for cryopreservation before orchiectomy during 2012 - 2023 were retrospectively enrolled (TT cohort). Controls consisted of healthy volunteers for sperm donation (HD), and of patients with other malignancies (OM). The following parameters were recorded in each participant: ejaculate volume (EV; ml), total sperm count in ejaculate (TSC), and proportion of progressive motility (PM) (%). Descriptive statistical methods were used to compare the 3 populations with each other. Results A total of 664 subjects were included, thereof 163 TT, 289 HD, and 212 OM. Median ejaculate volume was 3.0 ml, 3.5 ml, and 3.4 ml; median TSC was 56.9 x106, 207 x106, and 152 x106; median PM was 40%, 40.2%, and 43% in TT, HD, and OM, respectively. TSC, EV and several secondary parameters of semen quality observed in TT were significantly worse than those in the two control cohorts. HD and OM were within normal limits with regard to TSC and PM and were different in only a few secondary parameters. Conclusion This study confirmed significantly lower pre-orchiectomy semen quality in GCT patients in comparison to healthy males and to patients with other malignancies. Subfertility is an intrinsic feature of GCT preceding treatment that needs to be considered by care-givers.