Abstract
We read with interest the recent article by Yeager and Bjornard 1 on fertility and sexual health in the adolescent and young adult oncology population. While the authors appropriately highlight fertility risks associated with retroperitoneal lymph node dissection (RPLND), we believe azoospermia post-orchiectomy precedes and presents a greater fertility risk than primary RPLND.
Recent data, from Germany, demonstrate azoospermia rates approaching 15% shortly after orchiectomy alone. 2 These findings are consistent with a rate of azoospermia of 9% post-orchiectomy seen in a smaller cohort. 3 In contrast, modern primary nerve-sparing RPLND, when performed in experienced centers, is associated with substantially lower rates of ejaculatory dysfunction affecting fertility. 4
Thus, if sperm banking is delayed until “prior to initiation of chemotherapy,” the opportunity for fertility preservation may already be lost for a meaningful fraction of adolescent and young oncology patients with testicular cancer.
These data support counseling regarding fertility preservation prior to orchiectomy.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.