The other group of patients in whom the effects of chemotherapy on testicular function have been widely investigated is those with testicular cancer (29-32). To attempt to delineate which abnormalities are a result of cytotoxic chemotherapy, several of these studies also examined pretreatment testicular function or compared chemotherapy-treated patients with those who underwent orchidectomy alone. Lampe et al. (31) analyzed data concerning 170 patients with testicular germ cell cancers, who underwent treatment with either cisplatin-based or carboplatin-based chemotherapy. Of the 170 patients, 40 (24%) were azoospermic before treatment, with a further 41 (24%) oligospermia At a median of 30 mo after the completion of chemotherapy, only 64% of those who were normospermic before therapy remained normospermic, whereas 54 (32%) of the total cohort were azoospermic and 43 (25%) were oligospermia The probability of recovery to a normal sperm count was higher for those men with a normal pretreatment sperm count, those who received carboplatin-based rather than cisplatin-based therapy, and in those treated with fewer than five chemotherapy cycles. Recovery continued for more than 2 yr, with the calculated chance of oligospermia or normospermia at 2 yr being 48% and 80% at 5 yr. Several authors have compared testicular function in patients after chemotherapy with that of patients treated with orchidectomy alone (29,30,32). All have demonstrated greater testicular dysfunction in the cytotoxic-treated groups, with evidence of germinal epithelial damage indicated by raised FSH levels and/or reduced sperm counts. In addition, mild Leydig cell dysfunction, as indicated by a raised LH levels in the presence of a normal testosterone level, was found in 59 to 75% of men after chemotherapy, compared with 6 to 45% in those after orchidectomy alone.
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