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PubMed This is a summary of 13 peer-reviewed journal articles Updated
Oncology

Urgent: Fertility Preservation Before Treatment

At a Glance

Before starting treatment for testicular seminoma, it is crucial to bank sperm. Taking a few days to preserve fertility before surgery or chemotherapy is safe and protects your ability to father children, even if advanced techniques like onco-TESE are needed.

While your medical team is focused on removing the cancer, you have an urgent opportunity to protect your future. For many men with testicular seminoma, the standard treatment path is fast-moving. However, taking a few days to address fertility preservation before surgery or any other treatment is not only safe—it is a critical part of your care [1][2].

Why You Should Act Now

It is a medical reality that testicular cancer can impact your fertility even before you begin treatment. Nearly half of men newly diagnosed with this cancer already have some abnormalities in their semen quality [3][4].

Acting before your surgery (orchiectomy) is essential for several reasons:

  • Maximum Sample Quality: Your best chance of securing a high-quality sperm sample is before you lose one testicle and before the body undergoes the stress of surgery [1][5].
  • Treatment Impact: Chemotherapy (such as cisplatin) and radiation therapy can cause a temporary or even permanent decline in sperm production (spermatogenesis) [6][7]. Banking sperm before these therapies is the only way to ensure you have a “backup” [1].
  • Safe Delay: Taking 48 to 72 hours to bank sperm does not typically affect the success of your cancer treatment, but it makes a lifetime of difference for your family planning options [8][9].

If Your Sample Shows “Zero Sperm”

In some cases, a patient may provide a sample that shows no sperm in the ejaculate, a condition called azoospermia [4]. If this happens to you, do not lose hope. You may still have options.

A specialized procedure called onco-TESE (Onco-Testicular Sperm Extraction) can be performed during your orchiectomy [10][11]. While the surgeon is removing the tumor, a specialist can use a microscope to search for healthy, non-cancerous tissue within the same testicle that might still contain viable sperm [12][11]. Studies show that even in men with no sperm in their ejaculate, this technique can successfully recover sperm in about 25% of cases [10][13].

Your Action Plan

  1. Request a Semen Analysis immediately. This should be done before any surgical intervention.
  2. Contact a sperm bank. Many facilities can accommodate urgent “oncology banking” appointments within 24 hours.
  3. Discuss “Onco-TESE” with your surgeon if your initial semen analysis shows no sperm. This requires coordination with a reproductive urologist.
  4. Ask about financial assistance. The cost of sperm banking can be a barrier. Ask your clinic about programs like Livestrong Fertility or similar financial aid programs.

This is a brief window of time, but it is one you control. Protecting your ability to father biological children is an empowering step toward your life after cancer.

Common questions in this guide

Can I delay testicular cancer surgery to bank sperm?
Yes, taking 48 to 72 hours to bank sperm before your surgery is generally safe and does not negatively affect the success of your cancer treatment. It provides a critical window to preserve your future family planning options.
How do chemotherapy and radiation affect my fertility?
Treatments like chemotherapy and radiation can cause a temporary or permanent decline in sperm production. Banking sperm before starting these therapies is the most reliable way to protect your ability to father biological children.
What are my options if my semen analysis shows no sperm?
If you have zero sperm in your ejaculate, a specialized procedure called onco-TESE can often be performed during your surgery. While removing the tumor, a specialist searches the non-cancerous tissue of the testicle to find and extract viable sperm.
Should I bank sperm before or after my testicle is removed?
You should aim to bank sperm before your surgery. Banking before you lose a testicle and before your body experiences the stress of surgery gives you the best chance of securing a high-quality sample.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can we delay my surgery by 2-3 days so I can complete sperm banking?
  2. 2.Given the size of my tumor, what is the chance of finding healthy sperm in the non-cancerous part of the testicle?
  3. 3.If my semen analysis shows no sperm (azoospermia), can you perform an 'onco-TESE' procedure during my orchiectomy?
  4. 4.How might the planned treatments after surgery (like chemotherapy or radiation) affect my long-term fertility?
  5. 5.Do you have a reproductive urologist you partner with for patients like me?

Questions For You

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References

References (13)
  1. 1

    Testicular Cancer Survivorship and Fertility Preservation.

    Tverye A, Nangia A, Fantus RJ

    The Urologic clinics of North America 2024; (51(3)):429-438 doi:10.1016/j.ucl.2024.03.011.

    PMID: 38925745
  2. 2

    Frequent azoospermia in patients with testicular germ cell cancer and a history of cryptorchidism: a report of nine cases and review of the literature.

    Hagiuda J, Nakagawa K, Oya M

    Systems biology in reproductive medicine 2021; (67(3)):189-192 doi:10.1080/19396368.2020.1867666.

    PMID: 33630670
  3. 3

    Semen quality before cryopreservation and after thawing in 543 patients with testicular cancer.

    MacKenna A, Crosby J, Huidobro C, et al.

    JBRA assisted reproduction 2017; (21(1)):31-34 doi:10.5935/1518-0557.20170009.

    PMID: 28333030
  4. 4

    Semen parameters in testicular tumor patients before orchiectomy: What is the impact of testicular tumor stage and histology?

    Mendes G, Teixeira B, Madanelo M, et al.

    Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 2024; (96(1)):12238 doi:10.4081/aiua.2024.12238.

    PMID: 38389451
  5. 5

    Long-Term Experience of Sperm Cryopreservation in Cancer Patients in a Single Fertility Center.

    Song SH, Kim DK, Sung SY, et al.

    The world journal of men's health 2019; (37(2)):219-225 doi:10.5534/wjmh.180061.

    PMID: 30588786
  6. 6

    Concurrent bilateral testicular tumors with different histopathology: A case report.

    Rostami G, Shafi H, Ranaee M, et al.

    Caspian journal of internal medicine 2020; (11(4)):446-449 doi:10.22088/cjim.11.4.446.

    PMID: 33680389
  7. 7

    Diagnosis and therapy of recurrent renal metastases after surgery for testicular seminoma: a rare case report and review of the literature.

    Li Z, Luo Y, Yu B, et al.

    Frontiers in oncology 2025; (15()):1542368 doi:10.3389/fonc.2025.1542368.

    PMID: 40492123
  8. 8

    Imaging of Metastatic Germ Cell Tumors in Male Patients From Initial Diagnosis to Treatment-Related Toxicities: A Primer for Radiologists.

    Wood MJ, Thomas R, Howard SA, Braschi-Amirfarzan M

    AJR. American journal of roentgenology 2020; (214(1)):24-33 doi:10.2214/AJR.19.21623.

    PMID: 31573853
  9. 9

    Management of stage I testicular cancer.

    Padayachee J, Clark R, Warde P, Hamilton RJ

    Current opinion in urology 2022; (32(1)):17-23 doi:10.1097/MOU.0000000000000942.

    PMID: 34772865
  10. 10

    The Outcomes of Onco-Testis Sperm Extraction at the Time of Radical Orchiectomy.

    Flores JM, Henriquez I, Jue JS, et al.

    Urology 2025; (199()):90-94 doi:10.1016/j.urology.2024.12.005.

    PMID: 39674379
  11. 11

    Ex-vivo microscopic oncotesticular sperm extraction: step-by-step surgical technique at time of radical orchiectomy.

    Villota CK, Hou SW, Judge C, et al.

    Fertility and sterility 2024; (121(6)):1069-1071 doi:10.1016/j.fertnstert.2024.02.037.

    PMID: 38403108
  12. 12

    Spermatogenesis in tumor-bearing testes in germ cell testicular cancer patients.

    Suzuki K, Shin T, Shimomura Y, et al.

    Human reproduction (Oxford, England) 2015; (30(12)):2853-8 doi:10.1093/humrep/dev250.

    PMID: 26428212
  13. 13

    Onco-testicular sperm extraction (onco-TESE) for bilateral testicular tumors: two case reports.

    Tsutsumi S, Kawahara T, Takeshima T, et al.

    Journal of medical case reports 2017; (11(1)):139 doi:10.1186/s13256-017-1303-6.

    PMID: 28511670

This page provides educational information about fertility preservation for testicular seminoma patients. Always discuss your specific fertility options and treatment timeline directly with your urologist and oncologist.

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