Semen Cryopreservation in Testicular Cancer: Before or After Orchidectomy?

BACKGROUND: Fertility preservation in patients with testicular cancer remains a clinical priority, yet the optimal timing for sperm cryopreservation-before or after orchidectomy-remains a matter of debate. OBJECTIVES: The aim of this study was to determine the optimal timing for semen cryopreservation and the best-quality sample for ART. We evaluated various markers, including semen analysis, hormonal profiles, ultrasound analysis and sperm DNA fragmentation (SDF) before and after orchidectomy. MATERIAL AND METHODS: Comprehensive evaluations were conducted, including semen analysis, hormonal profiling, testicular ultrasound, and SDF assessment. RESULTS: Post-orchidectomy samples exhibited a significant decline in total sperm count and progressive motility, as well as an increase in morphological abnormalities. However, a notable and significant reduction in SDF was observed after surgery, suggesting improved chromatin integrity once the tumour had been removed. Elevated preoperative follicle-stimulating hormone (FSH) and higher body mass index (BMI) were identified as risk factors for post-operative oligozoospermia. Hormonal assessment revealed increased levels of FSH and luteinising hormone (LH) post-surgery, with a slight decrease in total testosterone. A significant relationship emerged between testicular volume and changes in SDF: patients with larger contralateral testicular volume experienced a more pronounced improvement in DNA fragmentation, while testicular echotextural heterogeneity was associated with a diminished benefit. DISCUSSION AND CONCLUSION: Although not all participants underwent full diagnostic evaluation, limiting certain analyses, the findings nonetheless underscore the importance of a detailed andrological assessment at the time of diagnosis. This should include semen analysis, hormonal evaluation and ultrasound examination of the contralateral testis to inform personalised fertility preservation strategies. Despite the deterioration in conventional semen parameters, the post-orchidectomy sample demonstrated better DNA integrity and may thus represent the more suitable sample for use in assisted reproductive technologies.