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Perspectives and Editorials |
Géraldine Delbes, Barbara F. Hales, Bernard
Robaire. Effects of the chemotherapy cocktail used to treat testicular cancer
on sperm chromatin integrity. J Androl. 2007
;28: 250
–251.
| Received for publication November 28, 2006; accepted for publication November 28, 2006. |
The correct identification of alterations in sperm quality are currently relevant because the introduction of ICSI has demonstrated that while immotile or abnormal spermatozoa can successfully fertilize oocytes, it is more and more recognized that poor sperm quality can adversely affect embryo development, implantation and early pregnancy. In this context, the finding that CT can affect chromatin integrity is significant because of the (partial?) recovery of sperm production that follows cancer treatment. As commented in this paper, approximately 80% of testicular cancer patients recover some degree of sperm production after long-term evolution. Most papers dealing with this subject evaluate recovery in terms of sperm concentration and usually do not take into account other sperm variables, like morphology and motility, that are frequently affected. This is important because oncologists tend to comment on the high recovery rate of patients after CT, while the study of their sperm shows that it is of suboptimal quality. Various publications have reported on structural and numerical chromosome abnormalities in these patients, with frequently contradictory results (Fossa et al, 1994; Martin, 1998; Thomas et al, 2004). Hopefully, new studies comprising larger series of patients may clarify the topic of the long-term effects of CT on sperm quality, which is pertinent when advising patients on the use of contraceptive methods while sperm quality is still compromised.
In the present model the effects of CT are investigated on previously healthy animals, so the interaction of BEP treatment with known deleterious influences of testicular cancer on spermatogenic function cannot be explored. One important aspect when analyzing deleterious influences of CT on patients suffering from testicular cancer is that the disease itself appears to result from previous developmental alterations of testicular function. The fact is that sperm quality in cancer patients treated with CT may depend as much on the deleterious action of CT on chromatin integrity as it depends on previous deterioration of spermatogenesis as part of what Skakkebaek calls the "testicular dysgenesis syndrome" (Petersen et al, 1998, 1999; Hallak et al 1999). This condition comprises a series of testicular pathologies resulting from genetic or environmental alterations in testicular embryonic development. Cryptorchidism, gonadal dysgenesis in intersex individuals, male infertility, and testicular cancer are all conditions that share a common biologic, epidemiologic and environmental background.
While male infertility seems to be on the rise in different parts of the world, the quality of life of human populations, including survivors of testicular cancer, shows considerable improvements, and with this the need to have a healthy offspring. The correct identification and adequate management of the consequences of CT on male fertility are an important issue to which the paper by Delbes, Hales, and Robaire makes a significant contribution.
References
Bieber AM, Marcon L, Hales BF, Robaire B. Effects of
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system, spermatozoa, and fertility. J Androl. 2006; 27: 189
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De Mas P, Daudin M, Vincent MC, Bourrouillou G, Calvas P, Mieusset
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Fossa SD, Silde J, Theodorsen, Pettersen EO. Pre-treatment DNA ploidy of sperm cells as a predictive parameter of post-treatment spermatogenesis in patients with testicular cancer. Br J Urol. 1994;74: 359 –365.[CrossRef][Medline]
Hallak J, Kolettis PN, Sekhon VS, Thomas AJ Jr, Agarwal A. Sperm cryopreservation in patients with testicular cancer. Urology. 1999;54: 894 –899.[CrossRef][Medline]
Martin R. Human sperm chromosome complements in chemotherapy patients and infertile men. Chromosoma. 1998; 107: 523 –527.[CrossRef][Medline]
Petersen PM, Giwercman A, Skakkebaek NE, Rorth M. Gonadal function in men with testicular cancer. Semin Oncol. 1998; 25: 224 –233.[Medline]
Petersen PM, Skakkebaek NE, Vistisen K, Rorth M, Giwercman A. Semen
quality and reproductive hormones before orchiectomy in men with testicular
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Thomas C, Cans C, Pelletier R, De Robertis C, Hazzouri M, Sele B,
Rousseaux S, Hennebicq S. No long term increase in sperm aneuploidy rates
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  H. Chemes Editorial Commentary J Androl, March 1, 2007; 28(2): 250 - 251. [Full Text] [PDF]
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