A new fertility risk rating system for surgical, radiotherapy, and chemotherapy interventions used in testicular cancer

The vast majority of patients diagnosed with testicular germ cell tumors will survive their disease. This raises the importance of survivorship issues, particularly fertility preservation given that half of patients diagnosed with testicular cancer are under the age of 34. In this perspective, we offer a novel fertility rating system based on the FDA’s A/B/C/D/X/N pregnancy risk category system for first line therapies (surgical, chemotherapeutic, and radiation therapies) listed by the National Comprehensive Cancer Network (NCCN). All chemotherapies (bleomycin, carboplatin, cisplatin, etoposide and ifosfamide) have available human data demonstrating a negative impact on fertility yielding category D ratings. Radiation therapy and surgical interventions such as unilateral orchiectomy and retroperitoneal lymph node dissections (RLND) were also designated category D. Despite the clear risk to fertility, the majority of men do not undergo semen cryopreservation (SCP). Future efforts should be made to reduce the barriers to reproductive counseling and fertility preservation for testicular cancer survivors.