睾丸癌是育龄期年轻男性中最常见的实体瘤。完成癌症治疗后，高达 77% 的癌症幸存者表示在完成癌症治疗后对亲子鉴定感兴趣。为了保持生育能力，大多数指南建议医生在开始性腺毒性治疗之前就精子冷冻保存向患者提供咨询。然而，在过去 20 年中，很少有研究评估睾丸癌治疗后的生育参数。为了缩小睾丸癌治疗性腺毒性的数据差距，以便能够更准确地提供有关生育力保存的咨询。在 Medline、Embase 和Cochrane 截止日期为 2022 年 12 月。系统评价包括接受过所有类型单侧睾丸癌治疗的男性的研究，而荟萃分析排除了未明确治疗、少于 10 名接受结果评估的患者或罕见肿瘤的研究。不孕症（即无精症、未能获得亲子鉴定或使用冷冻精子）被定义为结果。定性分析包括 30 项研究，涉及单侧睾丸癌后的 13,718 名男性。治疗包括单侧睾丸切除术（32.7%）、放疗（23.1%）、标准或低剂量化疗（33.7%）和高剂量化疗（1.4%）后的主动监测。 17 项研究对治疗后精子图进行了分析。定量综合包括 23 项研究，显示不孕症的总体汇总患病率 (95% CI) 为 14% (9%-21%)。无精子症的发生率为 8% (6%-12%)。对于接受标准治疗的预后良好的患者，不孕症的总体患病率仅为 4% (2%-10%)。到目前为止，这项针对总体不孕症患病率的首次荟萃分析为以下男性提供了生育预后的最佳近似值：已接受睾丸癌治疗。尽管不孕症患病率较低，但由于后续治疗的不确定性以及缺乏个体治疗效果的大量纵向数据，仍然建议进行精子冷冻保存。© 2024 作者。约翰·威利出版的《男科学》

Testicular cancer is the most common solid tumour among young men in the reproductive phase. After completing cancer treatment, up to 77% of cancer survivors report an interest in paternity after completing cancer treatment. To preserve fertility, most guidelines recommend that physicians should counsel their patients about sperm cryopreservation before initiating gonadotoxic therapy. However, few studies have assessed fertility parameters after testicular cancer therapies over the last 20 years.To close the gap of data regarding gonadotoxicity of testicular cancer therapies to enable more accurate counselling regarding fertility preservation.A systematic literature search was conducted in Medline, Embase and Cochrane until December 2022. The systematic review included studies of men who had undergone all types of unilateral testicular cancer treatment, whereas the meta-analysis excluded studies with unspecified treatments, less than 10 patients for outcome evaluation or rare tumours. Infertility (i.e. azoospermia, failure to achieve paternity or the usage of cryosperm) was defined as outcome.The qualitative analysis included 30 studies with a total of 13,718 men after unilateral testicular cancer. Treatment comprised active surveillance after unilateral orchidectomy (32.7%), radiotherapy (23.1%), standard- or low-dose chemotherapy (33.7%) and high-dose chemotherapy (1.4%). Post-treatment spermiograms were analysed in 17 studies. The quantitative synthesis included 23 studies, revealing an overall pooled prevalence of infertility (95% CI) of 14% (9%-21%). Azoospermia occurred in 8% (6%-12%). For good-prognosis patients who received standard therapy, the overall prevalence of infertility was only 4% (2%-10%).So far, this very first meta-analysis of overall infertility prevalence provides the best approximation of fertility prognosis for men who have undergone testicular cancer therapy. Despite the low prevalence of infertility, it is still recommended to undergo sperm cryopreservation because of the uncertainty of the subsequent therapy and the lack of large longitudinal data on individual treatment effects.© 2024 The Author(s). Andrology published by John Wiley & Sons Ltd on behalf of American Society of Andrology and European Academy of Andrology.