NEW YORK (Reuters Health) - Men presenting for infertility treatment are 20 times more likely than men in the general population to be diagnosed with testicular cancer, a new study shows. The finding underscores the importance of urological screening for any man with infertility, Dr. Marc Goldstein said, especially as such evaluation is often not a part of infertility treatment.

Male infertility is frequently handled by reproductive endocrinologists, and "a lot of these men are being funneled straight to IVF," Dr. Goldstein of New York-Presbyterian/Weill Cornell Medical Center told Reuters Health.

There is evidence that infertility and testicular cancer have a common etiology in many cases, beyond the well-known risk associated with cryptorchidism, Dr. Goldstein and his team note in the November issue of the Journal of Urology.

To investigate the incidence of testicular cancer among men with infertility and abnormal semen, the researchers reviewed charts from 3,800 men treated over a 10-year period at their center. Ten cases of testis cancer were identified. Based on the incidence of the disease among similarly aged men in the Surveillance, Epidemiology and End Results database, the infertile men had a 22.6-fold increased risk of testicular cancer.

Two of the men had a history of cryptorchidism. When they were excluded from the analysis, the remaining men still had an 18.3-fold greater risk of the disease.

The findings show that it would be necessary to screen 500 infertile men to identify one case of testicular cancer, compared to breast cancer screening of 1,500 women to pick up a single case.

If a man is infertile, "even if he has enough sperm to achieve a pregnancy using assisted reproductive techniques, he should still be seen by a urinologist for an examination and possibly an ultrasound of the testicle," Dr. Goldstein said.

He pointed out that infertility can signal other life-threatening diseases, such as diabetes, thyroid conditions, or other cancers.

J Urol 2005;174:1819-1822

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