Male Fertility Problems Linked to Testicular Cancer

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Oct. 12, 2000 -- Like many professional couples, Tim and Elizabeth delayed childbearing until their late 20s. "We had a lot of trouble getting pregnant," says Elizabeth, who spoke to WebMD on condition that her full name not be used. "Our bathroom started looking like a chemistry lab with all the kits we had in there, and all the fun was certainly out of it."

After several months of trying, the Baltimore-area couple sought medical help -- and learned that Tim had a low sperm count. In spite of this, Elizabeth became pregnant a few months later and eventually delivered a healthy baby girl.

When couples have infertility problems, it is usually the woman who first seeks help, but her partner may be tested as well. He is asked to provide a sample of semen, which is examined for certain characteristics that may indicate problems. Although many couples in which the man has such semen abnormalities will go on to conceive a child, some may end up with something else to worry about: A study recently published in the British Medical Journal shows that men with these abnormalities run a higher risk of developing testicular cancer and some abdominal cancers than other men.

"We are certainly not suggesting that every man with a semen abnormality needs to be aggressively screened for testicular cancer," says Rune Jacobsen, MS, the study's author. "But we do feel that this study points to an association between the two conditions, suggesting a common cause," perhaps something that happened while the man was still in his mother's womb. Jacobsen is a researcher at the Centre for Research in Health and Social Statistics, Danish National Research Foundation in Copenhagen.

It's not clear what kind of prenatal event might cause these conditions. But the idea that things that happen during pregnancy may affect the baby's life later is not new. Research on maternal consumption of alcohol, drug use, and cigarette smoking clearly shows that they affect the baby's health. Now research is starting to show a connection between more subtle events during pregnancy and the offspring's ultimate health.

Christopher Coe, PhD, professor of psychology at the University of Wisconsin, has been studying the effects of the intrauterine environment on offspring in rhesus monkeys. "We have been studying a 50-year-old colony of monkeys, encompassing five generations and more than 15,00 births, and have been examining systematically the effects of the mother's gestational experience on her offspring," he tells WebMD. "Such factors do indeed play a role in the size of the offspring, the age at which they reach puberty, their risk of pregnancy complications, and their ability to handle glucose [sugar]. All of these associations have also been suggested in humans.

"We're now starting to examine the effects of maternal nutrition and stress on the health of the offspring," Coe says. "We know the placenta isn't a perfect barrier, but the question remains, which factors are important and how long during pregnancy do they have a consequence? There appears to be some wisdom to our grandmothers' advice that, during pregnancy, a woman wants to be more careful and moderate her lifestyle."

The current study by Jacobsen and colleagues looked at the results of semen analysis in more than 30,000 Danish men, and correlated them with the development of various cancers. Men who had abnormal semen-analysis results were roughly twice as likely to develop testicular cancer. "We think this association may be due to a disruption in the mother's hormonal status during pregnancy," Jacobsen says. But researchers don't yet know what might cause such a disruption. "The next step is to study that association," Jacobsen says.

Right now, no one is suggesting that abnormal semen characteristics cause testicular cancer, since not all men with abnormal results will develop the disease, but Jacobsen does say that testicular cancer may be preceded by semen abnormalities.

"We see some interesting associations with semen abnormalities," Fady Sharara, MD, a reproductive endocrinologist with the Fertility and Reproductive Health Center in Arlington, Va. "or example, recently, a study reported such abnormalities in long distance truck drivers. My feeling is that such abnormalities arise from both a genetic component and an environmental one, and the hypothesis of a factor operating during pregnancy makes sense."

Whether or not they have semen abnormalities, experts say, men should do regular self-examinations for signs of testicular cancer. They should also see their doctor or a urologist if they have problems or questions about their risks.

For information about how to do a self-examination, see WebMD's article "Many Young Men Unaware of Importance of Testicular Exam."

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