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Abstract Study question Sperm quality is often already abnormal at diagnosis in testicular cancer subjects. We evaluated the fertility of testicular cancer survivors in our male infertility clinic. Summary answer Testicular cancer survivors even with azoospermia can make fatherhood through ICSI following precise evaluation and optimal sperm retrieval surgery. What is known already General improvements in the prognosis of patients with cancer have been achieved through recent advances in surgery, radiotherapy, and chemotherapy treatments, thus increasing the number of patients surviving therapy. However, anti-cancer treatment has detrimental effect on spermatogenesis and testicular cancer inevitably results in there being a single testicle following treatment, subsequent fertility will be a concern. Cryopreservation of ejaculated sperm before cancer treatment is considered to be essential, however it is rarely performed. In contrast, the use of cryopreserved ejaculated sperm for infertility treatment actually occurs in limited number of patients. Study design, size, duration From 2004 through 2023, 3361 male infertility patients consulted our clinic, 117 (3.5%) of whom had a history of cancer treatment. Thirty-nine patients diagnosed with testicular cancer were evaluated for cancer treatment, semen findings, and infertility treatment. Participants/materials, setting, methods The median age was 36 years, the duration from termination of cancer treatment was 5.5 years, and the duration of infertility was 3.0 years. Seminoma was observed in 29 participants, and non-seminomatous germ cell tumor was in 10 participants. Main results and the role of chance Twenty patients were treated with high orchidectomy alone. Whereas three patients were treated with orchidectomy followed by chemotherapy and sixteen participants underwent subsequent retroperitoneal lymph node dissection (RPLND). Semen analyses revealed azoospermia in 26 participants, whereas oligoasthenozoospermia in 13. Although none of the these oligoasthenozoospermic patients achieved spontaneous pregnancy, three achieved pregnancy and delivery through ICSI. Sperm retrieval surgery was attempted in 18 participants with azoospermia. 13 participants underwent microscopic testicular sperm extraction (micro-TESE), two participants received onco-TESE, two patients received microscopic sperm aspiration (MESA), and one patient received retrograde vasal sperm aspiration (ReVSA). Successful motile sperm recovery was observed in 15 participants. 8 deliveries were obtained through ICSI using surgically retrieved sperm. Limitations, reasons for caution Although patients with azoospermia were informed of the need for sperm retrieval surgery, several participants did not choose to undergo the operation. Wider implications of the findings Testicular cancer survivors, even those with azoospermia, can achieve fatherhood through ICSI, after precise evaluation and appropriate sperm retrieval surgery. Trial registration number No