Impaired fertility in men with newly diagnosed Hodgkins lymphoma



Year of publication 2005
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Description Introduction: Hodgkins lymphoma (HL) is a tumour disease mostly affecting the younger sections of the population. Thanks to the combined cytostatic therapy, it counts among diseases with excellent therapeutic prognosis (depending on the clinical stage and risk factors). In recent years, ever more emphasis was laid on the monitoring of late adverse effect of the therapy applied. As far as the impaired fertility is concerned, the blame is often put on the alkylating cytostatic drugs. However, as demonstrated several times before, serious damage to fertility is found in men with HL even before the start of the cytostatic treatment, which points a connection with the underlying diagnosis. Objectives: In newly diagnosed patients with HL, andrological and hormonal examinations were made in order to demonstrate the damage to fertility as early as at the time of diagnosis. Methods: We examined a total of 48 patients, in which andrological tests were carried out with sperm collection (spermiogram evaluations according to the WHO classification), and hormonal examination of the FSH, LH and testosterone levels (using the RIA method). The median of the patients age was 26 years (16-36). After the staging examinations, the early stage of the HL was found in 11 patients (23%), the intermediate stage in 14 patients (29%) and the advanced stage was found in 23 patients (48%). About a half of the patients (n=23) reported some of the B symptoms at the time of diagnosis (fever, weight loss or night sweats). The spermiogram parameters were compared with a reference set of 89 healthy men interested in sperm donation, with age median of 23 years (18-35). The t-test was used for statistical evaluations. Results: In 96 % (n=46) of the patients, insufficient sperm quality was established at the time of the diagnosis with low sperm cell count and defective sperm morphology. Severe defects of fertility such as azoospermia and oligoasthenoteratospermia were found in 23 % (n=11) and 21 % (n=10) patients respectively. In other patients, combined impairments such as asthenospermia in 15 % (n=7) and asthenoteratospermia in 37 % (n=18) of the patients were identified. Normal findings in the spermiogram were only established in two patients. In comparison with the control set of healthy men, prospective sperm donors, statistically significant differences were found (p=0.05) in the average concentration of sperm cells (29.0 vs 55.7 million/ml) and in the presence of progressively motile sperm cells (12.9 % vs 43.6 %) were found. No deviation from the normal reference range of serum levels of gonadotropic hormones (FSH: 1.9-8.0 IU/l, norm: 1.4-8.1 IU/l; LH: 1.6-8.3 IU/l, norm: 1.5-9.3 IU/l) and testosterone: (9.2-25.2 nmol/l, norm: 8.4-28.7 nmol/l) could be established in anyone of the patients. Conclusion: Serious impairment of fertility is met in most patients with HL as early as at the time of diagnosis. Even though the exact mechanism of these changes is not exactly known, some effect of the biological factors due to the basic illness is presumed (cytokines). We have not established any correlation between hormone levels and the state of fertility.

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