A spermogram was performed before treatment in 57 young patients with Hodgkin's disease. The mean results were normal, and similar to those reported in fertile populations. Nineteen patients had an abnormal spermogram; 12 of these men had had fever recently or were febrile at the time of the exam. When the temperature was below 38.5 degrees C, there was only asthenospermia. With a higher temperature, semen anomalies were more severe, with oligoasthenospermia or even azoospermia. Only five febrile men had a normal spermogram, and all had slight fevers. Therefore, semen anomalies noted in about one third of patients with Hodgkin's disease are probably not due to a disease specific gonadal alteration, but can be attributed to fever which gonadal effects have been recognized for a long time and are well-documented.
The testicular function of 47 men who had been treated by MOPP chemotherapy for a Hodgkin's disease was studied in a long-term survey. Azoospermia was constant during at least 14 months after completion of the treatment. After a follow-up period of 89.4f54.7 months, 26 men were still azoospermic. No correlation could be found between the therapeutic regimen and the results of semen analysis. For the same treatment, some men recovered spermatogenesis within 5 years, others after more than 10 years while some were still azoospermic after 20 years. However, the association of infra-diaphragmatic irradiation to high dose MOPP therapy had a profound detrimental effect on spermatogenesis: only 31 13 men recovered. Sperm recovery was often incomplete: 17/21 men had a sperm count below 20 million ml-'. Yet, spontaneous pregnancies were obtained with severe oligozoospermia: only 1 / 1 1 sperm counts performed close to fertilization exceeded 20 million ml-', and 8 were below 5 millions ml-'. FSH failed to be either a sensitive or a specific marker of sperm recovery, a discrepancy between FSH level and spermiogram being noticed in 18.2% of cases.
Major monomorphous teratozoospermia, due to sperm tail structural anomalies, were detected in 42 out of 4231 infertile patients during routine semen analysis. The flagella were very short or absent in 16 cases, shortened with thickness irregularity in 18 cases, and of normal length with diameter anomalies in eight cases. These syndromes were always associated with poor forward motility, while mobility and penetration into human cervical mucus were sometimes impaired only partially. With good sperm smears and an experienced observer, the diagnosis could be made without the need for electron microscopic analysis. All the affected patients were sterile and several syndromes could have been transmitted genetically.
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