Male reproductive potential after MOPP therapy for Hodgkin's disease: a long-term survey

Abstract

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.

Exposure to Chemotherapy During Childhood or Adulthood and Consequences on Spermatogenesis and Male Fertility

“…For instance, a return to normozoospermic levels was observed in 70% of men who received cumulative doses of cyclophosphamide under 7.5 g/m 2 , whereas only 10% recovered with higher doses after five years or even more [103]. It has been shown that 100% of the patients of reproductive age treated for Hodgkin's lymphoma with MOPP chemotherapy were azoospermic 14 months after the treatment [104,105]. The earliest sperm recovery has occurred 15 months after completion of the treatment, whereas some patients still presented an azoospermia 20 years after.…”

Non-Clonal Chromosome Aberrations and Genome Chaos in Somatic And Germ Cells from Patients and Survivors of Hodgkin Lymphoma, Induced by Anticancer Treatment

“…Alkylating agents such as procarbazine are highly toxic to the testis, causing depletion of the germinal epithelium and aplasia of germinal cells [44,45]. Most patients with HL, have poor semen quality following treatment and a low sperm density that is presented as oligospermia and permanent or transient azoospermia [46,47].…”

Fertility issues in cancer survivorship

“…In patients with Hodgkin disease, fertility after treatment is also dependent upon the treatment regimen. Investigators have reported that the older MOPP treatment (mechlorethamine, vincristine, prednisone, and procarbazine) caused azoospermia in 100% (47 of 47 cases) of cases 1 year after treatment . In contrast, the newer ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) appears to be less toxic to spermatogenesis, as one study showed that 90% of men had no change in their sperm count 1 year after treatment …”