The effects of Hodgkin's disease and combination chemotherapy on gonadal function in the adult male

Abstract

The effects of Hodgkin's disease and quadruple chemotherapy on gonadal function have been investigated in 92 male patients with Hodgkin's disease. Nineteen men were studied before they received chemotherapy. Fifteen of the 19 had a sperm count of 20 million/ml or greater and motility was at least 40% in all 15. In the remaining 74 men, gonadal function was studied after completion of chemotherapy (6 months--8 years). Semen was obtained from 49 men who had received six of more courses of MVPP. Forty-two were azoospermic and five of the remaining seven had a sperm count below 1 million/ml. Decreased libido and sexual activity was common during treatment but in the majority of men these returned to normal after completion of chemotherapy. The median FSH and LH levels and the median increments in serum FSH and LH levels after LHRH administration were significantly elevated compared with an age-matched control group. The mean testosterone level of the patients was significantly lower than in controls suggesting Leydig cell damage but androgen replacement therapy was not indicated in any individual patient. No evidence of hyperprolactinaemia as a result of MVPP therapy was found. These results suggest that sperm storage before chemotherapy represents the main possibility for these patients to have children after completing chemotherapy. Before starting chemotherapy, advice should be given to these patients concerning possible changes in sexual behavior during treatment and the very high incidence of permanent infertility following treatment.

Gonadal function in men with chronic illness

“…Mean testosterone levels were normal and LH levels were at or just above the upper limit of normal (Chapman et al, 1979). 10 out of 11 patients studied between 6 and 8 years post completion of therapy with MVPP or chlorambucil VPP, were azoospermic (Whitehead et al, 1982). Treatment with PADIC (cisplatin, adriamycin and dacarbazine) led to azoospermia during treatment, but sperm production had resumed in 30 of 32 examined at least 2 years post treatment.…”

“…MVPP led to lower testosterone levels suggesting Leydig cell damage in addition to reduced sperm counts (Whitehead et al, 1982). In general there appears to be a compensatory rise in LH amplitude and so androgen replacement is usually not thought necessary.…”

“…Another study showed that 15 out of 19 patients had semen of quality sufficient for cryopreservation (Whitehead et al, 1982). This has important implications for sperm banking prior to cytotoxic chemotherapy.…”

Effet de la chimiothérapie sur la fonction testiculaire et ovarienne

“…N6anmoins, sa toxicit6 chez la femme est modeste. Chez rhomme, une oligospermie et une atteinte des cellules de Leydig a 4t4 document6e chez 6 hommes sur 8 trait6s pour lymphome et recevant 10 mg de vinblastine par semaine [24]. L'6toposide (VP16) administr6 par voie orale est responsable d'oligom4norrh6es ou d'am6norrh4es persistant 4 ~ 6 mois apr6s rarr~t du traitement [26].…”

Male fertility after VAPEC-B chemotherapy for Hodgkin's disease and non-Hodgkin's lymphoma

“…Following conventional MOPP-like combinations, azoospermia is inevitable in males (Chapman et al, 1979;Whitehead et al, 1982). A pilot study to investigate fertility in men treated with VAPEC-B chemotherapy was therefore undertaken.…”