Gonadal function and fertility in male survivors treated for Hodgkin's disease in Iran

OBJECTIVE: To investigate the effect of chemotherapy on gonadal function of young men cured of childhood Hodgkin's disease.

METHODS: Young adult males surviving Hodgkin's disease, aged 17 and over at least 2 years after therapy were studied in Ali Asghar Children's Hospital, Tehran, Iran from March 2000 to March 2005. Clinical evaluation for secondary sexual characteristics, semen analysis, follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone was studied in 33 survivors of Hodgkin's disease.

RESULTS: The age at diagnosis was 5-15 years, median 9 years, age at study 17-29 years, median 19 years old. The median duration off therapy was 7 years (2-20 years). All 33 patients received chemotherapy as follows: 32 patients received nitrogen mustard (mechlorethamine), vincristine (Oncovin), procarbazine, prednisone (MOPP) / doxorubicin (adriamycin), bleomycin, vinblastine, dacarbazine (ABVD) 6-8 cycles, 5 of whom after relapses received other protocols. One received only MOPP. Twenty-seven (81.8%) had azoospermia, 2 had severe oligospermia, 3 had oligospermia, and one had normal sperm count (58000,000). All patients had normal secondary sexual characteristic. The FSH, and LH in 6/33 patients were above normal. Testosterone in 3/33 was below normal.

CONCLUSION: A prepubertal status does not protect the gonads from the harmful effect of chemotherapy, and approximately 87% of male survivors of Hodgkin's disease develop azoospermia or severe oligospermia.