Effect Of Malignancy Treatment On Fertility

Post-treatment of Hodgkin's lymphoma in men with chemotherapy results in testicular germ cell aplasia and decreased libido.5 The seminiferous epithelium inside the testes is most sensitive to the detrimental effects of chemotherapy. Therefore, after treatment with gonadotoxic agents, patients may be rendered oligozoospermic or azoospermic. Because testosterone production by the Leydig cells remains unaffected, patients still develop normal secondary sexual charac-teristics.19 However, treatment with high, cumulative doses of gonadotoxic chemotherapy can lead to Leydig cell dysfunction.

Doses as low as 0.1 Gy to 1.2 Gy can have detectable effects on spermatogenesis in adult males, with doses over 4 Gy causing more permanent effects.20 Somatic cells are more resistant to chemotherapy and radiation-induced damage than are germ cells. Indeed, Leydig cell dysfunction is not observed until doses of 20 Gy are administered to the prepubertal boy and up to 30 Gy in sexually mature males.21 Testosterone production is therefore relatively preserved below these doses. Thus, many patients develop normal secondary sexual characteristics despite a severe impairment of sper-matogenesis.

Young patients with a hematological malignancy are often treated with bone marrow transplantation (BMT).22 During BMT, patients may be given alkylating agents and receive total body irradiation for conditioning, both of which result in POF, hormonal disturbances, and eventually, infertility.23 Long-term female survivors treated with total body irradiation and BMT are at risk for ovarian follicular depletion and impaired uterine growth and blood flow, in addition to early pregnancy loss and premature labor if pregnancy is achieved.24 Because women aged above 30 years face a higher incidence of POF following chemotherapy, their treatment regimens should contain fewer alkylating agents.25

A study that documented the late effects associated with treatment of early Hodgkin's lymphoma revealed that 43/191 men and 16/149 women had sought medical advice for infertility, while 57/191 men and 54/149 women were able to parent children. In addition, sexual activity was disrupted in 25.8% of cases.26

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