Impact Of Malignancy On The Reproductive System

In the past, infertility associated with malignant disease was considered a side effect of the drugs and radiation used during the course of treatment. However, this view is changing due to strong evidence that decreased fertility sometimes exists before the treatment starts. In a study conducted on 158 male patients with Hodgkin lymphoma,3 severe damage to fertility was observed in 21% cases before treatment. The decrease in fertility was most prominent in patients with an elevated erythro-cyte sedimentation rate (ESR) and in those with advanced disease. In another study, semen analysis showed that 70% of male patients with Hodgkin lymphoma had reduced fertility before therapy.4

The effect of Hodgkin lymphoma on testicular function does not involve local tumor or metastasis. Instead, the disease may lead to structural abnormalities in the testicular parenchyma, such as tubular hyalinization.5 These changes may be caused by an immune-mediated disorder that alters the balance between distinct subpopulations of lymphocytes, which normally inhibit or stimulate the production of spermatozoa. However, this hypothesis requires further testing.6 In addition, cytokines (e.g., interleukins and tumor necrosis factor) that are secreted by tumor tissue may be partly responsible for the impaired testicular function seen in patients with Hodgkin's disease.7

In general, malignancy is associated with an increased catabolic state and malnutrition. Therefore, most patients experience weight loss and decreased reproductive capacity. In addition, hypothalamic dysfunction can occur and pituitary gonadotropin levels can fall, thus affecting the fertility.8 Stress hormones may further reduce fertility by leading to a rise in pro-lactin and endogenous opiate secretion, which in turn suppress gonadotropins.9

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