Fertility in Male Hodgkin Lymphoma Patients - A Report of German Hodgkin Study Group.

Purpose: We performed semen and hormone analysis before and after treatment to investigate the influence of disease and therapy on the fertility status of male patients with Hodgkin lymphoma (HL).

Patients & Methods: Patients (pts) with first diagnosis of HL without previous chemotherapy or radiotherapy who were enrolled into trials of German Hodgkin Study Group (GHSG) between 1988 and 2003 were analyzed. 202 pts were evaluated prior to treatment and 112 pts were evaluated after treatment.

Results: The median age in the pre-treatment evaluation group were 26 years and 27 years in the post-treatment evaluation group. In pre-treatment evaluation group 51% of pts were advance stage of disease, 31% in intermediate stage and 11% in early stage. In the post-treatment evaluation group 45% of pts were in intermediate stage of disease, 44% in advanced stage and 11% in early stage.

Before treatment 20% (40/202) of pts had normozoospermia and 80% (162/202) had dyspermia. After treatment, 64% (72/112) of pts had azoospermia, 30% (33/112) other dyspermia and 6% (7/112), the differences are significant (p<0.001). Azoospermia was observed in 67% (62/93) of pts treated with combined modality, in 90% (9/10) of those treated with chemotherapy alone and in 11% (1/9) of those treated with radiotherapy alone (p<0.001). Azoospermia was more frequent after BEACOPP then after COPP/ABVD - 85% (34/40) vs. 63% (37/59) (p<0.001). There was no difference between patients treated with 8 cycles of BEACOPP escalated (n=15) and those treated with 8 cycles BEACOPP baseline (n=21); with 93% and vs. 86% (p>0.05). The median time of onset of spermatogenesis was 27 months. During the first year after the treatment the onset of spermatogenesis was found in 18% of pts, during the second year in 23%, during the third year in 35% and in 35% after the third year. In univariate risk factors analysis, we found exttranodal involvement, risk groups, treatment with chemotherapy and BEACOPP being significantly predictive for asevere damage of fertility, none of these factors was significant in multivariate analysis.

In the contrast to the pre-treatment analysis, most of the pts (79%) showed abnormal FSH-levels (p<0.001). LH and testosterone were normal in most of patients; these results were similar to pre-treatment levels (p>0.005). There was the relationship between the post-therapeutic FSH level and sperm count; in the group with normal FSH levels, 23% of pts showed azoospermia and in the group with abnormal FSH level 78% of pts were azoospermic (p<0.001). The correlation between sperm count and LH and testosterone level was not so pronounced.

Conclusion: The majority of patients with HL were azoospermic after treatment, but recovery of spermatogenesis was observed depending on the treatment received. The FSH level appears to be helpful in diagnosis of the fertility status.