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Lymphoma Treatment Harms Patients’ Sperm: Most Recover Within Two Years; Degree of Harm Depends on the Treatment

July 24 , 2014
by: ASRM Ofice of Public Affairs
Published in ASRM Press Release

Hodgkin lymphoma is a cancer which mostly affects young people and non-Hodgkin lymphoma also strikes many in their reproductive years.  Although the prognosis for the diseases has improved over the last few decades, therapies can have a devastating effect on patients’ fertility.
 
In the multi-center, prospective study, researchers tracked the recovery period for the sperm of lymphoma patients undergoing different forms of treatment in order to determine how different treatments affect sperm characteristics and to discover variables which may predict sperm recovery.
 
Sperm from 57 Hodgkin lymphoma and 18 non-Hodgkin lymphoma patients referred for sperm banking was analyzed before they began cancer treatment and again at later intervals:  three months, six months, 12 months and 24 months post-treatment.  The patients’ sperm characteristics were compared to those of a control group of 257 healthy, fertile men.
 
The researchers found that at the study’s baseline, pre-treatment lymphoma patients already had impaired sperm quality.  Compared to fertile controls, patients had higher levels of sperm chromatin alterations and DNA fragmentation, with the only risk factor being their cancer diagnosis.  However, between 3 months and 6 months post-treatment, patients’ levels of sperm DNA fragmentation and chromatin structure damage improved, decreasing relative to their own pre-treatment levels of damage—while still remaining higher than damage levels in the control group.
 
Patients received combination chemotherapy, with or without radiation therapy, as appropriate to their diagnoses.  After treatment, patients’ sperm density, total count, motility and vitality decreased, with the lowest values seen at the three and six month marks.
 
Alkylating chemotherapy was found to be more detrimental to spermatogenesis than non-alkylating drugs, with those patients who received alkylating chemotherapy more likely to cease sperm production entirely or taking longer to resume sperm production than patients receiving non-alkylating chemo.  In all patients who received non-alkylating treatment (with or without radiation), sperm production resumed between 12 to 24 months after concluding treatment.  However, for 7% of the patients in the study, sperm production had not resumed two years after the conclusion of cancer treatment.
 
Rebecca Sokol, MD, MPH, President of the American Society for Reproductive Medicine, commented, ”While many men can look forward to their fertility returning after treatment is over, not all will be so fortunate.  It is imperative that prior to the initiation of therapy, counseling and sperm preservation be made available to all lymphoma patients and their partners who may want to have children in the future.”
 
Bujan et al, Impact of lymphoma treatments on spermatogenesis and sperm DNA: a multicenter prospective study from the CECOS network, Fertility and Sterility, in press.
 

The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 8,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, the Society of Reproductive Surgeons and the Society of Reproductive Biologists and Technologists.
 

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