ULTRASTRUCTURE OF HUMAN OVARIAN PRIMORDIAL FOLLICLES AFTER COMBINATION CHEMOTHERAPY FOR HODGKINS-DISEASE

Ovarian damage, with consequent permanent infertility, is one of the m ore common side-effects which occurs during chemotherapeutic treatment of patients affected by Hodgkin's disease. This damage is morphologic ally represented by a marked loss of primordial and primary follicles. The administration of contraceptive drugs before starting chemotherap y enhances survival of a greater number of ovarian follicles, as revea led by morphometric analyses, nevertheless, total ovarian protection i s not assured. This study evaluated the number and the morphology of o varian follicles, by means of transmission electron microscopy, in pat ients with Hodgkin's disease treated with multi-drug chemotherapeutic protocols following the administration of medroxyprogesterone acetate. Ovarian biopsies were performed prior to any pharmacological treatmen t, after medroxyprogesterone therapy, and after this therapy plus chem otherapy. Particular attention was given to the ultrastructure of prim ordial follicles. After morphometric evaluation, primordial follicles were numerous in controls and medroxyprogesterone therapy (28.55 +/- 6 .59/mm3 of ovarian cortex). After chemotherapy and medroxyprogesterone acetate, the number of follicles was slightly reduced (19.37 +/- 3.41 /mm3 of ovarian cortex) in contrast to the dramatic loss usually obser ved when protection is not given, although more follicles were atretic . Medroxyprogesterone may protect follicles only from acute, toxic eff ects of chemotherapy, which dramatically reduce their number and lead to sterility. Nevertheless, the quality of follicles is still impaired , and many undergo atresia, resulting in a shortened fertility period.