Semen analysis and cryoconservation before treatment in Hodgkin's disease

Background: The prophylaxis of the late effects of chemotherapy and radioth erapy has become one of the major concerns in the management of Hodgkin's d isease (HD). Unlike other complications, male sterility could be managed by prior semen preservation (SP). Patients and methods: To evaluate the semen quality of patients with HD and the outcome of insemination, we reviewed spermograms of patients who under went SP before any treatment. The following criteria were necessary: 1) age > 16 and < 50; 2) HD of any stage; 3) informed about male sterility after HD treatment; 4) fully consenting. Results: Such a proposal was made to 316 men, and 94 fulfilled the criteria . All patients underwent an initial chemotherapy. Mean age of the cohort wa s 27.5 years (range 16-48 years). Pretherapeutic staging of HD revealed 38 stage I (40%), 38 II (38%), 14 III (15%) and 4 IV (4%). Semen analysis befo re cryoconservation showed an overall 53% of normal or subnormal cases (50 cases). The analysis of semen quality and spermatozoid amount according to various parameters failed to find a correlation with stage, B symptoms, age , or biologic data (LDH, WBC, platelets, ESR). The use of cryopreserved sem en was requested by 13 patients; 88 inseminations were performed leading to 9 pregnancies and 2 births. Conclusions: The low rate of success with cryopreserved semen in these case s suggests the need for a more careful design of non-toxic chemotherapy reg imens in combined modality treatment.