Infertility after treatment of patients with Hodgkin's disease (HD) is cons
idered as a side effect of alkylating agent containing chemotherapy regimen
s. To investigate whether gonadal failure is related primarily to the toxic
effect of chemotherapy or rather to the disease itself, we investigated th
e fertility status before the onset of treatment.
Patients and Methods: Semen quality and hormonal status were evaluated in 1
58 patients with first diagnosis of HD enrolled into trials of the German H
odgkin Lymphoma Study Group (GHSG). The median age of the patients was 28 y
ears (range 16-52). Twenty patients (13%) were classified as early stage HD
, 63 patients (40%) as intermediate stage, and 75 patients (47%) as advance
d stage according GHSG grading. Sixty-seven patients (42%) showed systemic
symptoms. Semen analysis was performed according to WHO guidelines. Follicl
e-stimulating hormone (FSH) and luteinising hormone (LH) plasma levels were
measured by specific double-antibody radio-immune-assay (RIA) methods.
Results: Prior to treatment, severe damage of fertility, i.e., azoospermia
and oligoasthenoteratospermia (OAT-syndrome) was found in 13 (8%) and 20 pa
tients (13%), respectively. Thirty-eight patients (24%) had single, i.e., o
ligo-(O), astheno-(A) or teratospermia-(T), and 40 patients (26%) showed co
mbined damages, i.e., OA, OT or AT. In 47 patients (30%) a normal sperm cou
nt was found. Thus, 111 patients (70%) showed semen abnormalities before th
e onset of treatment. In a multivariate analysis elevated ESR (P < 0.003) a
nd advanced stage of disease (P < 0.01) could be distinguished as prognosti
c factors for severe damage of fertility. No correlation was found between
pre-therapeutic gonadotropine levels and fertility status.
Conclusion: Patients with HD have an increased risk for inadequate semen qu
ality even prior to treatment. Infertility is more frequent in patients wit
h elevated ESR and advanced stage of disease. This association demonstrates
the predominant influence of the disease on fertility. Assuming HD is the
major initial cause for infertility efforts should be made to identify new
non-gonadal toxic chemotherapies to be able to regain fertility after effec
tive therapy. Further investigations have to be performed to clarify mechan
isms inducing fertility defects in patients with HD.