Semen analysis and cryoconservation before treatment in Hodgkin's disease

Background:The prophylaxis of the late effects of chemotherapyand radiotherapy has become one of the major concerns in the management ofHodgkin's disease (HD). Unlike other complications, male sterility could bemanaged by prior semen preservation (SP).Patients and methods:To evaluate the semen quality of patientswith HD and the outcome of insemination, we reviewed spermograms of patientswho underwent SP before any treatment. The following criteria were necessary:1) age >16 and <50; 2) HD of any stage; 3) informed about male sterilityafter HD treatment; 4) fully consenting.Results:Such a proposal was made to 316 men, and 94 fulfilled thecriteria. All patients underwent an initial chemotherapy. Mean age of thecohort was 27.5 years (range 16–48 years). Pretherapeutic staging of HDrevealed 38 stage I (40%), 38 II (38%), 14 III (15%) and4 IV (4%). Semen analysis before cryoconservation showed an overall53% of normal or subnormal cases (50 cases). The analysis of semenquality and spermatozoid amount according to various parameters failed to finda correlation with stage, B symptoms, age, or biologic data (LDH, WBC,platelets, ESR). The use of cryopreserved semen 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 inthese cases suggests the need for a more careful design of non-toxicchemotherapy regimens in combined modality treatment.