Several studies have shown reduced fertility in men with Hodgkin's disease. Padron et al. (7a) found oligospermia (sperm count <20 x 106/mL) in 18 of 49 (37%) patients with Hodgkin's disease who produced semen for cryopreservation before treatment. Similar rates of oligospermia were also demonstrated by Vigersky et al. (8) (total sperm count <40 x 106 in 40%) and Chapman et al. (9) (total sperm count <50 x 106 in 36%). In addition to reductions in sperm number, there is also evidence of abnormalities of sperm motility. When this is considered, up to 70% of men with Hodgkin's disease have abnormal semen analysis before treatment (8,10-12). Because of severe debilitation or impotence, not all men can provide semen for cryopreservation before treatment. Because these reports examined only men who were able to do so, they may have selected out a slightly healthier cohort and may, thus, underestimate the extent of gonadal dysfunction before treatment.
The pathogenesis of this dyspermia is not clearly understood. It has been suggested that the general debilitation and psychological effects of the disease may account for the reductions in semen quality. However, this is not supported by the observation that the degree of gonadal involvement does not correlate with disease stage (10,12) and also does not explain why infertility is more common in men with Hodgkin's disease compared with other malignancies. Studies incorporating testicular biopsies have failed to find any evidence for a role of direct tumor involvement of the testes. A further possible explanation was proposed by Barr et al., who hypothesized that alterations in spermatogenesis may be immune mediated (13), although clear evidence for this is lacking.
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