Fertility preservation after chemotherapy for Hodgkin lymphoma

Abstract

Treatment for Hodgkin lymphoma can negatively affect fertility. This review summarizes data on fertility after chemotherapy in adult patients. Alkylating chemotherapy, especially if containing procarbazine and/or cyclophosphamide, is most harmful to gonadal functioning. Alkylating regimens cause prolonged azoospermia in 90-100% of men and ovarian failure in 5-25% of women under the age of 30. Non-alkylating chemotherapy, like ABVD, is much less harmful: one-third of male patients develop transient azoospermia, and almost no female patients experience ovarian failure. Age is an important factor for women: females over 30 years have a much higher risk of acute ovarian failure. However, with long-term follow-up the cumulative risk of menopause before the age of 40 becomes the same irrespective of treatment age. In males, semen cryopreservation before start of treatment should be offered to all (post)pubertal patients. For females with a partner, IVF followed by embryo cryopreservation is a widely available method, but this necessitates postponement of lymphoma therapy for at least a month. Oocyte cryopreservation and ovarian tissue cryopreservation are experimental techniques showing great promise. GnRH-analogues are being investigated as possible means to preserve fertility in women, but effectiveness has not yet been proven conclusively.