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Tsai SJ, Li LH, Chen WJ, Huang EYH, Huang CY, Brannigan RE, Huang WJ, Huang IS. Prediction of microdissection testicular sperm extraction outcomes of azoospermic patients post-chemotherapy using cyclophosphamide equivalent dose. J Assist Reprod Genet 2023:10.1007/s10815-023-02870-4. [PMID: 37368159 PMCID: PMC10371929 DOI: 10.1007/s10815-023-02870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE We determined the sperm retrieval rate in men with persistent azoospermia post-chemotherapy in relation to cyclophosphamide equivalent dose (CED), a unit for quantifying alkylating agent exposure. METHODS Medical records were retrospectively reviewed of 1098 patients diagnosed with non-obstructive azoospermia who had undergone microdissection testicular sperm extraction (mTESE) between January 2010 and 2021 at our institution. Twenty-three patients with a prior history of chemotherapy were included in the study. Oncological data, chemotherapy regime, and dosage were reviewed. The pretreatment hormone profile, CED, and mTESE outcomes were analyzed. RESULTS Testicular spermatozoa were successfully retrieved from 11 patients (47%). The mean patient age was 37.3 years (range, 27-41 years), and mean time interval from chemotherapy to mTESE, 11.8 years (range, 1-45 years). Patients exposed to alkylating agents had significantly lower sperm retrieval rates than those not exposed to alkylating agents (1/9, 11% vs. 10/14, 71%, p = 0.009). No men with CED > 4000 mg/m2 (n = 6) had viable sperm in the testes during mTESE. Moreover, patients diagnosed with testicular non-seminomatous germ cell tumors had a favorable sperm retrieval rate (67%) compared to patients with lymphoma (20%) or leukemia (33%). CONCLUSION Patients with permanent azoospermia post-chemotherapy have a lower testicular sperm retrieval rate when the chemotherapy regimen included alkylating agents. In cases where patients have undergone more intensive gonadotoxic treatments, such as higher CED, the likelihood of successful sperm retrieval is low. It is advisable to counsel such patients using the CED model prior to considering surgical sperm retrieval.
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Affiliation(s)
- Shi-Jie Tsai
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, 112, Taipei, Taiwan
| | - Li-Hua Li
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Wei-Jen Chen
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, 112, Taipei, Taiwan
- Department of Urology, College of Medicine, and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, 112, Taipei, Taiwan
- Department of Urology, College of Medicine, and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Yu Huang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, 112, Taipei, Taiwan
- Department of Urology, College of Medicine, and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Physiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, 112, Taipei, Taiwan.
- Department of Urology, College of Medicine, and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Physiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Demyashkin G, Koryakin S, Moiseev A, Saburov V, Zatsepina M, Epifanova M, Stepanova Y, Shchekin V, Vadyukhin M, Shegay P, Kaprin A. Assessment of Proliferation and Apoptosis in Testes of Rats after Experimental Localized Electron Irradiation. Curr Issues Mol Biol 2022; 44:5768-5777. [PMID: 36421675 PMCID: PMC9689034 DOI: 10.3390/cimb44110391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/17/2022] [Accepted: 11/17/2022] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND PURPOSE With the emergence of linear accelerators in radiotherapy, it becomes necessary to accurately select new dosing regimens. The purpose of this study was to assess the morphological changes of spermatogenesis after radiation exposure. MATERIALS AND METHODS Male Wistar rats (n = 40) were subjected to targeted ionizing radiation on a pulsed electron accelerator "NOVAC-11" with doses of 2, 8 and 12 Gy. Spermatogenesis was assessed a week later using light microscopy and immunohistochemical method (antibodies to Ki-67, Bcl-2, p53, Caspase 3). RESULTS A decrease in the number of normal germ cells was seen in all experimental groups, while radioresistant Sertoli and Leydig cells were barely affected. The most serious damage to the tubules and germ cells was observed in 8 and 12 Gy irradiation groups. IHC analysis of testes after irradiation showed a shift in the proliferative-apoptotic balance toward apoptosis of germ cells: a decrease in the expression levels of Ki-67 and Bcl-2, an increase in p53-positive and caspase 3-positive cells by the end of the experiment. CONCLUSION Dose-dependent progressive pathomorphological changes in histoarchitectonics of the testes are traced, and a decrease in the number of germ cells is seen on the seventh day after irradiation with a pulsed electron accelerator "NOVAC-11".
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Affiliation(s)
- Grigory Demyashkin
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
- Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Sergey Koryakin
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
| | - Aleksandr Moiseev
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
| | - Vyatcheslav Saburov
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
| | - Margarita Zatsepina
- Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Maya Epifanova
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Yulia Stepanova
- Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Vladimir Shchekin
- Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Matvey Vadyukhin
- Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Petr Shegay
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
| | - Andrei Kaprin
- National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Sechenov University, 249036 Obninsk, Russia
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Liu X, Liu B, Liu S, Xian Y, Zhao W, Jiang M, Zhou B, Li F. The effect of gonadal and extragonadal malignant cancers on sperm quality. Transl Cancer Res 2022; 10:5183-5190. [PMID: 35116368 PMCID: PMC8797935 DOI: 10.21037/tcr-21-1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022]
Abstract
Background Many studies have reported that testicular germ cell tumours (TGCTs) give rise to a decrease in sperm production and may further lead to infertility. However, little is known regarding sperm production in extragonadal germ cell tumours (EGCTs). We have studied the differences in the characteristics and sperm quality of patients with testicular cancer and patients with EGCTs. Methods We collected and analysed demographic factors, semen parameters, and the disposition of banked sperm. Results TGCTs accounted for the majority of malignant cancers compared with EGCTs (83.9% vs. 16.1%, respectively). There were no statistically significant differences in semen volume, pre-freeze concentration, pre-freeze motility, post-thaw concentration, post-thaw motility or recovery rate between patients with TGCTs and those with EGCTs. Both patients with TGCTs and EGCTs showed low pre-freeze and post-thaw sperm concentrations. Men with a seminoma had a higher median level of thaw-sperm motility in their ejaculate than men with non-seminomas. TGCT (67%) and EGCT (72%) patients chose to keep their specimens in storage. Conclusions Our study provides evidence that both patients with TGCTs and EGCTs have a high risk for impaired semen quality and gonadal dysfunction. This suggests that oncologists and patients should consider the effects of both TGCTs and EGCTs on fertility among males.
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Affiliation(s)
- Xiao Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bo Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shasha Liu
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yang Xian
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wenrui Zhao
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Min Jiang
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bin Zhou
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Clinical Research Center for Birth Defects of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Fuping Li
- Human Sperm Bank, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Faja F, Finocchi F, Carlini T, Rizzo F, Pallotti F, Spaziani M, Balercia G, Lenzi A, Paoli D, Lombardo F. PDE11A gene polymorphism in testicular cancer: sperm parameters and hormonal profile. J Endocrinol Invest 2021; 44:2273-2284. [PMID: 33661511 PMCID: PMC8421290 DOI: 10.1007/s40618-021-01534-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Testicular germ cell tumours (TGCTs) is the most common malignancy among young adult males. The etiology is multifactorial and both environmental and genetic factors play an important role in the origin and development of TGCT. Genetic susceptibility may result from the interaction of multiple common and low-penetrance genetic variants and one of the main candidate genes is PDE11A. Many PDE11A polymorphisms were found responsible for a reduced PDE activity in TGCT patients, who often also display impaired hormone and sperm profile. The aim of this study was to investigate testicular function and PDE11A sequence in testicular cancer cases. METHODS Semen analysis was performed in 116 patients with unilateral and bilateral sporadic TGCTs and in 120 cancer-free controls. We also investigated hormone profile and PDE11A polymorphisms using peripheral blood samples. RESULTS Our data revealed that TGCT patients showed lower testosterone levels, higher gonadotropins levels and worse semen quality than controls, although the mean and the medians of sperm parameters are within the reference limits. PDE11A sequencing detected ten polymorphisms not yet associated with TGCTs before. Among these, G223A in homozygosity and A288G in heterozygosity were significantly associated with a lower risk of testicular tumour and they displayed a positive correlation with total sperm number. CONCLUSIONS Our findings highlight the key role of PDE11A in testis and suggest the presence of an underlying complex and fine molecular mechanism which controls testis-specific gene expression and susceptibility to testicular cancer.
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Affiliation(s)
- F. Faja
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Finocchi
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - T. Carlini
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Rizzo
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Pallotti
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - M. Spaziani
- Hormone Laboratory, Department of Experimental Medicine - Medical Pathophysiology Section, “Sapienza” University of Rome, Rome, Italy
| | - G. Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - A. Lenzi
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - D. Paoli
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Lombardo
- Laboratory of Seminology - “Loredana Gandini” Sperm Bank, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Topuz B, Sarıkaya S, Korkmaz C, Baykal B, Kaya E, Ebiloğlu T, Zor M, Bedir S. Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor. ACTA ACUST UNITED AC 2021; 67:577-584. [PMID: 34495064 DOI: 10.1590/1806-9282.20201096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.
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Affiliation(s)
- Bahadır Topuz
- Gulhane Training and Research Hospital, Department of Urology - Ankara, Turkey
| | - Selçuk Sarıkaya
- Gulhane Training and Research Hospital, Department of Urology - Ankara, Turkey
| | - Cem Korkmaz
- Gulhane Training and Research Hospital, In Vitro Fertilization Center - Ankara, Turkey
| | - Barış Baykal
- Gulhane Training and Research Hospital, In Vitro Fertilization Center - Ankara, Turkey
| | - Engin Kaya
- Gulhane Training and Research Hospital, Department of Urology - Ankara, Turkey
| | - Turgay Ebiloğlu
- Gulhane Training and Research Hospital, Department of Urology - Ankara, Turkey
| | - Murat Zor
- Gulhane Training and Research Hospital, Department of Urology - Ankara, Turkey
| | - Selahattin Bedir
- Gulhane Training and Research Hospital, Department of Urology - Ankara, Turkey
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Nahata L, Dattilo TM, Olsavsky AL, Lipak KG, Whiteside S, Yeager ND, Audino A, Klosky JL, Rausch J, Saraf A, O'Brien SH, Quinn GP, Gerhardt CA. Impact of a novel family-centered values clarification tool on adolescent sperm banking attempts at the time of a new cancer diagnosis. J Assist Reprod Genet 2021; 38:1561-9. [PMID: 33564937 DOI: 10.1007/s10815-021-02092-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/26/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Over half of males experience fertility impairment after childhood cancer therapy, which often causes psychosocial distress. Yet, fertility preservation (FP) remains underutilized. The goals of this study were to determine the feasibility and impact of implementing a family-centered FP values clarification tool on sperm banking attempts among adolescent males newly diagnosed with cancer, and identify key determinants of banking attempts. METHODS A prospective pilot study was conducted among families of males (12-25 years old), prior to cancer therapy. Thirty-nine of 41 families agreed to participate (95%); 98 participants (32 adolescents, 37 mothers, 29 fathers) completed the Family-centered Adolescent Sperm banking values clarification Tool (FAST). Analyses assessed the impact of the FAST on banking attempts and examined associations between demographic/medical characteristics, FAST subscales (perceived threat, benefits, barriers), and banking attempts. RESULTS Twenty-three (59%) adolescents attempted to bank, compared to 8 adolescents (33%) during baseline assessment (p=.04). Significant associations were identified between banking attempts and adolescents' report of perceived threat (rpb=.45, p=.01) and benefits (rpb=.57, p=.01). Only mothers' proxy reports of adolescent perceived threat (rpb=.42, p=.01) and benefits (rpb=.47, p=.003) were associated with banking attempts, while fathers' self-reported perceived benefits (rpb=.43, p=.03), self-reported barriers (rpb=.49, p=.01), and proxy reports of adolescent perceived threat (rpb=.38, p=.04) and benefits (rpb=.59, p=.02) were associated with banking attempts. CONCLUSION Adolescent sperm banking attempt rates significantly increased after implementation of a family-centered FP values clarification tool prior to cancer treatment. Findings underscore the importance of targeting both adolescents and their parents, particularly fathers, in FP efforts.
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Amin MSA, Brunckhorst O, Scott C, Wrench D, Gleeson M, Kazmi M, Ahmed K. ABVD and BEACOPP regimens' effects on fertility in young males with Hodgkin lymphoma. Clin Transl Oncol 2020; 23:1067-1077. [PMID: 32944834 PMCID: PMC8084804 DOI: 10.1007/s12094-020-02483-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
Purpose Considering the increased cancer patient survivorship, the focus is now on addressing the impacts of treatment on quality of life. In young people, altered reproductive function is a major issue and its effects in young males are largely neglected by novel research. To improve clinician awareness, we systematically reviewed side effects of chemotherapy for Hodgkin lymphoma (HL) in young males. Methods The review was prospectively registered (PROSPERO N. CRD42019122868). Three databases (Medline via PUBMED, SCOPUS, and Cochrane Library) were searched for studies featuring males aged 13-51-years who underwent chemotherapy for HL using ABVD (Adriamycin® (doxorubicin), bleomycin, vinblastine, and dacarbazine) or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) regimens. These chemotherapy regimens were compared against each other using sperm characteristics, FSH, and inhibin B levels to measure fertility levels. Results Data were extracted from five studies featuring 1344 patients. 6 months post-ABVD saw marked deterioration in sperm count, further reduced by more cycles (P = 0.05). Patients treated with BEACOPP rather than ABVD were more prone to oligospermia. Receiving fewer cycles of both regimens increased the likelihood of sperm production recovering. Patients treated with 6-8 cycles of BEACOPP did not recover spermiogenesis. Conclusions ABVD and BEACOPP regimens significantly reduce fertility function to varying effects depending on treatment duration. ABVD temporarily causes significant reductions in male fertility, whereas BEACOPP’s effects are more permanent. Therefore, clinicians should discuss fertility preservation with male patients receiving infertility-inducing gonadotoxic therapy. Further high-quality studies are required to more adequality describe the risk to fertility by chemotherapy. Electronic supplementary material The online version of this article (10.1007/s12094-020-02483-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M S A Amin
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, SE1 9RT, UK
| | - O Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, SE1 9RT, UK
| | - C Scott
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, SE1 9RT, UK
| | - D Wrench
- Department of Haematology, Guy's Hospital, London, UK
| | - M Gleeson
- Department of Haematology, Guy's Hospital, London, UK
| | - M Kazmi
- Department of Haematology, Guy's Hospital, London, UK
| | - K Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, SE1 9RT, UK. .,Department of Urology, King's College Hospital, London, UK.
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