Hum. Reprod. Advance Access originally published online on February 2, 2005
Human Reproduction 2005 20(3):774-781; doi:10.1093/humrep/deh671
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Human Reproduction Vol. 20 No. 3 © The Author 2005; all rights reserved
Semen quality before and after gonadotoxic treatment
1 Fertility and Reproductive Medicine Laboratories, Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, University College Hospitals Trust, Rosenheim Building, 25 Grafton Way, London WC1E 6DB, 2 Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, 88–96 Chenies Mews, London WC1E 6DB and 3 Middlesex Hospital, The Institute of Urology and Nephrology (St Peters Hospital), London W1N 8AA, UK
4 To whom correspondence should be addressed. Email: g.bahadur{at}ucl.ac.uk
BACKGROUND: The aim of this study was to analyse the semen quality of patients before and after gonadotoxic therapy. PATIENTS AND METHODS: We evaluated semen quality in 314 patients over a 26 year period. The diagnostic categories were leukaemia (n=13); lymphoma (n=128); testicular cancer (n=102); benign conditions (n=13); and other malignant neoplasms (n=58). The degree of azoospermia or oligozoospermia for each disease category was recorded. We then analysed the recovery in semen quality over time for each disease category. RESULTS: The mean patient age was 27.9 years (range 13–65 years). A total of 1115 post-treatment semen samples were analysed from 314 patients. There was a significant reduction in the post-treatment sperm concentration, sperm motility and semen volume compared with pre-treatment levels (P<0.05) in the entire cohort. However, the sperm movement and motility grade remained unaffected. Patients with testicular carcinoma had the lowest pre-treatment sperm concentrations but also the lowest incidence of azoospermia after cancer treatment. Patients with lymphoma and leukaemia had the highest incidence of post-treatment azoospermia and oligospermia. Patients having the largest reductions in their sperm concentration after treatment required the longest recovery period for spermatogenesis. The diagnostic category was the only significant predictor of post-treatment azoospermia. CONCLUSION: Gonadotoxic treatment results in a significant reduction in sperm quality. The type of cancer or disease, and the pre-treatment sperm concentrations were found to be the most significant factors governing post-treatment semen quality and recovery of spermatogenesis. All categories of patients displayed varying degrees of azoospermia and oligozoospermia, and recovery of gonadal function from these states was not significant. This highlights the importance of ensuring sperm banking before treatment, including for patients with benign conditions. Several factors and associations are discussed further in order to give an insight into the pre- and post-gonadotoxic treatment effects.
Key words: azoospermia/cancer/gonadotoxicity/oligozoospermia/quality
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