Hodgkin's Disease and Fertility

John Han-Chih Chang, MD and Kenneth Blank, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
If someone could please respond to my query, I would be most appreciative. My brother was first diagnosed with Hodgkin's disease at seventeen, he's now thirty-one. He's in remission, but had relapsed once before. Anyhow, during his first bout with the disease, he was approached by doctors for sperm-banking. During this time, he was undergoing treatments of radiation and chemotherapy. Being only seventeen, my parents felt this matter was a little too much at such a young age. The doctors told us not to worry that if we waited at least two years, he'll be able to regain his fertility.

Now, at thirty-one, he is getting married, and was told last week by his doctor that he will never be able to fertilize an egg because he has zero sperm activity.

Can someone please help me? I am looking for a respectable, expert answer from your resources regarding this kind of situation. At a trying period like this, a reply from your staff would greatly ease my family's worries.  

Kenneth Blank, MD and John Han-Chih Chang, MD, OncoLink Editorial Assistants, respond:

Dear DW:
We wish we can report otherwise, but azospermia (the lack of sperm) is a known side effect of the treatment of Hodgkin's Disease.

Both radiation and chemotherapy can cause azospermia. Low doses of radiation directed at the testes will cause azospermia and for this reason radiation oncologists take great care to protect the testes from receiving any dose. It is rare that the testes are involved with lymphoma and, therefore, the they can be covered with a lead shield that usually successfully protects the sperm producing cells.

Chemotherapy can also cause sterility. Two chemotherapy medications (procarbazine and mechloethamine) are known to cause sterility and were commonly used in the past to treat Hodgkin's Disease. Today, other chemotherapy agents which do not cause sterility and are often recommended in patients who have a desire to remain fertile.

The use of these new chemotherapy agents and careful radiotherapy techniques have greatly reduced the rate of sterility in patients treated for Hodgkin's Disease. Unfortunately, this new treatment may be too late to help your brother.