Impact of chemotherapeutics and advanced testicular cancer or Hodgkin lymphoma on sperm deoxyribonucleic acid integrity

Objective: To determine the impact of combination chemotherapy on the quality of newly generated spermatozoa from patients with advanced testicular cancer and patients with Hodgkin lymphoma (HL). Design: Prospective longitudinal study. Setting: Academic facility. Patient(s): Patients with newly diagnosed metastatic testicular cancer and with HL that required chemotherapy were compared with age-matched healthy community volunteers. Intervention(s): None. Main Outcome Measure(s): Semen parameters, hormone levels, testis volume, and presence of sperm DNA strand breaks in patients with cancer and in healthy community volunteers were compared before and after the patients' chemotherapy at 6, 12, 18, and 24 months. Result(s): Before chemotherapy, both cancer groups had poorer semen quality compared with community volunteers. Among patients with testicular cancer and HL, 67% and 60%, respectively, had <5 x 10(6) sperm/mL at 6 months after chemotherapy. At 24 months, 60% and 57% of patients with testicular cancer and HL, respectively, had normal sperm concentrations. Level of FSH was significantly higher in the cancer group compared with community volunteers at 6 to 12 months after chemotherapy. Before chemotherapy, sperm DNA damage was higher in the cancer group than in community volunteers; this damage was increased further at 6 months and remained elevated 24 months after treatment. Conclusion(s): Sperm generated after chemotherapy maintain a significant degree of chromatin damage. Therefore, survivors of testicular cancer and HL are at risk of having abnormal reproductive outcome. Proper counseling to these patients on reproductive risks and fertility preservation before chemotherapy is recommended. (Fertil Steril (R) 2010;94:1374-9. (C) 2010 by American Society for Reproductive Medicine.)