High risk of azoospermia in men treated for childhood cancer.

ABSTRACT

Childhood cancer survivors (CCS) have an increased risk of impaired spermatogenesis, but data regarding the disease- and treatment-related risk factors of azoospermia are scarce. Such information is crucial both for counselling CCS and for selecting patients for testicular tissue cryopreservation. The proportion of azoospermic men in CCS was 18% [95% confidence interval (CI) 12-26], specifically for leukaemias (19%; 95% CI 5.5-42), Hodgkin's disease (53%; 95% CI 29-76), non-Hodgkin's lymphoma (11%; 95% CI 0.28-48) and testicular cancer (11%; 95% CI 0.28-48). In CCS treated with high doses of alkylating agents, the proportion of azoospermic men was 80% (95% CI 28-99) and if radiotherapy was used additionally, the proportion was 64% (95% CI 35-87). In CCS with subnormal Inhibin B levels, the proportion of azoospermic men was 66% (95% CI 47-81) and for those with elevated follicle-stimulating hormone (FSH) levels, the proportion was 50% (95% CI 35-67). Among CCS with subnormal testicular volume (≤ 24 mL), azoospermia was found in 61% (95% CI 39-80) of the cases. Most childhood cancer diagnoses are associated with an increased risk of azoospermia, especially in CCS receiving testicular irradiation, high doses of alkylating drugs and other types of cytotoxic treatment, if combined with irradiation. Inhibin B, FSH and testicular volume can be used as predictors for the risk of azoospermia.