Gonadal function and parenthood 20 years after treatment for childhood lymphoma: a cross-sectional study.
BACKGROUND
Gonadal function decades after treatment for childhood lymphoma (CL) is not well described. This cross-sectional study had two aims: (1) describe long-term gonadal function and fertility in childhood lymphoma survivors (CLSs), and (2) explore anti-Mullerian hormone (AMH) as a measure of ovarian function in CLSs.


METHODS
Seventy-four male and 62 female CLSs participated in a survey consisting of a questionnaire, clinical examination, and blood/semen analysis. Prior treatment was categorized according to gonadotoxicity. Hypogonadism was determined by levels of gonadal hormones based on luteinizing hormone, follicle-stimulating hormone, testosterone (males), AMH (females <40 years), and menstrual status. Fertility was explored according to pregnancies achieved, semen analysis, and AMH.


RESULTS
Hypogonadism was observed in 7 of 66 males (11%). Seven of 64 males (11%) were categorized as infertile. Nine of 45 females <40 years (20%) were at risk to develop premature ovarian failure (POF). Twenty of 45 females (44%) showed low-AMH levels indicating decreased fertility. Four "critically low" females reported pregnancies within the preceding 2 years. Sixty-four percent of the males and 93% of the females attempting parenthood had been successful (P = 0.01). Hypogonadism and low-AMH were related to treatment burden.


CONCLUSIONS
Twenty years after treatment of CL, female CLSs' attempts of pregnancy initiation are mostly successful, while males seem at higher risk of infertility. Hypogonadism is a problem in 10% of the male CLSs. Based on AMH levels, POF is a risk in 20% of the female CLSs. The clinical significance of AMH reflecting true probability of fertility needs further research in cancer survivors.
National Resource Center for Late Effects After Cancer, Division of Surgery and Cancer Medicine, Oslo University Hospital, The Norwegian Radium Hospital, Norway. hanne.mari.hamre@ous-hf.no
Hanne
H
Hamre
Cecilie E
CE
Kiserud
Ellen
E
Ruud
Per M
PM
Thorsby
Sophie D
SD
Fosså
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D005500:Follow-Up Studies; D006066:Gonads / Q000502:physiology*; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis* / Q000378:metabolism; D007246:Infertility / Q000175:diagnosis* / Q000378:metabolism; D007986:Luteinizing Hormone / Q000378:metabolism; D008223:Lymphoma / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis / Q000378:metabolism; D011379:Prognosis; D017741:Survivors; D013739:Testosterone / Q000378:metabolism; D055815:Young Adult
D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone