title: Cryopreservation, semen use and the likelihood of fatherhood in male Hodgkin lymphoma survivors: an EORTC-GELA Lymphoma Group cohort study.
abstract: OBJECTIVE
  How does the successful cryopreservation of semen affect the odds of post-treatment fatherhood among Hodgkin lymphoma (HL) survivors?
  
  
  CONCLUSIONS
  Among 334 survivors who wanted to have children, the availability of cryopreserved semen doubled the odds of post-treatment fatherhood.
  
  
  BACKGROUND
  Cryopreservation of semen is the easiest, safest and most accessible way to safeguard fertility in male patients facing cancer treatment. Little is known about what proportion of patients achieve successful semen cryopreservation. To our knowledge, neither the factors which influence the occurrence of semen cryopreservation nor the rates of fatherhood after semen has been cryopreserved have been analysed before.
  
  
  METHODS
  This is a cohort study with nested case-control analyses of consecutive Hodgkin survivors treated between 1974 and 2004 in multi-centre randomized controlled trials. A written questionnaire was developed and sent to 1849 male survivors.
  
  
  METHODS
  Nine hundred and two survivors provided analysable answers. The median age at treatment was 31 years. The median follow-up after cryopreservation was 13 years (range 5-36).
  
  
  RESULTS
  Three hundred and sixty-three out of 902 men (40%) cryopreserved semen before the start of potentially gonadotoxic treatment. The likelihood of semen cryopreservation was influenced by age, treatment period, disease stage, treatment modality and education level. Seventy eight of 363 men (21%) used their cryopreserved semen. Men treated between 1994 and 2004 had significantly lower odds of cryopreserved semen use compared with those treated earlier, whereas alkylating or second-line (chemo)therapy significantly increased the odds of use; no other influencing factors were identified. We found an adjusted odds ratio of 2.03 (95% confidence interval 1.11-3.73, P = 0.02) for post-treatment fatherhood if semen cryopreservation was performed. Forty-eight out of 258 men (19%) who had children after HL treatment became a father using cryopreserved semen.
  
  
  CONCLUSIONS
  Data came from questionnaires and so this study potentially suffers from response bias. We could not perform an analysis with correction for duration of follow-up or provide an actuarial use rate due to lack of dates of semen utilization. We do not have detailed information on either the techniques used in cryopreserved semen utilization or the number of cycles needed.
  
  
  BACKGROUND
  Lance Armstrong Foundation, Dutch Cancer Foundation, René Vogels Stichting, no competing interests.
authors.affiliation: Department of Internal Medicine, ZH 4A 35, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: M A E
authors.initials: MA
authors.lastname: van der Kaaij
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authors.lastname: Abeilard-Lemoisson
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authors.lastname: Lugtenburg
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authors.forename: E M
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authors.lastname: Noordijk
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authors.lastname: Fermé
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authors.initials: J
authors.lastname: Thomas
authors.forename: A
authors.initials: A
authors.lastname: Stamatoullas
authors.forename: C
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authors.lastname: Fruchart
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authors.initials: H
authors.lastname: Eghbali
authors.forename: P
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authors.lastname: Brice
authors.forename: W G J M
authors.initials: WG
authors.lastname: Smit
authors.forename: C
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authors.lastname: Sebban
authors.forename: J K
authors.initials: JK
authors.lastname: Doorduijn
authors.forename: J M
authors.initials: JM
authors.lastname: Roesink
authors.forename: I
authors.initials: I
authors.lastname: Gaillard
authors.forename: B
authors.initials: B
authors.lastname: Coiffier
authors.forename: M L M
authors.initials: ML
authors.lastname: Lybeert
authors.forename: O
authors.initials: O
authors.lastname: Casasnovas
authors.forename: M
authors.initials: M
authors.lastname: André
authors.forename: J M M
authors.initials: JM
authors.lastname: Raemaekers
authors.forename: M
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authors.lastname: Henry-Amar
authors.forename: J C
authors.initials: JC
authors.lastname: Kluin-Nelemans
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D015331:Cohort Studies; D015925:Cryopreservation; D005298:Fertility; D006689:Hodgkin Disease / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012661:Semen; D012662:Semen Preservation; D017741:Survivors
keywords: Hodgkin; cryopreservation; fertility; lymphoma; male