Aug. 28, 2000 -- The survival rate for Hodgkin's disease, one of the most frequent cancers during the reproductive years, is improving. So why is this disease still creating fear among most men who are diagnosed with the condition?
According to a study in the journal Annals of Oncology, researchers are aware of these men's concerns since they face almost certain sterility after treatment. The same researchers are highlighting the importance of early semen cryopreservation -- also known as sperm banking -- and less toxic therapies for the disease.
David J. Frid, MD, knows how important these options can be.
"I was told basically that there was a 95% to 99% chance after chemotherapy that I would be sterile. The likelihood of being infertile is quite high and quite scary," says Frid in an interview with WebMD. "This is an issue that every man who is at reproductive age has to think about."
Frid, who was diagnosed with Hodgkin's disease in 1997, admits that while the decision to participate in the option of sperm banking was made easier by already having children, "I had to be 100% sure that I did not want to have children after the chemotherapy."
As director of preventive and rehabilitative cardiology at the Ohio State University Medical Center in Columbus, Frid understands that physicians often overlook "issues not related to the disease process." This was the case for Frid's oncologist, who did not bring up the option of sperm banking that would allow him the possibility of having children in the future. "You have to be proactive and ask the questions that will affect your reproductive ability -- you have to be informed about your choices that are available before the treatment."
True to Frid's philosophy of knowing the facts, researchers in France brought this knowledge to 94 men with Hodgkin's disease who underwent semen preservation before any treatment. By evaluating their semen quality, the study reports only about 50% of the patients had normal sperm prior to treatment. Of the 13 patients who requested their semen be frozen, 88 inseminations of sperm were performed, leading to nine pregnancies but only two births.
With the low success rate often found with insemination, some experts argue that the study should have used a different technique -- in vitro fertilization -- for better results. "They were almost guaranteed failure. In this day and age, insemination is rarely used," Allen D. Seftel, MD, who was not involved in the study, tells WebMD. Seftel is associate professor of urology at Case Western Reserve University and is on staff in the department of urology at the University Hospitals of Cleveland.
Seftel points out that the first, and most important option, for those men who are of reproductive age is sperm banking. "Although some semen production may bounce back two years later, in most cases sterility is permanent," Seftel says. "This is the fact of today's current treatments -- that although they cause sterility, [they're] curing the disease. It remains to be seen if other, less-toxic therapies will be made available."
Frid adds that the study raises the all-important issue of the patient being informed of his choices. "If I was younger, I would have demanded to talk further with fertility experts about my options -- everyone with Hodgkin's disease should be provided with this information."