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. PROCEDURE: 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.
CONCLUSION: 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.