Fertility in Female Survivors Treated for Hodgkin Lymphoma as Children

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Female survivors treated for Hodgkin lymphoma may face declining fertility at a younger age, according to recent findings presented by Drechsel et al at the European Society of Human Reproduction and Embryology (ESHRE) 2023 Annual Meeting (Abstract O-083). The new research also suggested that the majority of those who attempt to become pregnancy may ultimately be successful.


“Hodgkin lymphoma is a type of cancer that can affect children and young adults. Thanks to improvements in treatment, most [patients] who are diagnosed with Hodgkin lymphoma now survive. However, we know that treatments such as chemo- and radiotherapy can lead to long-term side effects, including lower fertility,” explained lead study author Katja Drechsel, MD, a PhD candidate at the Princess Máxima Centre for Paediatric Oncology.

Study Methods and Results

In the recent study, the researchers included 84 female survivors, with a median age of 30 years, who had been treated for Hodgkin lymphoma as pediatric patients, at a median age of 13 years, as well as 798 female controls.

“These [patients] were treated for cancer in the 1970s, 1980s, and 1990s. It’s important to note that treatment for Hodgkin lymphoma [in pediatric patients] has changed in recent years, and the effects of current treatment schedules on fertility are likely to be less toxic,” Dr. Drechsel highlighted.

The researchers asked the patients whether they had children and how old they were when they became pregnant for the first time. They then tested the patients for three markers of fertility in their blood—anti-Mullerian hormones, follicle stimulating hormones, and inhibin B—and used ultrasound to gauge the patients’ antral follicle count. The researchers found that the patients who had been treated for Hodgkin lymphoma as children were more likely to have abnormal levels of all three fertility markers in their blood and lower egg cell counts compared with those of controls.

The Hodgkin lymphoma survivors were also about two and half times more likely to spend 1 year or more trying to become pregnant before succeeding for the first time. Further, the pregnancy rates and live birth rates were similar between the two groups. However, the patients who had been treated for Hodgkin lymphoma were on average 2 years younger than controls and 3 years younger than the general Dutch population when they had their first child (27 years vs 29 and 30 years, respectively).


“Our results suggest that treatment for Hodgkin lymphoma ... may have an impact on [female survivors’] fertility. In particular, they indicate that … fertility might decline at a younger age compared [with] other [female patients],” Dr. Drechsel stressed. “However, it’s encouraging to see that the [patients] who have already chosen to start a family have been successful. On average, they had their first child at a younger age, which may be because their [physicians] have spoken to them about the possible effects of their cancer treatment on fertility. We will need to follow this group for longer to see if they face greater difficulties becoming pregnant at older ages,” she added.

Dr. Drechsel and her colleagues plan to continue monitoring the fertility of the female patients in the longer term. They are also carrying out a larger prospective study—the fertility add-on study to the EuroNET-PHL-C2 trial—analyzing the signs of fertility in male and female patients treated according to the current European treatment protocol for Hodgkin lymphoma in five European countries.

“This study provides some reassurance for young [female survivors] who [were treated for] Hodgkin lymphoma as children. It shows that most of them who try for a baby do manage to become pregnant. However, the [patients] in this study were relatively young and some of them thought it was too soon to start a family. This means it is too early to be sure about the long-term effects of treatment for this disease. More [patients] need to be followed for a longer period of time,” urged Carlos Calhaz-Jorge, Chair of the ESHRE, Full Professor of Obstetrics and Gynaecology at the Universidade de Lisboa Medical School, as well as Director of the Department of Obstetrics, Gynaecology, and Reproductive Medicine at Northern Lisbon Hospital Centre and the Hospital de Santa Maria—who was not involved in this study.

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