Recovery of spermatogenesis following pelvic irradiation for Hodgkin's disease

Spermatogenesis of 18 male patients who underwent pelvic irradiation for Hodgkin's disease was assessed. All patients had supplemental testicular shielding to limit the testicular dose. The total calculated gonadal dose ranged from 28 to 135 rad, delivered in 22 to 29 fractions, whereas the adjacent lymph nodes were treated to 3750-4500 rad. Sperm concentration of 20 million per ml or greater was considered fertile. Oligospermic and azoospermic determinations were considered subfertile. Whereas only one of six patients (17%) was fertile when tested less than 18 months following pelvic radiotherapy, four of six (66%) were fertile when tested between 18 and 26 months following therapy. Seven of eight patients (88%) were fertile when tested more than 26 mo following completion of treatment. The results are compared to other reports in the literature. Our data support the concept of a time-dependent recovery of spermatogenesis following irradiation. The observed relatively short duration of temporary sterilization should encourage the use of meticulous pelvic shielding, including supplemental testicular shielding to minimize the absorbed gonadal dose.