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Influence of sickle cell disease and treatment with hydroxyurea on sperm parameters and fertility of human males

¹ CECOS, Service d’Histologie, Biologie de la Reproduction et Cytogénétique EA 1533 (UPMC), Hôpital Tenon (APHP), Paris
² Service de Chirurgie, Institution Nationale des Invalides, Paris
³ Centre de la Drépanocytose, Hôpital Henri Mondor (APHP), Créteil
⁴ Département de Santé Publique, Hôpital Tenon (APHP), UPMC, Paris
⁵ CECOS, Service d’Histologie, Biologie de la Reproduction et Cytogénétique, Hôpital Cochin (APHP), Paris
⁶ Service d’Hématologie, Hôpital Tenon (APHP), Paris, France

Correspondence: Jacqueline Mandelbaum, Service d’Histologie, Biologie de, la Reproduction et Cytogénétique, CECOS Hôpital Tenon 4, rue de la, Chine 75020 Paris, France. E-mail:jacqueline.mandelbaum{at}tnn.aphp.fr

Background: Recent progress in the treatment of sickle cell disease, in particular the use of hydroxyurea, has considerably modified the prognosis of this disease. Many more patients now reach reproductive age. The objective of this study was to assess the potential impact of hydroxyurea on the semen of patients.

Design and Methods: In this retrospective multicenter study, we evaluated the sperm parameters and fertility of 44 patients and analyzed the potential impact of hydroxyurea.

Results: We report data from the largest series so far of semen analyses in patients with sickle cell disease: 108 samples were analyzed, of which 76 were collected before treatment. We found that at least one sperm parameter was abnormal in 91% of the patients before treatment, in agreement with published literature. All sperm parameters seemed to be affected in semen samples collected during hydroxyurea treatment, and this impairment occurred in less than 6 months, later reaching a plateau. Furthermore, after hydroxyurea cessation, while global results in 30 patients were not statistically different before and after hydroxyurea treatment, in four individuals follow-up sperm parameters did not seem to recover quickly and the total number of spermatozoa per ejaculate fell below the normal range in about half the cases.

Conclusions: The observed alterations of semen parameters due to sickle cell disease seem to be exacerbated by hydroxyurea treatment. Until prospective studies reveal reassuring findings, we suggest that a pre-treatment sperm analysis be performed and sperm cryopreservation be offered to patients before hydroxyurea treatment.

Key words: sickle cell disease, hydroxyurea, sperm, male fertility.