Haematologica, Vol 93, Issue 11, e67 doi:10.3324/haematol.13659
Copyright © 2008 by Ferrata Storti Foundation
Use of hydroxyurea from childhood to adult age in sickle cell disease: semen analysis
A.K. Lukusa1,
C. Vermylen2
1 Pediatrics Department, Université de Kinshasa, Congo the Dem. Rep
2 Pediatrics Hemato-Oncology unit, Cliniques Universitaires St-LUC Hippocrate, Bruxelles, Belgium
We read with interest the paper by Berthaut et al.1, who studied the influence of hydroxyurea on sperm parameters and fertility of human males.
In that retrospective multicenter study, sperm parameters and fertility were evaluated in 44 adult patients. They suggested that a pre-treatment semen analysis be performed and sperm cryopreservation be offered to patients before Hydroxyurea treatment. In five patients, six semen samples were collected during Hydroxyurea treatment .The treatment duration varied from 2 to 10 years. No details on ages at the beginning of the treatment were given for these five patients. As the mean ages of their all forty-four patients was 25.8 years (range, 16–48 years), we could suppose that the treatment was initiated in adult patients.
We know that long term use of hydroxyurea has been largely performing in children with good outcomes on morbidity and survival.2–5 While exploring these improvements no fertility overviews were taken into account. But now a day, most of these children have reached adulthood, thus a fertility issue raised.
We investigated the effect of Hydroxyurea treatment on fertility when initiated during childhood in four patients since it was not possible to have semen for analysis at that age with their 11.2 years mean age (range, 8–16). Semen samples were analyzed according to WHO standards.6 Among our 4 patients (mean age 22.2 years, range 19–24 years), two experienced severe oligozoospermia and two azoospermia. The oligozoospermic patients had shorter treatment duration (8 and 9 years) than the azoospermic subjects, who had been on HU for 12 and 15 years respectively. They also had increased percentages of morphologically abnormal spermatozoa. Details of these four patients are given in Table 1.
The remaining questions are about the:
- - quality of spermatogenesis, even after hydroxyurea removal, more than fifteen years after its early starting before puberty. Furthermore in patient who had never experienced normal spermatogenesis.
- - organization of an informed counseling to be provided to parents on immature testicular tissue cryopreservation in children before HU initiation.
- - alternative treatment if hydroxyurea removal is decided, with a view to semen cryopreservation when best values are obtained.
This study must therefore be extended to a larger cohort of patients to determine the real risk factors in order to ensure better management of male sickle cell disease patients receiving Hydroxyurea since childhood.
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References
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- Berthaut I, Guignedoux G, Kirsh-Noir F, De Larouziere V, Ravel C, Bachir D, et al. Infuence of sickle cell disease and treatment with hydroxyurea on sperm parameters and fertility of human males. Haematologica 2008;93:988-93.[Abstract/Free Full Text]
- Ferster A, Vermylen C, Cornu G, Buyse M, Corazza F, Delvack C, et al. Hydroxyurea for treatment of severe sickle cell anemia: a pediatric clinical trial. Blood 2001;98:2878-9.[Free Full Text]
- Rogers ZR, Buchan GR. Expanding the role of hydroxyurea in children with sickle cell disease. J Pediatr 2004;145:287-8.[CrossRef][ISI][Medline]
- Hankins JS, Ware RE, Rogers ZR, Wynn LW, Lane PA, Scott JP, et al. Long-term hydroxyurea therapy for infants with sickle cell anemia: the HUSOFT extension study. Blood 2005;106:2269-75.
- De Montalembert M, Brousse V, Elie C, Bernaudin F, Shi J, Landais P. Long-term hydroxyurea treatment in children with sickle cell disease: tolerance and clinical outcomes. Haematologica 2006;91:125-28.[Abstract/Free Full Text]
- Rowe PJ, Comhaire FH, Harcreave TB, Mahmoud AM. WHO manual for the standardized investigation, diagnosis and management of the infertile male. Cambridge University Press. 2000. p. 91.
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References