Hematologic malignancies: fertility in males and couples

Treatment of hematologic malignancies may affect the fertility of couples when one of the partners has been treated. Effects on fertility depend on sex, age at onset of therapy and nature of the treatment. Male fertility is particularly affected by alkylating agents - Radiotherapy is per se gonadotoxic and this toxicity is enhanced by polychemotherapy. The main targets are germinal cells, which deterioration vary according to their maturation or differentiation stage. This, in part, may account for the best resistance of pre-pubertal testes. These early alterations of spermatogenesis are likely to recover: semen analysis is the best test to evaluate male fertility. PMA can be proposed in case of incomplete recovery: (IVF: in vitro fertilization, ICSI: intra-cytoplasmic sperm injection). Cryopreservation, when possible, before therapy, remains necessary due to incomplete knowledge on mutagenicity of male gametes. As for sex behavior, published data account for an emerging awareness regarding interrogations faced by adolescent and adults.