Study of seminal fluid parameters and fertility of male sickle-cell disease patients and potential impact of hydroxyurea treatment

Context: Male sickle-cell disease (SCD) patients often have moderate to severe hypogonadism resulting in abnormal seminal fluid parameters. Hydroxyurea (HU) used in SCD patients has been found to further aggravate the testicular dysfunction. Aims: To study the seminal fluid parameters and fertility of male SCD patients and to evaluate the potential impact of HU treatment on the above factors. Settings and Design: This was a prospective study of 100 male SCD patients of age group 18 to 45 years. Materials and Methods: Seminal fluid analysis was done before starting low dose of HU (10 mg/kg/day) and every 3 months after initiation of HU. Patients with abnormal seminal parameters before HU therapy were not given HU therapy. In SCD patients with HU therapy, who developed abnormal seminal fluid parameters, HU was stopped for 3 months and seminal fluid parameters were re-evaluated. Results: Among SCD patients without HU therapy, nine (18%) patients developed oligospermia and two (4%) developed azoospermia. Among SCD patients with HU therapy, 10 (20%) patients developed oligospermia and five (10%) developed azoospermia. Seminal fluid parameters reverted to normal after stoppage of HU for 3 months in 73% of patients. Conclusions: Alteration of sperm parameters is seen in a significant number of SCD patients. Also, alterations of seminal fluid parameters are exacerbated by HU treatment even with low dose.