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The European Society of Human Reproduction and Embryology held its 39th Annual Meeting from June 25-28, 2023. During the Meeting, various stakeholders within these fields discussed scientific practice, embryo transfer techniques, and novel research. One such presentation, shares News Medical, focused on the impact of pediatric Hodgkin lymphoma on female fertility. 

Looking at the Long-Term Effects on Fertility

Hodgkin lymphoma most often occurs in adolescents between 15-19 years old. Medical advances mean that many people with Hodgkin lymphoma, both older and younger, have positive outcomes after treatment. However, treatments like chemotherapy can have negative physical impacts on the body. One of those is that females may experience issues with fertility. 

This research, presented by Dr. Katja Drechsel, focused on 84 adult females who were diagnosed with pediatric Hodgkin lymphoma. The study also included 798 females who never had this form of cancer. Within the study, women were asked to provide insights into their past pregnancies (if any), their age when becoming pregnant, and other similar details. Tests on the women also sought to understand how many egg cells they had and what kinds of fertility markers they had in their blood. Ultimately, findings from the study determined that:

• Fertility markers were abnormal, and often lesser, in people who had been treated for this cancer as children. These women also had lower amounts of eggs. 
• On average, it took women who were treated for Hodgkin lymphoma more than 1 year of trying for a baby before pregnancy. These women were 2.5x more likely to spend this length of time than those who had never undergone treatment. 
• Fertility is believed to decline at a younger age in women who had Hodgkin lymphoma. These women were also more likely to have children at younger ages. 
• Despite the various fertility challenges associated with pediatric Hodgkin lymphoma treatment, many women in the study were able to get pregnant over time.

Study Considerations

Although this study suggests that pediatric Hodgkin lymphoma treatment may alter fertility in adulthood, there are some things that we have to consider. The first is that the women in the study became pregnant at younger ages. This means that we do not know if those women would have struggled more with fertility as they aged. Following this population and assessing this could give more insight into the longer-term effects of treatment. Dr. Drechsel is planning on doing this with her team. 

Another consideration is that treatments have improved over time. The study participants had been treated in the 1970s-1990s. It is very possible that, since that time, treatments have become less toxic or prone to adverse effects like fertility issues. 

The Basics: Hodgkin Lymphoma

Hodgkin lymphoma forms in the lymphatic system (part of the immune system). This cancer makes it more difficult for the body to fight infection. It is typically broken into four subsets: nodular-sclerosing, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted. The former two subsets are most common in children and adolescents. Risk factors for childhood Hodgkin lymphoma included Epstein-Barr virus (EBV) or HIV infection, autoimmune diseases, having a family history of Hodgkin lymphoma, or being immunocompromised.

Symptoms of Hodgkin lymphoma can include:

• An enlarged liver and/or spleen
• Swollen lymph nodes in the neck, armpits, chest, abdomen, or groin
• Low-grade fever with no known cause
• Chills and night sweats
• Unintended weight loss
• Skin itchiness
• Extreme fatigue
• Chronic cough
• Anorexia
• Difficulty breathing, especially when lying down
• Gastrointestinal or nephrological abnormalities