Abstract
BackgroundIt is difficult to predict the reproductive capacity of children given hematopoietic cell transplantation (HCT) before pubertal age because the plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are not informative and no spermogram can be done.MethodsWe classified the gonadal function of 38 boys and 34 girls given HCT during childhood who had reached pubertal age according to their pubertal development and FSH and LH and compared this to their plasma inhibin B and anti-Müllerian hormone (AMH).ResultsTen (26%) boys had normal testicular function, 16 (42%) had isolated tubular failure and 12 (32%) also had Leydig cell failure. All 16 boys given melphalan had tubular failure. AMH were normal in 25 patients and decreased in 6, all of whom had increased FSH and low inhibin B.Seven (21%) girls had normal ovarian function, 11 (32%) had partial and 16 (47%) complete ovarian failure. 7/8 girls given busulfan had increased FSH and LH and 7/8 had low inhibin B. AMH indicated that ovarian function was impaired in all girls.FSH and inhibin B were negatively correlated in boys (P < 0.0001) and girls (P = 0.0006). Neither the age at HCT nor the interval between HCT and evaluation influenced gonadal function.ConclusionThe concordance between FSH and inhibin B suggests that inhibin B may help in counselling at pubertal age. In boys, AMH were difficult to use as they normally decrease when testosterone increases at puberty. In girls, low AMH suggest that there is major loss of primordial follicles.
Highlights
It is difficult to predict the reproductive capacity of children given hematopoietic cell transplantation (HCT) before pubertal age because the plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are not informative and no spermogram can be done
Gonadal function and the plasma inhibin B concentrations did not differ with the type of HCT, or of total body irradiation (TBI)
The mean plasma inhibin B and anti-Müllerian hormone (AMH) concentrations were significantly higher in the boys with normal testicular function than in those with tubular failure, and among these latter higher in those with isolated tubular failure than in those with tubular and Leydig cell failures
Summary
It is difficult to predict the reproductive capacity of children given hematopoietic cell transplantation (HCT) before pubertal age because the plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are not informative and no spermogram can be done. Conditioning for hematopoietic cell transplantation (HCT) may alter the production of gonadal hormones (testosterone in boys, estradiol and progesterone in girls) and the viability of the germ cells. Gonadal failure may result in incomplete sexual development and growth at puberty, and sterility in adulthood. Gonadal hormones are required for the development of secondary sexual characteristics and the growth spurt which normally occurs at puberty. Sanders et al [2] showed that 15 (13%) of 114 prepubertal boys developed normal testicular function and the partners of 2 of them became pregnant; the great majority of those who recovered testicular function had been given cyclophosphamide without irradiation. 23 (28%) of 82 prepubertal girls developed normal ovarian function, 9 of whom became pregnant; the pregnancies of all 5 given total body irradiation (TBI) ended in spontaneous abortion
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