Testicular function following combination chemotherapy with cis-platin, vinblastine, and bleomycin

Recovery of the pituitary-gonadal axis following treatment with vinblastine, bleomycin, cis-platin +/- doxorubicin (VBP +/- A) is assessed retrospectively in 18 men with germinal neoplasms. One patient also received VP-16-213. In the first year after completing treatment all men demonstrated elevated follicle stimulating hormone (FSH) and luteinizing hormone (LH) values with concomitant azoospermia. Of the 11 men evaluated at least 24 months from completion of therapy, seven (64%) had recovery of both FSH and LH to normal or near normal levels. Spermatogenesis was present in five of six (83%) men providing semen samples and who were at least 2 years from stopping VBP. Five of seven (71%) men who were within 24 months of therapy were azoospermic. Regardless of the time of evaluation, most men (94%) had normal serum testosterone. Patients receiving maintenance vinblastine had more prolonged elevation of serum gonadotropins. We conclude that some men have evidence of recovery of fertility beginning two years after VBP +/- A. In addition to germinal epithelium destruction, transient Leydig cell dysfunction occurs but is not accompanied by clinical findings of hypogonadism.