Q: I am a 35 years old married male diagnosed with a malignant tumour (Hodgkin) stage 1, 15 years back. I was referred for treatment such as radiotherapy and chemotherapy. Neither my family nor I was aware of the treatment and its effect on my reproductive system. Now I came to know after a sperm test that there are no active sperm cells. How can my sperm production be revived?

A:The recovery of sperm production after chemotherapy depends on the survival of the spermatogonial stem cells (precursors of mature sperms) and their ability to differentiate and transform into mature sperms capable of fertilization. Surviving stem cells can remain in the testes but fail to differentiate into sperms for several years after the use of chemotherapy. At lower doses of chemotherapy drugs, recovery to normal sperm levels can occur within 1 to 3 years, but at higher doses, azoospermia can be more prolonged or even permanent. Although the probability that spermatogenesis will recover decreases with the duration of azoospermia, a few men have recovered spermatogenesis after as long as 20 years of azoospermia. Patient with oligospermic counts are managed in the same way, as are those in the general population with male factor infertility, including the use of IVF and IVF with ICSI (Intra Cytoplasmic Sperm Injection). Specific to your situation, it will depend upon the possibility of getting sperms by testicular biopsy and using it for ICSI. You should consult an expert in male infertility to explore this option.