Hazardous Influence of Hydroxyurea on Spermatogenesis in Thalassemia Intermedia Patients: An Egyptian Cohort Study

Background: Hydroxyurea (HU), frequently used in thalassemia intermedia (TI), might have adverse effects on spermatogenesis. Aim: To assess the effects of HU treatment on sperm parameters and potential reversibility on its discontinuation in TI patients. Methods: Twenty fully-pubertal male TI patients regularly followed-up at the Ain Shams University Thalassemia Center were classified according to previous HU treatment (1:1); first group had received HU for ≥ one year, while the second had never received HU. All recruited patients were subjected to full clinical assessments. Sperm parameters (number, abnormal forms, motility and forward progression) were assessed at enrollment and reassessed six- months after stopping HU treatment. Result: Eleven patients on HU therapy had statistically significant lower sperm count in comparison to those who had never received HU. At six months off HU therapy, there was statistically significant improvement of all sperm parameters. Nevertheless, such parameters were still lower than those of patients who had never received HU. Statistically significant relationships were noted between total sperm count and HU dose, compliance and duration of therapy. Conclusion: HU appears to have a hazardous yet reversible effect on sperm health in pubertal TI patients. Counseling should be offered with close follow-up of its effect on fertility.