Рассмотрена проблема фертильности взрослых, излеченных в детском возрасте от лимфомы Ходжкина. Химиотерапия, проведенная девочкам, в последующем часто приводит к снижению овариального резерва и, как следствие, раннему наступлению менопаузы. Облучение органов малого таза в детском возрасте в дальнейшем может стать причиной нарушения имплантации плодного яйца, снижения проходимости маточных труб, а в случае наступления беременностисамопроизвольного патологического прерывания беременности, мертворождения, задержки роста плода, преэклампсии и преждевременных родов. К причинам бесплодия у мужчин после перенесенного в детстве лечения болезни Ходжкина причисляют лучевое поражение яичек, нарушения сперматогенеза, механические повреждения мочеполовой системы, сексуальные дисфункции. Признана целесообразной оценка фертильной функции мужчин и женщин, леченных в детстве от лимфомы Ходжкина, на этапе планирования беременности с целью своевременного применения вспомогательных репродуктивных технологий.

Hodgkin’s lymphoma, being a highly malignant disease, has now acquired the property of a curative one. The article describes the basic principles of therapy of children with Hodgkin’s lymphoma, slow fixation of risk-adapted treatment positions. The possibility of complete cure of most patients appeared, which made this tumor a unique model for studying the remote consequences of cancer treatment. After the antitumor treatment of Hodgkin’s lymphoma, boys may suffer from testicular insufficiency (due to cytostatics), obstructive azoospermia (as a consequence of radiation therapy in the pelvic area), hypogonadism (secondary - after exposure of the pituitary gland to radiation, primary - after exposure of the pelvis due to the toxic effects of cytostatics). In order to reduce the gonadotoxicity of treatment, studies are being conducted to modify chemotherapy in the direction of lowering the doses of alkylating cytostatics, reducing the doses of radiation therapy without losing the effectiveness of treatment. Regardless of the cause of male infertility diagnosis includes the collection of reproductive history, external examination of the genitals, analysis of ejaculate, ultrasound examination of the scrotum, assessment of hormone levels (follicle stimulating hormone, total testosterone, serum testosterone, luteinizing hormone, prolactin, inhibin B, thyroid stimulating hormone).

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The concept of risk-adapted therapy is a modern standard of choice for the treatment regimen of Hodgkin’s lymphoma in childhood.  As a rule, patients are distributed depending on the number of factors in the groups of low, intermediate and high risk with a  particular volume of the treatment program. The rational use of chemotherapy and radiation therapy can reduce the risk of gonadal  toxicity. Loss of oocytes in patients receiving Hodgkin’s lymphoma therapy in childhood is usually associated with systemic  chemotherapy and pelvic irradiation. A combination of inhibin B and FSH is proposed as a screening marker to assess the gonadotoxic  effects of chemotherapy, in both girls and boys.