CCoPE
Date: 2009-06-22

Question:
I have a male patient who takes Hydroxiurea from 5 years now due to sickle cell anemia (without this drug he was undergoing continuously to hemolityc crisis). he now wants a baby but his sperm is without cells. He stopped for 4 months hydroxiurea but no sign of recovery. It is possible that he became sterile?

Answer:
Reproductive toxicity subsequent to hydroxyurea administration has been shown in male rats. Animal studies have shown alterations of sperm chromatin structure, abnormal sperm head morphology, decreased sperm density, and decreased circulating testosterone with hydroxyurea application. These effects are probably induced by the inhibition of ribonucleotide reductase and DNA synthesis leading to the depletion of meiotic daughter cells and differentiated cell types that normally produce mature sperm. Also apoptosis of germ cells appears to be increased by this agent. In human cases, a retrospective review of semen analysis from four adult men taking between 1 and 1.5 g/day of this medication for a period of 8 to 126 months, and from three of these men after cessation of therapy, it was suggested that hydroxyurea may reduce sperm count and motility and may results in abnormal morphology. One of these men with azoospermia, recovered from spermatogenesis upon the cessation of hydroxyurea treatment; however, in the other two cases sperm morphology and mobility remained impaired.