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Cyclophosphamide Gonadotoxicity Fertility — ESENeph MCQ

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ModerateRenal VasculitisCyclophosphamide Gonadotoxicity FertilityESENeph

A 40-year-old man with ANCA vasculitis completed 6 months of Cyclophosphamide induction (total dose 9 g). He asks about fertility. What should he be told?

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Correct answer: B — Cyclophosphamide causes dose-dependent gonadotoxicity – at 9 g cumulative dose, the risk of sustained azoospermia is approximately 50-60% in men; sperm banking should have been offered pre-treatment; fertility may recover in some patients over 1-5 years

Cyclophosphamide is a potent gonadotoxin. In men, it causes dose-dependent spermatogonial damage: at cumulative doses >7.5 g, the risk of sustained azoospermia is 50-70%. Recovery is possible (months to years) but not guaranteed. KDIGO 2024 AAV guideline recommends offering sperm banking before Cyclophosphamide treatment. In women, the risk of premature ovarian failure increases with age and cumulative dose – GnRH agonist co-administration may provide partial ovarian protection. This is a major reason KDIGO 2024 now recommends Rituximab over Cyclophosphamide for induction in many AAV patients.

Reference: KDIGO 2024 – AAV; NICE – Fertility Preservation in Cancer Treatment