Synchronous hodgkin lymphoma in monozygotic twins: a case report of ovarian stimulation with aromatase inhibitors and recombinant follicle-stimulating hormone

Hodgkin lymphoma (HL) is one of the most common malignancies affecting young adults of reproductive age. Given the high long-term survival rates, fertility preservation has become a critical aspect of comprehensive patient care. Alkylating agents (procarbazine, cyclophosphamide), which are included in standard chemotherapy regimens, exhibit the highest gonadotoxic potential. However, cases of synchronous HL in monozygotic twins followed by controlled ovarian stimulation are extremely rare in the literature.
Aim. To present a clinical case of successful controlled ovarian stimulation using Aromatase inhibitors and recombinant follicle-stimulating hormone (rFSH) with subsequent oocyte cryopreservation in two patients with synchronous classical HL prior to the initiation of antitumor therapy.
The study included two monozygotic female twins born in 2000 with newly diagnosed classical HL. The first patient was diagnosed with stage IIA disease (international prognostic index 0.4), the second with stage IVB (international prognostic index 1). Both patients underwent controlled ovarian stimulation using a protocol with Aromatase inhibitors and rFSH, followed by transvaginal oocyte retrieval and vitrification of mature oocytes prior to chemotherapy. After completion of the fertility preservation procedures, the patients received polychemotherapy according to the ABVD regimen (6 cycles) and BEACOPP-14 (8 cycles), respectively. Treatment response was assessed by positron emission tomography / computed tomography.
A total of 7 and 5 mature oocytes were successfully retrieved and cryopreserved in the first and second patient, respectively. Both procedures were well tolerated, with no adverse events requiring protocol modification  or discontinuation. Following completion of chemotherapy, both patients achieved complete metabolic response  on positron emission tomography / computed tomography.
This case report demonstrates that controlled ovarian stimulation with Aromatase inhibitors and rFSH followed by oocyte cryopreservation is a feasible and effective fertility preservation strategy in patients with synchronous HL, including those with advanced-stage disease requiring intensive chemotherapy regimens. This observation underscores the critical importance of early multidisciplinary collaboration between oncologists and reproductive medicine specialists to ensure timely fertility preservation in young patients.

1. Kahn J., Dabaja B., Wu S. et al. Classic Hodgkin lymphoma. Hematol Oncol 2024;42:e3239. DOI: 10.1002/hon.3239

2. Huang J., Pang W.S., Lok V. et al. Incidence, mortality, risk factors, and trends for Hodgkin lymphoma: A global data analysis. J Hematol Oncol 2022; 15:57. DOI: 10.1186/s13045-022-01281-9

3. Robert Koch Institute, Department of Epidemiology and Health Monitoring Available at: https://www.krebsdaten.de/Krebs/DE/Content/Krebsarten/Morbus%20Hodgkin/morbus%20hodgkin_node.html

4. Van Nimwegen F.A., Schaapveld M., Janus C.P. et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med 2015;175(6):1007–17. DOI: 10.1001/jamainternmed.2015.1180

5. De Vries S., Schaapveld M., Janus C.P.M. et al. Long-term cause-specific mortality in Hodgkin lymphoma patients. J Natl Cancer Inst 2021;113:760–9. DOI: 10.1093/jnci/djaa194

6. Johnson A.C., Mays D., Rehberg K. et al. Knowledge and beliefs about oncofertility and associations with quality of life among adolescent and young adult survivors of pediatric cancer. J Adolesc Young Adult Oncol 2018;7:424–9. DOI: 10.1089/jayao.2018.0014

7. Benedict C., Thom B., Friedman D.N. et al. Fertility information needs and concerns post-treatment contribute to lowered quality of life among young adult female cancer survivors. Support Care Cancer 2018;26:2209–15. DOI: 10.1007/s00520-017-4006-z

8. Kiseleva M.V., Lunkova M.N. Preservation of fertility in patients with breast cancer. Literature review. Practice Oriented Science UAE-RUSSIA-INDIA. UAE 2023:149–63.

9. Kiserud C.E., Fosså A., Bjøro T. et al. Gonadal function in male patients after treatment for malignant lymphomas, with emphasis on chemotherapy. Br J Cancer 2009;100:455–63. DOI: 10.1038/sj.bjc.6604892

10. Kulkarni S.S., Sastry P.S., Saikia T.K. et al. Gonadal function following ABVD therapy for Hodgkin’s disease. Am J Clin Oncol 1997;20:354–7. DOI: 10.1097/00000421-199708000-00006

11. Oktem O., Oktay K. Quantitative assessment of the impact of chemotherapy on ovarian follicle reserve and stromal function. Cancer 2007;110:2222–9. DOI: 10.1002/cncr.23071

12. Sonigo C., Beau I., Binart N. et al. The impact of chemotherapy on the ovaries: molecular aspects and the prevention of ovarian damage. Int J Mol Sci 2019;20:5342. DOI: 10.3390/ijms20215342

13. Spears N., Lopes F., Stefansdottir A. et al. Ovarian damage from chemotherapy and current approaches to its protection. Hum Reprod Update 2019;25:673–93. DOI: 10.1093/humupd/dmz027

14. Lokshin V.N., Karibaeva Sh.K., Isenova S.Sh. et al. Preservation of oncofertility in cancer patients. In: Practical Reproductology. Kazakhstan, Almaty, 2023. 386 p. (In Russ.).

15. Reproductive health of cancer patients. Oncology: textbook. Ed. by A.D. Kaprin. Moscow: Molodaya Gvardiya, 2025. 568 p. Рр. 306–311. (In Russ.).

16. Vidal A., Nordhoff V., Suerdieck M. et al. Development of medical freezing measures in women during the last decade from 2014 to 2023: registry data of the tri-national network FertiPROTEKT. Arch Gynecol Obstet 2026;313:36. DOI: 10.1007/s00404-025-08253-7