Fertility in Women with Mesothelioma
Living with mesothelioma is already a terrible burden to bear, but to find out that your dream of having children may be destroyed by cancer adds another element to the burden. While many people diagnosed with mesothelioma are older men, women are not immune to this type of cancer. In fact, young women have been diagnosed with peritoneal mesothelioma, and this type is more common in women than in men.
Cancer can affect fertility in women in a number of ways and can potentially leave her completely infertile. It may be the cancer, the metastatic tumors, the treatments, or a combination of all of these that limit fertility. It is important for any woman diagnosed with any type of cancer to talk to her medical team about the possibility of losing fertility and what can be done to ensure she can still have children if she wants to in the future.
Infertility in Women
Being infertile means not being able to conceive a child. Both men and women can be infertile and it may be permanent or temporary. Fertility may be limited, making conception challenging, but not impossible, or a person may become completely infertile, making pregnancy impossible. There are a few ways in which a woman may become infertile: her ovaries do not produce mature, viable eggs; her eggs cannot be fertilized because of some damage to the reproductive organs; her eggs may become fertilized, but will not implant inside the uterus.
How Cancer Can Cause Infertility
It is more likely that the treatment for cancer, rather than the cancer itself, will cause infertility in a woman. However, it is possible for certain types of cancer to impact fertility directly, regardless of treatments. For example, cancers of the reproductive organs may affect fertility, as may metastatic tumors in these organs that originated as mesothelioma. Tumors that impact the glands producing hormones that affect fertility may also cause infertility in women.
Chemotherapy and Fertility
Most people with mesothelioma will undergo chemotherapy at some point in time. It is the most commonly used treatment for most types of cancers and is often very effective at shrinking tumors. It works by sending drugs into the body that kill fast-growing cells, including cancer cells. Certain chemotherapy drugs are more likely than others to destroy eggs in a woman’s ovaries: busulfan, carboplatin, carmustine, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, doxorubicin, ifosfamide, lomustine, mechlorethamine, melphalan, procarbazine, and temozolomide.
A woman only has a fixed number of eggs and when they are destroyed, they cannot be recreated. Not all women will become infertile because of these chemotherapy drugs, but the risks are high. Other chemotherapy drugs carry a risk of causing infertility, but it is much lower. Chemotherapy-caused fertility is more likely in women treated over the age of 35. For younger women who are not infertile after chemotherapy, fertility may not last as long as normal.
Surgery and Fertility
Surgical treatment for mesothelioma is usually only likely to put fertility at risk if it is done near the reproductive organs. Certain types of cancer, such as uterine or ovarian cancer, may require the removal of these organs, which leads to infertility. Any surgery in the abdomen has the potential to cause damage to reproductive organs. This could include surgery to remove abdominal tumors in women with peritoneal mesothelioma.
Radiation and Fertility
Radiation may also be a concern when it comes to fertility. This type of treatment involves aiming a beam of high energy radiation at tumors to kill cancer cells. While targeted, this radiation can also hit other organs and cause damage. For fertility this is especially a concern when the targeted tumors are in the abdomen, near the reproductive organs. Radiation for peritoneal tumors may cause damage to organs, and that could limit fertility. Radiation used on metastatic brain tumors can also affect fertility if there is damage to the pituitary gland, the gland responsible for producing some of the hormones involved in conception.
The type of mesothelioma most likely to affect fertility in women is peritoneal, the type of the cancer that affects the lining of the abdominal organs. Because women of child-bearing years may be diagnosed with peritoneal mesothelioma, and the cancer is in the same part of the body as reproductive organs, fertility is a significant concern. In one study, researchers found it was possible to preserve fertility in young women undergoing surgery and heated intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma.
Surgery was used to remove as much of the tumors as possible, while HIPEC was used as a strategy to inject heated chemotherapy drugs directly into the abdominal cavity. Seven out of seven women studied were able to conceive and give birth within two years of these treatments, a hopeful outcome for other women diagnosed with peritoneal mesothelioma.
Speak up about Fertility, Before Treatment
According to research, women are less likely to be informed about infertility when being treated for cancer than men are. This means that women must speak up and ask for and demand the information about how the cancer and its treatments may affect fertility. They also ask questions about what can be done to preserve fertility before going ahead with treatments. Young women living with mesothelioma are not common, but they do exist and they may want to have children if they can beat their cancer. If this sounds like you, speak up and ask. Don’t wait for the information that may never come until it’s too late.
There are steps that can be taken to make sure a woman will be able to have a child after undergoing treatment for mesothelioma and other types of cancer. The most common way to do this is to harvest mature, viable eggs from the ovaries before a woman undergoes cancer treatment. The eggs can then be frozen indefinitely and later fertilized with sperm. The resulting embryos can then be implanted into the woman’s uterus or in the uterus of a surrogate if carrying the child to term is not possible for the mother.
Fertility is an important health issue for most women. While the number of women of child-bearing age diagnosed with mesothelioma is low, there are young women facing this and other types of cancer that could prevent them from having children. From the tumors to the treatments, cancer impacts fertility in several ways. If you have been given a mesothelioma diagnosis and you want to have the option of having children, talk to your doctor and oncologist and find out what your risks are and what options you have for preserving fertility.
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