Mesothelioma and Fertility in Men
Mesothelioma is a terrible type of cancer to live with for many reasons. It causes uncomfortable symptoms and most patients will undergo treatments that cause side effects. Additionally, people with this kind of cancer are likely facing a shortened life expectancy and the stress and fear of living with that poor prognosis.
Most of the people diagnosed with mesothelioma are men and for those diagnosed at a younger age, fertility may be a major concern. Cancer and its treatments can reduce fertility in men and make having children later difficult or impossible. There is hope, though, and steps that medical caregivers can take to help limit damage and to allow men to preserve some fertility for the future.
What is Infertility?
Fertility is the ability to conceive a child. In men, it is associated with the ability of the testicles to produce viable sperm cells. Specific cells within the testicles are responsible for producing sperm, but this can’t happen without certain hormones that are produced by the pituitary gland in the brain. A man may be infertile if his testicles do not produce sperm or produce sperm cells that don’t function properly or if certain pathways for the release of sperm are blocked. Damage or problems in the pituitary gland or in the testicles can cause infertility.
How Having Cancer Can Affect Fertility
For most men living with cancer, the disease itself may not impact fertility. The exceptions to this include cancers that directly affect the testicles or the pituitary gland—the gland that produces hormones affecting fertility and sperm production. For example, testicular cancer can directly impact fertility and reduce sperm production in men.
More often, living with a cancer like mesothelioma, fertility is not affected by the tumors; it is affected by the treatments used to kill cancer cells, remove tumors, and shrink tumors. Chemotherapy, radiation therapy, and surgery all have the potential to reduce fertility by damaging the organs that produce sperm or by killing sperm cells. This infertility may be partial or total, and temporary or permanent.
Chemotherapy and Fertility
Chemotherapy is a common treatment for mesothelioma, but it is also the treatment most likely to negatively impact fertility. Drugs used in chemotherapy are not specific to tumor cells; they target and kill any fast-growing cells in the body, including sperm cells. Sperm cells grow and divide rapidly, and so they are often targeted and may be destroyed by chemotherapy drugs.
The extent of the damage caused by chemotherapy varies and depends on several factors. Some men may lose some fertility, but still have some sperm-producing cells left after treatment. Others may have all their sperm-producing cells destroyed, rendering them completely and permanently infertile.
Men over 40 are less likely to recover any of these cells, but the type of chemotherapy drug used and the dose also have an impact. Certain drugs are more likely than others to cause infertility, while higher doses of any of the drugs will cause more damage. Chemotherapy drugs with the highest risk of infertility include actinomycin D, busulfan, carboplatin, chlorambucil, carmustine, cisplatin, Cytoxan, cytarabine, lomustine, ifosfamide, melphalan, mechlorethamine, and procarbazine.
Radiation Therapy and Fertility
Radiation is also often used to treat mesothelioma. A beam of high-energy radiation aimed at tumors can shrink them. This is often done either before surgery to make a tumor smaller and easier to remove or after surgery to reduce the possibility that a tumor will recur in the same spot. Radiation kills cells, which is why it is aimed directly at a tumor. If the radiation is being given in the vicinity of the testicles, or in the brain near the pituitary gland, it can cause damage that reduces fertility. This may occur in mesothelioma if radiation is being used to shrink metastatic tumors.
Mesothelioma is a rare type of cancer and the rarest of all types affects the testicles. It is officially known as mesothelioma of the tunica vaginalis testis. Only 100 or so cases have ever been reported and some of these were in young men, as young as 20. The tunica vaginalis is the thin layer of mesothelium that surrounds the testes.
The prognosis for this type of mesothelioma is typically better than for other types because treatment is as simple as surgically removing the tumor. There are potential risks, though, and any time surgery is done in or around the testes, damage that may lead to infertility is possible. In some of the few reported cases of this type of mesothelioma, patients had an entire testicle removed, which greatly impacts fertility.
It is important that you speak to your medical team about fertility if you think you may want to have children. Your doctors can give you options for protecting your fertility during treatment, for taking steps to reduce the chances of becoming infertile, or for banking sperm to be used in the future for conception. Your doctors may not realize that fertility is a concern for you, so don’t be afraid to speak up about it and ask questions before you undergo any mesothelioma treatments.
Sperm banking is one of the most successful ways to ensure the ability to conceive a child after treatment for cancer. This is the preserving of sperm by freezing it so that it can be used later for in vitro fertilization. Even frozen samples with low numbers of sperm can be used successfully to conceive. Frozen samples remain viable for decades.
Although many of the men diagnosed with mesothelioma are 50 years old or older, there are plenty of men diagnosed who are still hoping to start families. Men are able to produce viable sperm and conceive much later in life than women and may want to retain that option after a diagnosis of cancer. If you are a man living with a mesothelioma diagnosis, know what your options are and if you are thinking of starting or growing your family, know that cancer does not have to stop you from doing so. Talk to your partner and talk to your medical team to find out what your risks of becoming infertile are and what you can do about it.
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