Mesothelioma and Fertility in Men

Mesothelioma is a rare and devastating cancer. Not only does the disease cause uncomfortable symptoms, but treatments also cause unpleasant side effects. Those suffering with this aggressive cancer rarely live long and must face the stress and fear of that poor prognosis.

Most people diagnosed with mesothelioma are men. Those men diagnosed at younger ages may worry about fertility. Cancer and its treatments can reduce male fertility and make having children difficult or impossible. However, medical caregivers can take steps to limit damage and allow men hope for the future.

What is Infertility?

Fertility is the ability to produce offspring. For men to produce children, the testicles must produce viable sperm cells. Specific cells within the testicles make sperm, but this can’t happen without certain hormones produced by the pituitary gland in the brain. A man may be infertile if his testicles do not produce sperm, or if they produce sperm that function improperly. Also, if the pathways that release sperm are partially or fully blocked, this can have a negative impact on a man’s fertility. Damage to the pituitary gland can also cause infertility.

How Having Cancer Can Affect Fertility

Cancer itself does not impact fertility in most men. Only cancers that directly affect the testicles or pituitary gland have specific impacts on fertility. For example,testicular cancer can obviously impact fertility and reduce sperm production.

Although mesothelioma does not directly impact fertility, the treatments used against this cancer do. Chemotherapy, radiation therapy, and surgery can all reduce fertility by damaging organs that produce sperm or by directly killing sperm cells. This infertility may be partial or total, and temporary or permanent.

Chemotherapy and Fertility

Chemotherapy is a common treatment for mesothelioma and is most likely to reduce fertility. Chemo drugs are not specific to tumor cells. Instead, they target any fast-growing cells in the body, including healthy sperm cells. Because sperm cells grow and divide rapidly, they are often destroyed by the drugs used in chemotherapy.

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 these cells. However, the type of chemotherapy drug used and the dose matters. Certain drugs are more likely to cause infertility than others. Also, higher doses of chemotherapy drugs will cause more damage. Chemotherapy drugs with the highest impact on fertility include actinomycin D, busulfan, carboplatin, chlorambucil, carmustine, cisplatin, Cytoxan, cytarabine, lomustine, ifosfamide, melphalan, mechlorethamine, and procarbazine.

Radiation Therapy and Fertility

Radiation is also used to treat mesothelioma. This therpay uses a concentrated high-energy beam to shrink tumors. Radiation is usually done either before surgery to reduce tumor size, making it easier to remove, or after surgery to reduce the possibility of recurrence. Radiation kills cells, which is why it is aimed directly at a tumor. If the radiation is administered in the vicinity of the testicles, or in the brain near the pituitary gland, it can cause damage that reduces fertility. This may occur during mesothelioma treatments if radiation is being used to shrink metastatic tumors.

Testicular Mesothelioma

Mesothelioma is a rare cancer and the rarest form of mesothelioma affects the testicles. This incredibly rare cancer is officially known as mesothelioma of the tunica vaginalis testis. Only 100 or so cases have ever been reported, some in 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. This is because treatment is a simple surgery to remove the tumor. There are potential risks, however, and when surgery is performed near the testes, there could be possible damage to the reproductive organs. In some of the few reported cases of this type of mesothelioma, patients had an entire testicle removed. This obviously had a huge impact on patient fertility.

Preserving Fertility

Talk to your medical team about fertility if you think you may want to have children. Your doctors can provide options for protecting fertility during treatment. He or she can also take steps to reduce the chances of infertility and may offer sperm banking for future conception. Your doctors may not realize fertility is a concern, so don’t be afraid to 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 cancer treatment. Sperm is stored frozen and can used later for in vitro fertilization. Even frozen samples with low sperm numbers can be used successfully to conceive, and frozen samples remain viable for decades.

Although many men diagnosed with mesothelioma are over 50, there are plenty of men diagnosed who hope to start families. Men are able to produce viable sperm and conceive much later in life than women, and even older men may want to retain that option after a cancer diagnosis. If you are a man with mesothelioma, know your options. If you are considering having children, know that cancer does not mean the end of your fertility. Talk to your medical team to find out the risks to your fertility and what you can do to preserve it.

Page Edited by Patient Advocate Dave Foster

Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available.

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