We have a male patient undergoing treatment who got his female partner pregnant. He and his partner were referred the couple to high risk OB/Gyn. I was concerned over the chemotherapy affecting the quality of the sperm and placing the fetus at rick of birth defects. I know this is the case with drugs like Revlimid and Thalomid. But what about other chemo drugs affecting the quality of sperm? I thought my group should be more informed on this topic and be able to advise them more. Thanks in advance for your input.
This is a great question, and your concerns are appropriate. Aside from the risk of impaired spermatogenesis after treatment is completed, there are 2 other reproductive health concerns in males undergoing chemotherapy:
First, is the risk of genotoxicity or mutagenicity. Because of this, there may be genetic mutations in sperm that are exposed to chemotherapy during their maturation. If the patient impregnates someone with these sperm there could be potential health effects on the child if they choose to keep the pregnancy, as you allude to in your question. Of course the child may be fine, but we have no way of knowing for certain. This is why we advise that sperm banking be completed before treatment begins (before exposure to chemotherapy) and that men should use contraception during treatment, and for at least 6-12 months after completing treatment (to clear the body of any damaged sperm). Referring your patient and his wife to a maternal fetal specialist was the right thing to do, but ultimately this is a personal decision they have to make. My experience has been that if the couple is relatively young, they often decide to terminate.
The second concern is embryo-fetal toxicity. Some drugs (like Revlimid, Thalidomide, and chemotherapy) can cause genetic damage to a growing embryo or fetus. That is why we instruct women to avoid pregnancy on treatment. In regard to male patients, we know that chemotherapy can be eliminated in the semen of men on treatment, and if they are engaging in vaginal intercourse, there is a risk that drug could be absorbed through the vaginal membranes into the woman’s blood stream, and ultimately into the fetus’ blood stream. To protect the fetus, we always recommend that men use condoms throughout treatment if their female partner is pregnant, or if there is any chance at all she could become pregnant (including an unplanned pregnancy).
I hope this is helpful, but let me know if any of this is not clear…