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Stacey-help please: reposted from previous thread on Male fertility and TKI therapy.

Submitted by stacbrown14 on Wed, 18/02/2015 - 21:51.
Hello my name is Stacey my husband has been on dasatinib for cml for 14 months he is 34 and I am 27 we were trying to get pregnant when he was diagnosed, we are in the US and no one here thinks its a good idea to try. I was so happy when I found this site can anyone get me in touch with someone that could help thank you.
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Hi Stacey and welcome,
There has been a lot of discussion about the issue of male fertility and fathering children whilst on TKI therapy... see here for the full conversation thread from last year:
http://www.cmlsupport.org.uk/node/8477

Owing to the interest in this subject, I have asked my own doctor (expert CML with an interest in TKi and pregnancy) and she has advised that males taking TKIs are not at any greater risk of causing foetal abnormality than the normal population. (It is different for women as the risk to the foetus in the first trimester if taking TKI therapy is there.)

You might find the following link is from the EBMT Learning Programme for CML of some help....
Click the link for Module 3: Managing TKI treatments and special CML populations- which is a good (up to date) slide presentation regarding issues with CML and its therapy:
https://www.ebmt.org/Contents/Resources/Library/Resourcesfornurses/Docum...

This PPT presentation includes a section regarding pregnancy and fertility issues for both women and men, diagnosed with CML within child bearing age group (approx 10%) treated with TKIs. See start of the relevant section at:
slide 85: Fertility and Pregnancy
and
Slide 86
*CML gives rise to special issues during pregnancy since the condition requires lifelong therapy
*The situation differs for male and female patients'

For the current advice for Males fathering children when treated with TKIs scroll down to slides 99 - 101

Slide 101
Male - conclusions fertility and pregnancy studies:
*Due to possible adverse effects on male fertility sperm banking should be discussed at diagnosis as an option
*Studies show no suggestion of any problems in pregnancy, delivery or any increase in congenital abnormalities when the father is being treated for CML
*For male patients fathering children can be achieved without interruption of treatment

I hope this is of some help to you and you are able to convince your husbands doctor to at least consider doing some more research- or talking with other CML specialists. Let me know if you would like to get a second expert opinion on this and I will put you in contact with someone in the US who could advise you.

Best wishes,
Sandy

For all the EBMT modules on CML see this link:
https://www.ebmt.org/Contents/Resources/Library/Resourcesfornurses/Pages...

Hi Stacey,

The link between dasatinib and pregnancy isn't that well understood. At the CML Patient conference here in the UK a couple of years ago, we had a seminar on fertility whilst on TKIs - lead by Prof Jane Apperley (I'm afraid there were not slides or notes from that seminar to share). Jane's thoughts are that there are much more concerns over dasatinib (and other TKIs) with regard to fertility when it's the woman taking the TKI - and much less (though not none) concern when it's the male.

The 'safest' method that was discussed was for a man to discontinue TKI therapy whilst trying with their other half to get pregnant. The TKIs 'wash out' of your system quite quickly (2 or 3 weeks, I believe). So the hope is that you do that, get pregnant quickly and then go back on the TKI. Obviously for a woman, this is much more complicated since there's 9 months of pregnancy to worry about - which is why it's easier for the guys.

When I was diagnosed, pretty much the first thing we did was get sent to the sperm bank - so if you were given that chance, then I suppose that might be the best route.

Jane did mention back then that she was aware of several babies born to people on various TKIs who did not discontinue therapy - all doing well.

If it were me, and I had no sperm banked, I think I would discontinue dasatinib whilst trying for a baby with my wife, and just hope that it didn't take too long. If it did take too long, then perhaps I'd then consider something else but for me there's not too much harm that can be done by taking a TKI break and going for it (hoping for the best) so long as the disease is well monitored during the break period.

David.

I was diagnosed 11/01/2013. My wife and I had a 6 month old son at the time. After looking into the treatment, we noticed the warnings for preganency for males taking sprycel. We wanted more children, but we still opted not to store sperm at a bank. It was expensive, and I personally felt weird about it. My doctor respected our decision and felt some of the warning with the medication was more to protect the drug companies since there hasn't been a lot of research on preganency and the drugs.

We became pregnant again in September 2014. We are expecting a baby girl in June. All ultrasounds have been good so far. My wife has had a healthy pregnancy so far. I took no break in the medication during conception. However, I was at a lower dose than some other patients. I was and still am at 50mg.

I will keep you posted.

God Bless!