Sperm banking is not being offered to many young men who are about to undergo a cancer treatment that could render them infertile, experts say.
Sperm banking is fast and relatively inexpensive. But misconceptions that it could delay treatment or that it comes with an exorbitant price tag seem to keep healthcare providers from referring patients, according to a new review.
"Once a man has no sperm, all the money in the world can't replace that. It's an invaluable insurance policy," Robert Brannigan MD, professor of urology at Northwestern Memorial Hospital in Chicago, told Medscape Medical News.
Most young men who develop cancer have a good chance of survival. For male patients aged 15 to 39 who are diagnosed with cancer, the survival rate is 80%, and for patients with certain cancers, it is even higher, up to 95% at 5 years.
Aside from survival, fertility is the number one concern for patients battling cancer, said Laurie McKenzie, MD, reproductive endocrinologist at Baylor College of Medicine and the University of Texas MD Anderson Cancer Center, in Houston, Texas.
However, because of the cancer treatments they receive, about one fourth of survivors become infertile.
Fewer than half (43%) of eligible cancer patients report being counseled on fertility preservation options, according to a 2020 survey. In addition, semen cryopreservation was offered only to 25% of adolescent cancer patients.
Despite the relative ease of and access to sperm banking, it "has been strikingly underutilized" across all cancer patient age groups, McKenzie and colleagues write in a recent review published in the Journal of Clinical Oncology.
The authors call for a more comprehensive effort in cancer care to preserve male fertility, saying misconceptions about sperm banking are a major limiting factor.
Time and lack of awareness are the two factors that most often get in the way of preserving sperm, McKenzie said. A cancer diagnosis is life-altering, and patients and doctors alike are rightly focused on starting treatment. But in the urgency, fertility preservation tends to fall by the wayside.
Patients and doctors "don't realize how fast it is to bank — we literally do it on the same day," said Larry Lipshultz, MD, a urologist at Baylor Medicine and co-author of the review.
"There's also a lack of awareness that it is not expensive," Lipshultz said.
Some types of fertility preservation are expensive and invasive. Cryopreservation of eggs, for instance, requires a surgical procedure and costs between $8000 and $12,000, depending on the medications. That's time and money that many women newly diagnosed with cancer simply don't have.
But "semen freezing doesn't have any of these barriers," said Kyle Orwig, PhD, director of the Fertility Preservation Program and the Center for Reproductive Transplantation at the University of Pittsburgh Medical Center. "The time is short, the cost is lower, but that's the group we fail to serve so much."
Sperm banking with 1 year of cryostorage costs between $350 and $650, according to the review. Eleven states mandate insurance coverage for cancer patients' fertility preservation. In states in which coverage is not mandated, financial aid organizations may help offset the costs.
McKenzie said that at MD Anderson Cancer Center, reproductive specialists have a commitment to see interested patients for a consult within 72 hours, though they see most within 48 hours. Sperm banking can be performed on the same day, she said.
But other experts say that more often, they see patients after treatment is underway. "It frequently happens that [a patient] comes in and says he started chemo yesterday but wants to save a semen sample," Orwig said.
Doctors don't know what effect one round of chemotherapy, or even 1 week of treatment, has on sperm. Most clinics would still preserve a patient's sperm under these circumstances, although currently there are no data on this.
The best safeguard for a young cancer patient's reproductive future is to bank sperm before initiating treatment, the review authors recommend. This is especially true, given that cancer treatments are evolving and that the pace of cancer research and the introduction of new types of treatment far outpace fertility research.
In addition, some newer cancer treatments, such as tyrosine kinase inhibitors, may be administered over years. While experts don't know what that means for sperm, it's critical that patients are counseled on the risks and that they feel they can bank sperm if they want to, McKenzie said.
Similarly, it's unclear what options the youngest male patients with cancer have. For boys who have not yet reached puberty and for young adolescents, there is an increasing effort to cryopreserve testicular tissue. The hope is that by the time these patients are ready to start families of their own, the science will have progressed to the point where this tissue can be matured to produce sperm.
Orwig's research group is currently working on bringing two such methods, which have already been tested in primates, to the clinic. He also heads a program that couriers testicular tissue from young cancer patients across the country to Pittsburgh, where it's cryopreserved in their fertility lab.
Fertility preservation for cancer patients is critical, but admittedly it is not always easy, all the experts agree. Navigating the appointments and costs of fertility preservation for cancer patients is time intensive. In terms of coordinating fertility and cancer care, it's also "very difficult to ask someone with a full-time job, like a surgeon or the cancer care team, to take that on," Orwig said.
This is why it's essential to bring in patient navigators, "the individuals who help us to deliver fertility preservation care in the midst of oncologic care," Brannigan said. This is especially true with pediatric and adolescent cancer patients who typically receive cancer treatment at facilities in which there are no reproductive specialists, he said.
In addition to having staff dedicated to fertility preservation, some cancer centers are doing more to prioritize it within their system.
At MD Anderson, where McKenzie and Lipshultz practice, the electronic medical record reminds oncologists to refer reproductive-age patients to a fertility specialist. At Pittsburgh, where Orwig works, oncologists know they only have to call a number to connect a patient to fertility support. The aim is to make it as easy as possible for patients and doctors to reach the staff that can act on fertility preservation.
This is important for patients, because "if they didn't preserve [their fertility], this is one more thing cancer took from them," Orwig said.
J Clin Oncol. Published online June 20, 2022. Full text
Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, gene editing, and anything that affects the way we eat. She has a master's degree from NYU's Arthur L. Carter Journalism Institute and a master's in molecular nutrition from Aarhus University in Denmark.
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Cite this: Sperm Banking Before Cancer Therapy 'Strikingly Underutilized' - Medscape - Sep 20, 2022.