A team from Children’s Healthcare of Atlanta reports unexpected factors determining which adolescents participated in sperm banking.
Among teen males with cancer, successful sperm collection and banking in the face of possible future infertility was associated with adolescent developmental and psychological factors; perception of parent and provider recommendations; and consultation with a fertility specialist, a team of pediatric oncologists reports.
“Although fertility preservation is optional, accurate, digestible, and timely communications regarding fertility risk and counseling are not,” James L. Klosky, PhD, of the Aflac Center and Blood Disorders Center at Children’s Healthcare of Atlanta, and colleagues, wrote in Cancer. “By providing and participating in these discussions, health care providers will not only be adhering to the recommended guidelines, but also will provide patients with an opportunity to maintain their option of biological fatherhood.”
Sperm banking in adolescents with cancer at risk for infertility remains underused. Klocky and colleagues recently conducted a study to examine patient factors that influence decisions to bank sperm.
They conducted a cross-sectional study of 146 adolescent males aged 13 to 21 who were newly diagnosed with cancer and were at risk of infertility secondary to impending gonadotoxic treatment. Participants completed a survey within 1 week of diagnosis. The survey was given to patients at eight pediatric oncology centers in the United States, and there was an 80% participation rate.
Of the participants, 53.4% made a collection attempt; of those who attempted, 82.1% banked sperm. This translated into only 43.8% of participants successfully banking sperm. The researchers did note that they relied on self-report of sperm banking rather than medical record verification.
The greatest factor associated with adolescent collection attempts was parent recommendation to bank (odds ratio [OR], 4.88; 95% CI, 1.15–20.71; P = .03). The patient’s Tanner stage was also highly influential (OR, 4.25; 95% CI, 1.60–11.27; P < .01).
“Whereas previous research and clinical lore has suggested that age is the most important determinant influencing fertility preservation outcomes, the current study data have suggested that Tanner stage may be more influential,” the researchers wrote. “Thus, Tanner stage, an indicator of physical maturity, may be a more accurate indicator of readiness and/or spermatogenesis for providers as opposed to exclusively working from an age criterion.”
Other factors influencing collection attempts were greater perceived benefits (OR, 1.41) and lower social barriers to banking (OR, 0.88).
Successful sperm banking was associated with meeting with a fertility specialist (OR, 3.44), parent or provider recommendation (OR, 3.02 and OR, 2.67, respectively), and greater adolescent self-efficacy to bank (OR, 1.16). Participants who reported greater barriers to banking in their social environments were significantly less likely to bank (OR, 0.88; P = .005).
“Within the context of these findings, recommendations for future interventions to promote sperm banking outcomes could focus on training medical teams who can assist adolescents and their parents in navigating these factors and encourage optimal decision making for each adolescent,” the researchers wrote.