Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship

Abstract

Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility-related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their "top 3" life goals. Only 40% reported fertility-related discussions with their health care providers in survivorship. Given the importance of biological children among this cohort, future guidelines should encourage a more proactive approach to providing fertility counseling and offering testing, to mitigate distress and prevent unplanned pregnancies.

Examining predictors and outcomes of fertility consults among children, adolescents, and young adults with cancer

“…Despite known benefits of an oncofertility program, FP rates remain low—a recent study examining fertility attitudes and parenthood goals among survivors at our institution showed that only 31% of pubertal males had banked sperm prior to therapy . Studies suggest not all at‐risk patients receive a fertility consult, but predictors of consult utilization remain unclear in pediatric oncology .…”

Challenges in fertility preservation among male adolescent and young adult cancer survivors

“…Nahata et al. suggest the influence of a developmental perspective on adolescent decision making . A systematic review of FP perspectives among patients, parents, and providers supports this hypothesis .…”

“…Notably, the mean age of survivors in this cohort was 35 years old. In Nahata et al.’s cohort, it is likely that the survivors’ relatively young age (mean = 19.5 years ± 2.6 years) strongly influenced the low priority with which they ranked fatherhood as a goal. Literature on parenting desires among childless adults in the general population has found that age and relationship formation are significant factors in the timing of childbearing goal‐adjustment .…”

“…In this edition of Pediatric Blood and Cancer , Nahata et al. present data on parenthood goals and discussion of FP in survivorship from a survey of male adolescent AYA cancer survivors at a Midwest academic pediatric center . In their cohort of 45 survivors, only 14 had cryopreserved sperm prior to treatment.…”

“…Nahata et al. did not investigate the rate of pretreatment FP counseling among their patients, but many AYA cancer survivors report that FP was never provided as an option prior to treatment . Despite guidelines recommending FP counseling prior to cancer treatment whenever possible, referrals for FP are inconsistently made and most patients are neither seen by a reproductive specialist nor undergo sperm cryopreservation.…”