Prevalence and Predictors of Sperm Banking in Adolescents Newly Diagnosed With Cancer: Examination of Adolescent, Parent, and Provider Factors Influencing Fertility Preservation Outcomes

Abstract

Purpose To estimate the prevalence of sperm banking among adolescent males newly diagnosed with cancer and to identify factors associated with banking outcomes. Patients and Methods A prospective, single-group, observational study design was used to test the contribution of sociodemographic, medical, psychological/health belief, communication, and developmental factors to fertility preservation outcomes. At-risk adolescent males (N = 146; age 13.00 to 21.99 years; Tanner stage ≥ 3), their parents, and medical providers from eight leading pediatric oncology centers across the United States and Canada completed self-report questionnaires within 1 week of treatment initiation. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs for specified banking outcomes (collection attempt v no attempt and successful completion of banking v no banking). Results Among adolescents (mean age, 16.49 years; standard deviation, 2.02 years), 53.4% (78 of 146) made a collection attempt, with 43.8% (64 of 146) successfully banking sperm (82.1% of attempters). The overall attempt model revealed adolescent consultation with a fertility specialist (OR, 29.96; 95% CI, 2.48 to 361.41; P = .007), parent recommendation to bank (OR, 12.30; 95% CI, 2.01 to 75.94; P = .007), and higher Tanner stage (OR, 5.42; 95% CI, 1.75 to 16.78; P = .003) were associated with an increased likelihood of a collection attempt. Adolescent history of masturbation (OR, 5.99; 95% CI, 1.25 to 28.50; P = .025), banking self-efficacy (OR, 1.23; 95% CI, 1.05 to 1.45; P = .012), and parent (OR, 4.62; 95% CI, 1.46 to 14.73; P = .010) or medical team (OR, 4.26; 95% CI, 1.45 to 12.43; P = .008) recommendation to bank were associated with increased likelihood of sperm banking completion. Conclusion Although findings suggest that banking is underutilized, modifiable adolescent, parent, and provider factors associated with banking outcomes were identified and should be targeted in future intervention efforts.

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…Parent or medical team recommendation was associated with increased likelihood of sperm banking completion. 110 Psychosocial providers can assist patients and families in the decision-making process about fertility preservation, particularly when AYA patients are distressed about the potential infertility associated with cancer treatment. 106 The Oncofertility Consortium, a group of clinicians and researchers in the United States, was formed in 2007 to address reproductive barriers facing AYA patients and to identify research priorities in this area.…”

Accurate understanding of infertility risk among families of adolescent males newly diagnosed with cancer

“…It was indicated that, irrespective of whether adolescents (or parents) underreported, overreported, or accurately reported risk, they were equally likely to attempt sperm banking [Fisher exact test = 0.185/ χ 2 = 3.322, P = .190 (adolescents); Fisher exact test = 0.555/ χ 2 = 1.370, P = .504 (parents)]; note that although Fisher exact test accounts for small cell frequencies, the smallest cell included only n = 3). For more details regarding sperm banking outcomes, please see a previously published manuscript …”

“…All procedures followed the ethical standards of the US Federal Policy for the Protection of Human Subjects and were approved by the Institutional Review Boards at all sites (SJCRH#Pro00001628). Data presented here are part of a larger study about sperm cryopreservation among adolescent cancer patients …”

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

“…Up to 60% of male childhood cancer survivors experience fertility impairment, and while sperm banking is generally noninvasive, only ∼25% of eligible males bank sperm before treatment . Despite efforts to address common barriers to FP (for example, inadequate knowledge, urgency to begin treatment, and costs), rates remain low, suggesting that other factors likely affect FP decisions . Specifically, adolescents may struggle with anticipating future parenthood goals and making such decisions .…”

“…Specifically, adolescents may struggle with anticipating future parenthood goals and making such decisions . Further, masturbating to collect a semen sample may be challenging for those with little sexual experience and/or physical and psychological discomfort due to cancer …”