Provider Influences on Sperm Banking Outcomes Among Adolescent Males Newly Diagnosed With Cancer

Abstract

Purpose To examine provider communication and sociodemographic factors which associate with sperm banking outcomes in at-risk adolescents newly diagnosed with cancer. Methods A prospective single group quasi-experimental study design was utilized to test the contributions of provider factors on sperm banking outcomes. Medical providers (N=52, 86.5% oncologists) and 99 of their at-risk adolescent patients from eight leading pediatric oncology centers in North America completed questionnaires querying provider factors and patient sperm banking outcomes. Logistic regression with single covariates was utilized to test each provider factor as a potential correlate of the two binary sperm banking study outcomes (collection attempt/no attempt and successful sperm bank/no bank). Multi-covariate logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for specified banking outcomes. Results Fertility referral (OR=9.01, 95% CI=2.54–31.90, p<.001) and provider comfort/skills in negotiating barriers to sperm banking with families (OR=1.94, 95% CI=1.03–3.63, p<0.04) were associated with collection attempts. Adolescents who were referred for a specialized fertility consultation were also almost 5 times more likely to successfully bank (OR=4.96, 95% CI=1.54–16.00, p<.01) relative to those who were not. Conclusions Provider training in communicating/managing adolescents and their families about sperm banking, and increasing utilization of fertility preservation referrals, should increase the proportion of at-risk males preserving fertility prior to treatment initiation. Title Registration Clinicaltrials.gov NCT01152268

Desire for parenthood and reproductive health knowledge in adolescents and young adults with sickle cell disease and their caregivers

“…Studies among other pediatric disease survivors where reproductive health may be impacted show high levels of fertility‐related distress, regret among both AYA and their parents about missed opportunities for fertility preservation, and unplanned pregnancies due to inadequate counseling and misconceptions about fertility status . Counseling about fertility and referrals to fertility specialists increase utilization of fertility preservation and improve patient satisfaction . At this point, fertility preservation methods for postpubertal patients (sperm, oocyte, and embryo cryopreservation) are established, and Institutional Review Board protocols for experimental options for prepubertal youth (testicular and ovarian tissue cryopreservation) are increasingly available at pediatric centers.…”

“…In light of these data, the American Society of Clinical Oncology and the American Society for Reproductive Medicine published guidelines urging providers to have discussions at diagnosis about potential infertility risks and fertility preservation options (including sperm, oocyte, and tissue preservation) with these youth and their parents . Studies show that timely fertility counseling and referrals to fertility specialists improve patient satisfaction in youth with cancer . Based on this evidence, reproductive health counseling is recommended in other at‐risk pediatric populations, including AYA with SCD .…”

Fertility counseling and preservation: considerations for the pediatric endocrinologist

“…Studies show that timely fertility counseling results in higher rates of fertility preservation and improved satisfaction among patients and families (82,83). Further, adolescents and young adults state that they want health care providers to address these issues and help them navigate how to discuss their fertility status with friends and romantic partners (84).…”

“…In the past 5-10 years, however, it is becoming increasingly apparent that there are several groups of patients in which fertility counseling would be beneficial, including patients with differences of sex development, congenital causes of primary gonadal failure, gender dysphoria, and others. Fertility counseling and provider comfort in discussing topics such as sperm cryopreservation have been shown to impact fertility preservation rates among adolescents (3). Unfortunately, fertility related practices in pediatrics remain inconsistent at this time due to a variety of factors, such as time constraints, inadequate access to fertility specialists, and insufficient knowledge of infertility risk and fertility preservation options.…”

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

“…One commonly reported late effect is impaired fertility, especially among survivors treated with alkylating agents and pelvic/cranial radiation . Therefore, fertility preservation prior to treatment initiation has been emphasized, but it remains underutilized in the pediatric setting . This underutilization may be due to the attitudes, knowledge, and beliefs of families and providers, as well as time, institutional, and/or financial constraints .…”