Utilization of sperm cryopreservation in patients with testicular cancer

Abstract

Purpose Since 2021, the German health insurance covers sperm cryopreservation, impacting pre-chemotherapy decisions. We assessed sperm cryopreservation utilization before 2021, when patients covered expenses.Methods Between 2011 and 2021, testicular cancer survivors (TCS) at our clinic completed a questionnaire, including EORTC QLQ-TC26, covering sperm cryopreservation, sociodemographic details, post-treatment births, and artificial insemination.Results After 5.7 ± 3.0 years, 279 participants (64%) responded to the questionnaire. Among them, 33% (91/279) testicular cancer survivors (TCS) chose sperm cryopreservation prior treatment, with 11% (10/91) using it for insemination. Conversely, 2% (3/188) without cryopreservation reported unfulfilled desire to have children. Univariate analysis showed TCS with cryopreservation were younger (30.6 ± 7.1 (35 (21–59)) vs. 42.4 ± 10.9 (48 (22–81)) years; p = 0.001), had a lower BMI (24.2 ± 3.3 vs. 26.6 ± 4.6 kg/m²; p = 0.009) and a lower Charlson Score (> 3: 36% vs. 60%; p < 0.001). Multivariate analysis revealed older age (≥ 37 years: OR 13.1 (5.5–31.2), p < 0.001) and lower education (middle school or less: OR 3.3 (1.6–6.9), p = 0.001) as independent factors associated with not undergoing cryopreservation. Regarding quality of life (EORTC QLQ-TC26), multivariate analysis identified a lower infertility anxiety score (OR 4.3 (2.0–9.0), p < 0.001) and higher age (≥ 44 years: OR 5.4 (2.6–11.3); p < 0.001) were predictors for absence of prior cryopreservation.Conclusions Age and education seem to impact the choice of undergoing paid sperm cryopreservation. Urologists should inform testicular cancer patients about costs and coverage. Importantly, the occurrence of unmet desires for parenthood is minimal among those who forego cryopreservation.