Sperm banking in testicular cancer survivors
Low utilization, high costs, and patient-reported barriers from a Canadian cohort
DOI:
https://doi.org/10.5489/cuaj.9504Keywords:
Sperm cryopreservation, Sperm banking, Testicular cancer, OncofertilityAbstract
Introduction: Testicular cancer (TC) affects young men in their reproductive years. Although sperm cryopreservation is recommended before treatment, real-world utilization and patient experiences in Canada remain poorly described.
Methods: We conducted a retrospective chart review with a prospective telephone survey of men with TC who underwent sperm cryopreservation (2007–2019) at Manitoba’s sole fertility preservation centre. Demographic, treatment, and semen parameters were abstracted from medical records. A structured questionnaire assessed counseling, decision-making, costs, banked sperm utilization, and fertility outcomes.
Results: Of 42 eligible men, 24 (57%) completed the survey. The mean age at banking was 25.6 years. Most (71%) received chemotherapy in addition to orchiectomy; 29% underwent orchiectomy alone. Only two men (8%) banked sperm before orchiectomy; the remainder did so prior to systemic therapy. Abnormal semen parameters were common (79%), with a median sperm concentration (13.0 million/mL, interquartile range [IQR] 3.0–21.5) and total sperm count (14.8 million, IQR 8.6–84.9) below WHO 2021 limits. Counseling occurred for 88% of men, though half felt rushed in their decision-making. The mean cost was approximately $2000 over three years, and 58% found this burdensome. Only three men (13%) used their cryopreserved sperm, all after chemotherapy, each resulting in a live birth through assisted reproductive technology (ART). Eleven men (46%) conceived naturally after treatment, eight (33%) had not yet attempted conception.
Conclusions: In this Canadian cohort, sperm banking utilization was low, and most survivors achieved natural conception. Financial burden and decisional stress were frequent. Enhanced counseling and public funding for fertility preservation may improve equitable access and survivorship care.
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