Improved fertility preservation care for male patients with cancer after establishment of formalized oncofertility program

Authors Sheth KR, Sharma V, Helfand BT, et al.

Review Date April 2012

Citation Journal of Urology 2012;187:979-986

Background

Survival to reproductive age among men with cancer has steadily increased and future fatherhood is a concern of many males diagnosed with cancer. However, there are many barriers to males receiving adequate information, counselling or access to fertility preservation.

Aim

Since 2006, a formalised fertility preservation program with expedited fertility care has been used in a single US institution. The aim of this study was to assess the impact of this program by comparing the frequency of sperm cryopreservation and patient characteristics before and after its implementation.

Methods

Men 18 to 55 years old diagnosed with cancer at the institution between 2002 and 2010 were included in the study. Patient charts were reviewed retrospectively to identify those who were offered and subsequently used fertility preservation services before and after the program’s implementation.

Results

A total of 4,818 men aged 18 to 55 years were diagnosed with cancer during the time period, of whom 411 were offered a fertility preservation consultation, 266 wanted to bank sperm, and 249 undertook sperm cryopreservation (attempts were unsuccessful in 17).

Since the program’s implementation, the annual number of men receiving a fertility preservation consultation and undergoing sperm cryopreservation increased by 2.4 and 2.7-fold, respectively, while the total number diagnosed with cancer remained fairly constant. Upon sub-stratifying patients into the more conventional reproductive age range of 18 to 40 years 23.4% of all men with cancer in this group were offered consultation before program formalisation vs 43.3% after program formalisation (p<0.05). The overall sperm use and discard rates were 8.4% and 14.8%, respectively.

Conclusion

A formalised institutional fertility preservation program significantly increased the overall number and percent of male patients with cancer who received fertility preservation consultation and pursued sperm cryopreservation. These increases were seen in men with all types of cancer and across all demographic characteristics.

Points to Note

1. Despite recommendations that fertility preservation should be discussed with potentially interested patients shortly after cancer diagnosis, there are many barriers to this occurring.
2. The results of this study suggest that programs to increase access to information, counselling and facilities for fertility preservation for male patients have the potential to overcome some barriers. However, more work is needed to measure the success of such programs with respect to pregnancy rates and outcomes.
3. The consultation rates among the older age group were very low. This may be due to perceptions of the medical team that men over 40 do not need fertility preservation despite the fact that some in this age group may still have interest in fatherhood. 
4. The study findings are limited by the before/after study design with no control group. It appears that the rates of fertility preservation consultations were increasing even before the program was formalised, which could be related to increasing awareness of fertility preservation issues and clinical guideline recommendations.
5. Other limitations include the retrospective medical record review data collection method.

Website: www.ncbi.nlm.nih.gov/pubmed/22264454