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Reviewed research
Authors Eiser C, Arden-Close E, Morris K, Pacey AA.
Review Date Sep 2011
Citation Human Reproduction 2011; Jul 21 [Epub ahead of print]
Background
For men newly diagnosed with cancer, thinking about the possible effects of treatment on later fertility, and whether they should store sperm, can add to an already distressing situation. Sperm banking is recommended for all men before cancer treatments that carry a risk of long-term gonadal damage. However, relatively few men take up the offer. Among those who do store their sperm, few attend for fertility monitoring or agree to sperm disposal when fertility recovers. Sperm banks are therefore burdened by long-term storage of samples that may not be needed for conception, with implications for healthcare resources.
Aim
The aims of this study were to determine the views of men regarding personal benefits of sperm banking, and the advantages and disadvantages of fertility monitoring and disposal in the longer term. The authors also looked at what was helpful to men in the sperm banking and monitoring process.
Methods
Semi-structured interviews were conducted with 19 men who were diagnosed with cancer and had banked sperm at least 5 years previously. Men were asked to recall their experiences from diagnosis to the present time, focusing on the consequences for their fertility. Interviews were transcribed and analysed using interpretative phenomenological analysis.
Results
Results are discussed in relation to decisions surrounding banking sperm, fertility monitoring and attitudes to disposal of banked sperm.
Complex attitudes were identified, with men’s views reflecting their understanding of their current and future fertility and the possible trajectory of cancer itself. Men reported that the doctor (oncologist) taking responsibility for starting the discussion about fertility and organising sperm storage was the most important factor in helping them to manage the process. Younger men also valued family support. Some men did not fully understand the effects of treatment on fertility, but thought storing sperm acted like a ‘safety-net’.
Men who did not attend appointments for fertility checks in the years following cancer treatment reported anxiety about their fertility and not wanting to face possible infertility – some did not realise their fertility might improve over time. Disposing of stored sperm was difficult for many men, even if they were fertile, partly due to fear of cancer returning.
Men were overwhelmed by information on diagnosis and failed to understand the implications of cancer treatment for their future fertility.
Conclusion
On diagnosis, men are given large amounts of information about cancer and treatment but fail to understand the longer-term implications of sperm banking. These implications need to be specifically addressed at subsequent appointments in order to optimize fertility monitoring and timely disposal of sperm samples.
Men might also benefit from more information and support in the years following treatment, to help them understand that fertility can recover over time and to manage ongoing concerns about fertility and cancer.
Points to Note
- This is a small qualitative study of men in the UK so caution needs to be taken in applying these findings to Australian men.
- Given these caveats, the study highlighted some problems that can arise for men making decisions about whether to store sperm and in subsequent fertility monitoring and sperm disposal.
- Given the excess of information men receive at the time of a cancer diagnosis, this study highlighted the need for ongoing information and support so that men understand the implications of sperm storage and fertility following treatment for cancer.
- Health professionals involved with men undergoing cancer treatment can play an important role in helping men understand the fertility implications, the process for sperm banking and the importance of fertility monitoring in the longer term.
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