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Copyright of Psycho-Oncologie is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose The purpose of this study was 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 used 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 used 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). Multicovariate 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 < .04) were associated with collection attempts. Adolescents who were referred for a specialized fertility consultation were also almost five times more likely to successfully bank (OR, 4.96; 95% CI, 1.54–16.00; p < .01) compared 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 before treatment initiation. [ABSTRACT FROM AUTHOR]

Most sperm donation that occurs in the USA proceeds through anonymous donation. While some clinics make the identity of the sperm donor available to a donor-conceived child at age 18 as part of 'open identification' or 'identity release programs,' no US law requires clinics to do so, and the majority of individuals do not use these programs. By contrast, in many parts of the world, there have been significant legislative initiatives requiring that sperm donor identities be made available to children after a certain age (typically when the child turns 18).One major concern with prohibiting anonymous sperm donation has been that the number of willing sperm donors will decrease leading to shortages, as have been experienced in some of the countries that have prohibited sperm donor anonymity. One possible solution, suggested by prior work, would be to pay current anonymous sperm donors more per donation to continue to donate when their anonymity is removed. Using a unique sample of current anonymous and open identity sperm donors from a large sperm bank in the USA, we test that approach. As far as we know, this is the first attempt to examine what would happen if the USA adopted a prohibition on anonymous sperm donation that used the most ecologically valid population, current sperm donors. We find that 29% of current anonymous sperm donors in the sample would refuse to donate if the law changed such that they were required to put their names in a registry available to donor-conceived children at age 18. When we look at the remaining sperm donors who would be willing to participate, we find that they would demand an additional $60 per donation (using our preferred specification).We also discuss the ramifications for the industry. [ABSTRACT FROM AUTHOR]

The aim of the present work was to study the spermatic feasibility after 20 years of freezing, thawing and refreezing. A young man affected by testicular cancer sought the sperm freezing service. After 20 years, the samples were thawed and frozen again. After two days, thawing and analysis of the material took place. Comparison of the findings showed activity reduction from the first thawing to the fresh semen 59.09%. For the second thawing it was 77.27%. Considering the morphology, first thawing showed a reduction of 44.64% in relation to fresh semen. In the second thawing, the reduction was of 75%. Spermatic motility decreased by 64.28% in relation to fresh semen and 92.85% at the level of second thawing. The patient had gone through in vitro fertilization in 2007, obtaining success in the first one attempt.Este trabalho mostra a viabilidade espermática após 20 anos de congelamento seminal, descongelamento e novo congelamento. Jovem do sexo masculino afetado por câncer testicular procurou o serviço para congelamento de espermatozóides. Após vinte anos, as amostras foram descongeladas e congeladas novamente. Após dois dias, realizou-se um novo descongelamento e análise do material. As comparações dos resultados mostraram uma redução da atividade do primeiro descongelamento ao semen fresco em 59,09%. A partir do segundo descongelamento era de 77,27%. Considerando a morfologia, o primeiro descongelamento mostrou uma redução de 44,64% em relação ao sêmen fresco. No segundo descongelamento, a redução foi de 75%. A motilidade espermática diminuiu 64,28% em relação ao semen fresco e 92,85% a nível do segundo descongelamento. O paciente passou por fertilização in vitro em 2007, obtendo sucesso na primeira tentativa.

The goal of this study was to identify factors that influenced the ability to successfully rescue sperm post-mortem from rhinoceroses maintained in North American zoos. Factors considered included procedural technicalities, individual rhinoceros characteristics and timing. Gross testicular pathology was noted in 17.4% of males (4/23) but did not impact sperm recovery except in one case of azoospermia (4.3%). Of the males in which sperm recovery was attempted ( n = 21), 62% yielded quality samples considered adequate for cryopreservation (≥30% motility with ≥2.0 forward progressive status). A high percentage of males (70.6%; 12/17) from which reproductive tissue was removed and cooled ≤4 h after death yielded quality sperm samples, whereas only 25% (1/4) of males from which tissue was removed >4 h after death yielded quality samples. Quality samples were recovered 1–51 h post-mortem from rhinoceroses 8 to 36 years old. Neither type of illness (prolonged or acute), or method of death (euthanasia or natural) affected the ability to harvest quality samples ( P > 0.05). The Indian rhinoceros yielded significantly more sperm on average (40 × 10 9 ) than the African black rhinoceros (3.6 × 10 9 ; P < 0.01) and the African white rhinoceros (3.2 × 10 9 ; P < 0.05). Across all species and samples assessed ( n = 11), mean post-thaw sperm motility (41%), was only 15% less than pre-freeze motility (56%) and only decreased to 22% during the 6 h post-thaw assessment period. Rhinoceros sperm rescue post-mortem is relatively successful across a wide range of variables, especially when tissues are removed and cooled promptly after death, and should be considered standard practice among zoos. [ABSTRACT FROM AUTHOR]

The article presents a study that deals with adolescent and young adults' discussions of fertility in the context of discussing their survivorship experiences.

Background: Loss of fertility is one of the many potential late effects of cancer treatment. For young men and women who have not yet started or completed building their families, this can be a source of considerable emotional distress. Advances in reproductive technology can enable many of these patients to preserve their fertility; however, discussions must be initiated early enough during treatment planning to enable them to take advantage of these options. Objectives: The purpose of this article is to provide oncology nurses with information, strategies, and resources to discuss fertility with men and women starting cancer treatment. Methods: This article summarizes the literature on treatment-related fertility risks and fertility preservation options, and provides a systematic framework for nurses to integrate these discussions into practice. Findings: Oncology nurses can effectively collaborate with other members of the healthcare team to ensure that young men and women starting cancer treatment are informed of the potential risks to fertility from their planned treatment, understand options to preserve fertility before treatment, and, if interested, are referred to appropriate reproductive specialists. [ABSTRACT FROM AUTHOR]

Purpose: Testicular cancer is the most common carcinoma in 20- to 40-year-old men. Eighty percent of patients with metastases achieve disease-free status with chemotherapy with or without surgical resection. Standard first-line chemotherapy is bleomycin, etoposide, and cisplatin (BEP) for three to four courses or etoposide and cisplatin (EP) for four courses. Forty percent of patients receiving chemotherapy will have permanently reduced sperm counts impairing future fertility. Sperm banking is an effective method of maintaining fertility. This retrospective study was performed to assess utilization and results from sperm banking, as well as the barriers to its use. Methods: Patients 18 and older who had received chemotherapy were given a five-item questionnaire on follow-up visit. This questionnaire included a mix of quantitative and qualitative questions. Results: Two hundred patients enrolled in the study, and all 200 completed the questionnaire. Of the two hundred, 139 (70 %) patients chose not to bank sperm; 71 (51 %) of those were not interested, 25 (18 %) declined due to desire to start chemotherapy, 24 (17 %) were not offered, 12 (9 %) declined due to cost, and 7 (5 %) answered 'other.' The average age at cancer diagnosis of patients who banked sperm was 28.4 as opposed to 32.6 for patients who did not ( p = 0.003). The percentage of patients that had children before their diagnosis was 21 % in the sperm banking group, and 50 % in the group that did not ( p = 0.0002). Sixty-one (30 %) chose to bank sperm; 11 of 61 patients (18 %) utilized the banked sperm; 9 of 11 (82 %) patients that utilized were successful; and 3 of 9 (33 %) successes resulted in multiple gestations. Conclusions: Sperm banking provides the opportunity for paternity in testicular cancer patients with reduced sperm counts following treatment. However, the majority of these patients chose not to bank sperm or were not offered the opportunity. A range of factors such as time, emotional state, patient age, disease stage, prior children, institutional practices, and cost all influence whether banking is offered to patients and taken up. The authors provide recommendations to help clinicians overcome some of these barriers. [ABSTRACT FROM AUTHOR]

Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider. [ABSTRACT FROM AUTHOR]

Purpose: Infertility is a frequent consequence of cancer therapy and is often associated with psychological distress. Although adult survivors prioritize fertility and parenthood, this issue remains unexplored among adolescent males. This study examined future fertility as a priority (relative to other life goals) at time of diagnosis for at-risk adolescents and their parents. Methods: Newly diagnosed adolescent males ( n = 96; age = 13.0-21.9 years) at increased risk for infertility secondary to cancer treatment prioritized eight life goals: to have school/work success, children, friends, wealth, health, a nice home, faith, and a romantic relationship. Patients' parents (fathers, n = 30; mothers, n = 61) rank-ordered the same priorities for their children. Results: 'Having children' was ranked as a 'top 3' life goal among 43.8 % of adolescents, 36.7 % of fathers, and 21.3 % of mothers. Fertility ranked third among adolescents, fourth among fathers, and fifth among mothers. Future health was ranked the top priority across groups, distinct from all other goals ( ps < 0.001), and fertility ranked higher than home ownership and wealth for all groups ( ps < 0.001). For adolescents, low/moderate fertility risk perception was associated with higher fertility rankings than no/high risk perceptions ( p = 0.01). Conclusions: Good health is the most important life goal among adolescents newly diagnosed with cancer and their parents. In this relatively small sample, adolescents prioritized fertility as a top goal, parents also rated fertility as being more important than home ownership and financial wealth. Health care providers should communicate fertility risk and preservation options at diagnosis and facilitate timely discussion among families, who may differ in prioritization of future fertility. [ABSTRACT FROM AUTHOR]

Sperm cryopreservation is the only method currently available that offers men with cancer insurance against sterilising iatrogenic treatments. We carried out two cohort and cross-sectional audits to identify trends with sperm cryopreservation referral rates and sample usage rates for men diagnosed with cancer and who banked sperm at The Andrology Laboratory, Hammersmith Hospital, Imperial College NHS Trust. These retrospective audits revealed that a total of 4362 men with cancer successfully banked sperm between 1976 and 2013. Truncating the dataset to 2009 to allow for lag times between storage and use, the overall sample usage rate for cancer patients was 6.0% with 75 live births. Increased median age at referral influences the cancer profile of men seen at the bank, which is highlighted by a disproportionate rise in the number of men with prostate cancer. Among men who use banked sperm, a large rise in the use of intracytoplasmic sperm injection has occurred over time. The number of patients requiring the service is sharply increasing year on year as are the number of patients who go on to use their sample in assisted conception. The historical use rates of frozen sperm are likely to be significant underestimations of future use. [ABSTRACT FROM AUTHOR]

Introduction: As fertility may be impaired due to gonadotoxic cancer treatment, fertility preservation should be offered to young cancer patients. Despite affirmative guidelines, sperm cryopreservation rates are still unsatisfying.Objective: To examine how male cancer patients experience the current practice of counseling regarding fertility preservation and the needs they have for additional online support tools.Methods: A cross-sectional mixed methods study of men above 18 years old with a cancer diagnosis within the last 10 years. The quantitative part was a retrospective questionnaire-based online survey; the qualitative part used focus-group methodology. The mean age of participants (n=72) was 32.94 years (SD 8.38) and the predominant cancer types were testicular cancer (55.6%), lymphomas (16.7%), and leukemias (13.9%).Results: Participants rated the significance of the counseling as high (M=4.2, SD=1.05) and experienced professionals as supportive (M=4.37, SD=0.66). A majority of participants (70.8%) stated that they would use an additional support tool designed for male cancer patients. The tool should contain not only information about fertility preservation, but also about sexuality, virility, consequences for partners, and experience reports from other patients.Conclusions: Cancer patients undergoing gonadotoxic therapies should be counseled about fertility preservation. Professional, individualized information and a well-organized fertility preservation process improve the subjective experience of cancer patients. An online support tool that provides information about fertility preservation and general reproductive health was considered as a helpful, low-threshold offer that would be appreciated. [ABSTRACT FROM AUTHOR]

Introduction: This descriptive study aimed to identify the knowledge and practices regarding sperm banks among doctors and nurses treating young male patients with cancer. Materials and Methods: The study population comprised 71 doctors and 150 nurses working in the oncology clinics of hospitals affiliated with the Istanbul Health Directorate between January 1st and March 30th, 2012. No sampling was carried out, because the study aimed to reach the whole population. Results: Among the participants, 70% of the doctors and 42% of the nurses stated that there were no written rules on sperm preservation in their current institutions. Those wishing to have children, who are single, and who have to start chemotherapy immediately were the 3 most important patient groups doctors recommended for sperm preservation. Meanwhile, the nurses reported those wishing to have children, who were diagnosed recently, and who have to start chemotherapy immediately as the most important patients for fertility preservation. Doctors’ and nurses’ practices related to sperm freezing were unsatisfactory; the main factors influencing this situation were cultural factors, religious beliefs, and work load. Conclusions: Although health personnel are aware of the importance of sperm preservation in young male patients diagnosed with cancer, the related practices are not at desirable levels. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Sperm banking is an effective method to preserve fertility, but is not universally offered to males facing gonadotoxic treatment in the United States. We compared the disposition and semen parameters of cryopreserved sperm from individuals referred for sperm banking secondary to a cancer diagnosis to those of sperm from men banking for infertility reasons. Study design: We performed a retrospective cohort study that reviewed 1118 records from males who presented to bank sperm at Washington University between 1991 and 2010. We collected and analyzed demographics, semen parameters, and disposition of banked sperm. Results: Four hundred and twenty-three men with cancer and 348 banking for infertility reasons attempted sperm cryopreservation in our unit during the specified time period. The most prevalent cancers in our cohort were testicular (32%), lymphoma (25%), and leukemia (11%). Patients with leukemia had the lowest pre-thaw counts and motility. Most cancer patients (57%) who banked elected to use, transfer to another facility, or keep their specimens in storage. The remaining samples were discarded electively (34%) or following death (8%). Overall semen parameters were similar between the cancer and infertility groups, but demographics, ability to bank a sample, azoospermia rates, length of storage, current banking status, and use of banked sperm differed significantly between the two groups. Conclusions: The majority of cancer patients who banked survived their cancer and chose to continue storage of banked samples. Cancer patients were more likely than infertility patients to use or continue storage of banked samples. Our study provides evidence that sperm banking is a utilized modality of fertility preservation in patients with a myriad of cancer diagnoses and should be offered to all men facing gonadotoxic therapies. Further work is needed to determine where disparities in access to sperm banking exist to improve the potential for future fertility in these males. [Copyright &y& Elsevier]

The purpose of this study was to survey the current state of oncology sperm banking services provided by fertility clinics across Canada. A total of 78 Canadian fertility facilities were invited to complete a questionnaire related to the availability, accessibility, affordability and utilisation of sperm banking services for cancer patients. The total response rate was 59%, with 20 (69%) in vitro fertilisation clinics and 26 (53%) other fertility centres returning the survey. A total of 24 responding facilities accepted oncology sperm banking referrals. The time frame to book the first banking appointment for 19 (79%) facilities was within 2 days. Inconsistent practice was found regarding the consent process for cancer patients who are of minority age. Eight (33%) facilities did not provide any subsidy and charged a standard banking fee regardless of patients' financial situations. Overall, the utilisation of oncology sperm banking services was low despite its availability and established efficacy, suggesting that Canadian cancer patients are notably underserved. The study has highlighted some important issues for further consideration in improving access to sperm banking services for cancer patients, especially for adolescents. Better collaboration between oncology and reproductive medicine to target healthcare providers would help to improve sperm banking rates. [ABSTRACT FROM AUTHOR]

Sperm banking is routinely offered to men where there is a risk of infertility following cancer treatment but uptake is lower than expected. Since these men may turn to the internet for information, we used the search engine to identify the material available about sperm banking and fertility preservation options. Sixty-six resources (NHS/Private Clinic, Charity, Press Releases, General and Forums/Blogs) fulfilled the criteria for inclusion and were examined for quality including readability, layout and content. The most frequently reported information related to: (1) effects of cancer treatment on fertility (77.3%); (2) reasons to bank sperm (69.7%); and (3) fertility recovery after treatment (57.6%). Information about maintaining contact with the sperm bank (18.2%) and disposal of banked samples (10.6%) was less often included. The quality of information available on the Internet about sperm banking was variable. The readability of all resources was assessed as 'fairly difficult', i.e. reading skills required were too complex for the average member of the public to understand. Furthermore, visual presentation of material (e.g. lay out) did not facilitate easy reading. More attention should be given to information about longer-term issues, such as fertility recovery and the use or disposal of banked sperm. [ABSTRACT FROM AUTHOR]

An increasing number of cancer patients can now hope to have a full and normal life due to significant improvements in treatment outcomes and survival rates. The application of cryobiology to store fertile gametes before sterilizing treatments has been a natural progression. Greater awareness has markedly increased the worldwide demand for long-term storage of sperm, and has prompted the UK Human Fertilization and Embryology Authority to extend the period of storage permitted by their regulations to 55 years. Other patients undergoing sterilizing chemotherapy and/or radiotherapy such as haemoglobinopathies requiring bone marrow transplantation and autoimmune disorders such as rheumatoid arthritis may further increase the indications for sperm storage. Most adult and adolescent patients and their relatives/spouses/parents/guardians value this service even though very few eventually use the sperm. There is an urgent need to develop national and international guidelines for the provision, organization, maintenance and management of the cryopreservation services. [ABSTRACT FROM PUBLISHER]

Summary Different cancer treatments such as chemotherapy and radiotherapy can lead to azoospermia and even sterility for an unknown period. Whether the type of cancer could affect semen quality or not is under debate. In this study, we have reviewed semen parameters of men with cancer who deposited their sperm samples at the Avicenna Research Institute tissue bank before undergoing cytotoxic treatment. This descriptive retrospective study examined 73 cases referred to sperm bank, because of malignancy, prior to initiation of cancer treatments including chemotherapy and radiotherapy. The data recorded were age, marital status, reproductive history, semen analysis reports and cancer history of the patients. Semen samples were analysed according to recommendations of the World Health Organization (1999) before freezing. Results of the analysis showed that 71.2% (52) of patients had oligozoospermia, 93.2% (68) teratozoospermia and 86.3% (63) asthenozoospermia. Different groups of cancer patients did not show any differences in oligozoospermia, teratozoospermia and asthenozoospermia. Impaired spermatogenesis even prior to cancer treatment indicates the importance of fertility preservation. As the majority of patients had suitable specimens for freezing and assisted reproduction, sperm banking is recommended to be performed promptly and before any treatment, especially surgery. [ABSTRACT FROM AUTHOR]

Background: Fertility after cancer therapy is a significant quality-of-life concern for many patients, their partners and families. Authoritative guidance states that men whose fertility may be affected by impending therapies should be offered sperm banking. Yet some patients are not offered this opportunity and are thereby disadvantaged. We sought to understand oncologists’ and haematologists’ decision making concerning sperm-banking referrals.Design: We surveyed all oncologists and haematologists on the Royal College of Radiotherapists’ Faculty of Oncology and British Society for Haematology circulation lists.Results: From 2357 across all specialities, 499 responses were received: 253 haematologists and 246 oncologists (21% response rate). Twenty-one percent of respondents were unaware of local policies on sperm banking and 42% considered that sperm banking should be offered to more patients. Respondents’ decisions reveal either assumptions about patients’ needs based on characteristics such as age, sexual orientation and severity of illness or the influence of their own moral conclusions upon their patients. The survey identified paucity of training for clinicians, information for patients and systematic recording of discussions about fertility.Conclusions: A robust care infrastructure supporting male fertility storage is needed urgently to include targeted information for cancer clinicians and patients, identified individuals responsible for coordination and documentation of discussions with patients. [ABSTRACT FROM PUBLISHER]

In Denmark and Sweden sperm donation is the most debated and contested of the reproductive technologies that are currently in use. Although the two countries are neighbouring welfare states with public healthcare in common, policies and practices of sperm banking and sperm donation differ strongly. Drawing on ethnographic fieldwork, this article explores how the sperm used for donor insemination is narrated, chosen, produced and consumed at sperm banks in Denmark and Sweden.The analysis illustrates that marginalization and stigmatization of infertile men, donors, single women, lesbians and donor children not only takes place in the media and during debates in the Danish and Swedish parliaments where the technology has historically been contested, but also at the sperm banks and fertility clinics. This article therefore calls for more inclusive stories on sperm donation to be narrated. [ABSTRACT FROM PUBLISHER]

Abstract: The increasing number of paediatric cancer survivors in the last few decades has focused attention on minimizing long-term effects caused by oncological therapy without compromising survival rates. Loss of reproductive function is one of the most distressing potential adverse consequences of successful treatment. Several new reproductive techniques are now available for fertility preservation in these patients. Predicting the risk to fertility for an individual of a planned course of treatment is extremely difficult, particularly in the pediatric population. In this review we discuss the practical and ethical issues that must be addressed so that our patients can benefit from these new technologies. Multidisciplinary teams, specialized centers and decisions made in the “child and young person''s best interests” form the basis of the optimal approach to fertility preservation. [Copyright &y& Elsevier]

Objectives: To review the treatment factors that can affect male fertility, and the practices at a large metropolitan children''s hospital that has successfully developed a sperm banking program. The role of the nurse in the education of families and facilitating the sperm banking process will be described. Data Sources: Review of the literature and anecdotal information. Conclusion: Because of increased survival rates over the past three decades in children diagnosed with cancer, the importance of preserving fertility has become paramount in the minds of health care providers, families, and patients. Implications for Nursing Practice: Early identification and prompt referral for sperm banking by nurses are key factors in helping young male adolescents with cancer. [Copyright &y& Elsevier]

Objectives: We conducted pilot studies of the feasibility and efficacy of an interactive, computerized educational tool, Banking on Fatherhood (BOF). Methods: Two small randomized trials were conducted, with 20 male cancer patients eligible to bank sperm in Study 1 and 19 oncology fellows or residents in Study 2. In each trial, half of the subjects viewed BOF before completing questionnaires, and half viewed it afterward. Outcome measures included a knowledge test in both trials and a Decisional Conflict scale in the patient trial. All participants, plus a panel of 10 experts, ultimately viewed BOF and completed a form evaluating its usability and value. Results: Patients who completed questionnaires after viewing BOF had significantly less decisional conflict about banking sperm than those who had not viewed it (P=0.0065), but knowledge scores were not significantly different between groups. Physicians who filled out questionnaires after viewing BOF scored significantly higher on the knowledge test (P<0.006). Patients, physicians and experts rated BOF as easy to use, informative and addressing important psychosocial concerns, with videos and animations adding to the value of the educational tool. Conclusion: Pilot studies suggest that BOF is a feasible intervention that could enhance decisions about sperm banking. Research with larger groups is needed to validate its effectiveness. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Discussion and management of potential reproductive health sequelae of adolescent cancer are essential and challenging components of care for the multidisciplinary team. Despite this, research has been limited to specific experiences (e.g. sperm banking) or fertility-related concerns of adult survivors. This grounded theory study of 38 male and female survivors of adolescent cancer aged 16–30 years drew on in-depth single interviews to map the range of experiences of being advised that treatment might affect fertility. Strong support for being told at around diagnosis was found regardless of gender, age, incapacity or availability of fertility preservation services. Age and life stage appeared less significant for impact than the perceived level of threat to personal and social well-being. Women were more likely to achieve lower levels of comprehension about the physiological impact, to report later distress from lack of fertility preservation services and to revisit more frequently those decisions made by the few offered fertility preservation. Men found decision making about sperm banking straightforward on the whole and reported satisfaction with having the choice regardless of outcome. Findings suggest that young people can cope with this information alongside diagnosis especially when professional and parental support is proportionate to the particular impact on them. [ABSTRACT FROM AUTHOR]

Existing research into sperm banking by young males following a cancer diagnosis is predominantly quantitative; little is known about personal experiences, psychosocial and attitudinal barriers to it amongst patients and/or professionals, or the later impact of potential or actual subfertility when banking has or has not taken place. This qualitative study used single in-depth interviews with 16 males aged 13 to 20 at diagnosis (16 to 30 years at interview) to report retrospectively on their experiences, concerns and satisfactions. There was support for sperm banking, including among those who declined to bank or failed to do so successfully. Many reported that, when successful, it eased any later fertility-related concerns by offering a possible alternative route to biological fatherhood. There was satisfaction with levels of understanding, recall and decision making, though lack of clarity about consent conditions. Sperm bank professionals were less likely than oncology staff to achieve good rapport. Improvements to consent arrangements, facilities, written information and sharing of results were suggested. Small numbers from minority ethnic or disabled communities meant that any uniqueness in their experiences could not be identified. While some improvements to the process of sperm banking and follow-up can be acted upon with minimal implications, others may be more complex. [ABSTRACT FROM AUTHOR]

The article discusses the development of a booklet on sperm banking for adolescents with cancer. It is suggested that materials of this type enhance health literacy and promote patient education. Main reference for the project is the book "Writing Health Information for Patients and Families," by L. Wizowski, T. Harper & T. Hutchings. No evaluation of outcomes such as changes in patients' knowledge about sperm banking has been undertaken.

The article presents a study which reviewed literature on cryopreservation of semen, or sperm banking, for adolescent and young adult males with cancer. Information on sperm banking and advances in in vitro fertilization technology is presented. It is stated that follow-up care for survivors of childhood cancer and the effects of therapy on the quality of survival are the focal points of the Cancer Survivorship Program at the Children's Hospital of Philadelphia. Also noted is the role of nurses in sperm banking programs.

The article presents a study which determined the nurses interacting with adolescent and young adult males with cancer before the initiation of chemotherapy who had participated in discussions about sperm banking. The barriers to ensure that the educational materials would help nurses are also evaluated. Data collection was done through open-ended survey. The authors identified factors that are important to ascertain like whether nurses had had discussions with adolescents and young adults about sperm banking.

Increased awareness of the importance of fertility concerns to teenage cancer survivors is leading to growing numbers of male teenagers being offered sperm banking at the time of diagnosis. This is now extending to males diagnosed with other conditions where gonadotoxic agents are used in treatment. The storage of sperm in these circumstances is a challenging aspect of health care, given the complex issues and timescale involved. UK law has been enacted to protect legal minors from the potentially harmful effects of exposure to pornographic materials, yet there is reason to suppose that their use in this context could have therapeutic benefit in aiding successful masturbation. This paper uses material gained through consultation with the eleven largest UK sperm banks and 94 male teenage cancer survivors, to discuss the associated legal and ethical dilemmas, including those around the role of parents/carers. Findings suggest that there is variable practice in sperm banks, that almost a quarter of teenage males wanted access to soft porn when banking sperm, and half wanted to bring in their own materials. It concludes that there is an urgent need for any legal barriers to the therapeutic use of pornographic materials to be understood and examined. [ABSTRACT FROM AUTHOR]

Authors from the USA present a study aimed at identifying the frequency with which sperm banking was used in patients being treated for testicular cancer. They found that only a minority of their patients chose to bank sperm, and among those who did, the use was low. Advanced penile cancer requires extensive ablative surgery with resultant anatomical defects that can result in severe loss of quality of life. Authors from the UK describe their experience with the vertical rectus abdominis musculocutaneous flap in such patients, finding it to be useful. They stressed that a multidisciplinary approach involving the urological reconstructive surgeon and the plastic surgeon is essential. OBJECTIVE To identify the frequency that sperm banking was used by men being treated for testicular cancer at our institution, and to characterize the differences between men choosing to bank sperm or not, and outcomes in terms of after-treatment pregnancies. PATIENTS AND METHODS A questionnaire addressing sperm banking and fertility was administered to men treated for testicular cancer at our institution between 1994 and 2004; the results were evaluated statistically. RESULTS Overall, 31 of 129 (24%) respondents had banked sperm. Of these, two had used their banked sperm to father a child, and 12 had had children naturally. Men who banked sperm were a mean of 10.3 years younger ( P < 0.001) and less likely to have children at the time of diagnosis ( P < 0.025) than men choosing not to bank sperm. The cost of banking sperm was reported to include a mean fee of US $358 (median 300, range 0–1000), and a mean annual maintenance fee of $243.86 (median 300, range 0–1200). CONCLUSIONS Only a minority of men in this study chose to bank sperm (24%). Among those who did, the use of banked sperm was low (<10%), and many men could have children without using banked sperm. Given the relatively high costs of sperm banking and the low rate of sample use, patients should be counselled on the costs and benefits of sperm banking before treatment for testicular cancer. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To explore fertility issues for young men who had been diagnosed and treated for cancer and to examine communication problems surrounding these fertility issues. Method: Narrative interviews were conducted with 21 young men previously treated for cancer in the United Kingdom. Eighteen talked about fertility issues at some length. A qualitative interpretive approach was taken, combining thematic analysis with constant comparison. Results: Communication about sperm storage was sometimes difficult and embarrassing. Young men wanted the opportunity to bank their sperm but decisions were often rushed. Some would have appreciated counseling and were unprepared for the process of sperm banking and criticized facilities. Uncertainty about fertility status caused worries for the future. Conclusions: More still needs to be done to help young men with cancer to address issues of fertility. All adolescents and young men treated for cancer should be offered sperm banking if their fertility may be affected. They should be offered counseling at every stage by professionals who feel comfortable talking about the subject. Interactive, educational CD-ROMs or websites may be useful. Physical facilities for sperm banking should be improved. [Copyright &y& Elsevier]

The impressive increase in the survival rate of childhood cancer patients has produced increased interest in quality of life issues. This research addresses nurse practice issues in determining whether the newly diagnosed adolescent male patient is offered the option of sperm banking before undergoing chemotherapy treatment. Questionnaires were distributed to nurses and nurse practitioners on 3 inpatient and outpatient units who care for adolescent male cancer patients at the time of diagnosis, during chemotherapy, and during follow-up care. Findings indicate that 96.3% of respondents agreed that all male patients undergoing cancer treatment with infertility as a potential side effect should be offered sperm banking. Respondents viewed oncologists and nurse practitioners as appropriate professionals to discuss the option. Lack of knowledge regarding sperm banking could be limiting nurses’ willingness to introduce the topic, and education regarding cryopreservation may improve their knowledge and practice. [ABSTRACT FROM PUBLISHER]

The authors describe the clinical application of semen cryostorage, survival of micro-organism during cryostorage procedures and the risk of cross-contamination. [ABSTRACT FROM AUTHOR]

As the number of young and adult nulliparous cancer survivors is constantly increasing due to progress in the field of oncology, the adverse effect of the life saving cancer therapy on reproductive function is assuming greater importance. Appropriate strategies to spare fertility in all young cancer patients must be considered. Recent advances in assisted reproduction technology such as in-vitro fertilization (IVF), intra-cytoplasmic sperm injection (ICSI) and cryopreservation have revolutionized the options available to these patients for their fertility preservation. While sperm and embryo cryopreservation are now established procedures, oocyte (mature or immature) cryopreservation has limited application till date. Ovarian tissue cryopreservation although at present an experimental technique, is fast emerging out as the most promising future option for fertility preservation. There is need for the professionals dealing with young cancer patients to familiarize themselves with these developments and with the importance of describing and providing access to these options. All possible fertility preservation options should be offered and discussed before starting the therapy for cancer. A multidisciplinary approach involving a close liaison between oncology and assisted conception units is crucial for providing the proper guidance and support to the young vulnerable patients diagnosed with cancer and their families in deciding what is likely to be the most appropriate course of action for them. [Copyright &y& Elsevier]

Abstract: Purpose:: To evaluate the role of semen cryopreservation (SCP) in the fertility saving management of testicular cancer (TC) patients, treated at the Norwegian Radium Hospital between 1983 and 2002. Patients and methods:: 422 of 1388 newly diagnosed TC patients had SCP All patients were followed up for post-treatment paternity. Results:: During the 20 years study period, by 2002 an increasing percentage of patients had pre-treatment SCP, reaching 43% after 1994. Twenty-nine (7%) of the 422 patients with SCP had used their frozen semen for assisted reproductive techniques (ART) at least once to achieve fatherhood. Pregnancies were achieved in 16 of these patients’ partners, but two of these pregnancies ended in abortions. 67(17%) of 393 men with SCP fathered at least one child without use of frozen semen. The comparable figures for those without SCP were 205 out of 966(21%). Twenty years after orchiectomy the cumulative incidence of first post-treatment fatherhood was 47% for the 393 patients who had SCP but did not use it for ART, and 34% for the 966 patients without SCP (p =0.12). Conclusion:: If offered, about 50% of the young and middle-aged patients newly diagnosed with TC are interested in pre-treatment SCP. Though our study reveals that a considerable number of TC patients referred to SCP, achieve fatherhood without the use of frozen semen, the psychological impact of pre-treatment cryopreservation is undeniable. Furthermore, for some TC survivors ART with cryopreserved sperm offers the only chance of post-treatment paternity. [Copyright &y& Elsevier]

Semen cryopreservation is a useful tool for preserving fertility in men who have been diagnosed with cancer and will undergo chemotherapy, radiotherapy or testicular surgery. Semen is also commonly cryopreserved prior to its use in assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection. The post-thaw quality of banked sperm can vary, which may negatively affect fertilization rates. The objective of our study was to assess the pre-freeze and post-thaw variability of sperm parameters in patients who used our sperm banking services. Multiple samples obtained after a short period of sexual abstinence were examined for variation in sperm characteristics. Semen samples showed a high degree of post-thaw inter-sample variability in sperm motility, motion characteristics, and percentage cryosurvival rate compared with the pre-freeze inter-sample variability. Further research is necessary to understand the mechanism(s) responsible for this variability. This may also assist clinicians utilize semen samples with optimum semen quality in ART procedures. [Copyright &y& Elsevier]

Interviews were undertaken with 22 health and social work professionals. Their analysis was completed using 'selective transcription", noting understanding of process, issues and themes, and building a picture against which to consider the analysis of subsequent interviews with teenagers and parents. Professionals were also asked to identify areas for feedback from these participants. This work was part of a larger study of (i) the perceptions of adolescent males and their parents of fertility preservation services following a cancer diagnosis, and (ii) national postal surveys of common practices, areas of variance and issues experienced by professionals in UK regional paediatric oncology centres and licensed assisted conception centres. A large number of concerns were identified, which reflected professionals' difficulties in building and maintaining a relevant, adequate knowledge and skills base given the limited numbers of teenagers offered this service. The lack of appropriate training about the legal and consent frameworks, and the processes involved was also highlighted across all professional groups as was the confusion around professional and legal responsibilities for follow up. Thus, there was considerable professional uncertainty in a number of aspects of this sensitive area of service provision. Consideration needs to be given to the needs for national guidance, for training, support and updating, for liaison between the different health and social care sectors that may be involved, and for appropriate information systems. These need to be in place for each stage of the process, from diagnosis through to eventual discharge from the health system. [ABSTRACT FROM AUTHOR]

: ObjectiveTo study patient characteristics associated with the preferences for the disposition of cryopreserved semen and embryos in the event of death or divorce.: DesignRetrospective exploratory study.: SettingTertiary care academic medical center.: Patient(s)One hundred twelve men banking sperm, 54 female patients (partners of men banking sperm) undergoing in vitro fertilization (IVF), and 112 women undergoing IVF who were not partners of men banking sperm.: Intervention(s)Male patients banking sperm and couples undergoing IVF completed a standard consent form detailing their desired dispositions (disposal or release to a surviving party) of cryopreserved sperm and embryos in the event of death or divorce.: Main outcome measure(s)Effect of marital status, age, reason for sperm banking, infertility diagnosis, partner status (single or significant-other partner) on sperm, and embryo disposition choice.: Result(s)In the event of death, married men were 5.5 times more likely to release banked sperm to a surviving party than were single men. The estimated odds of giving sperm to a survivor were 1.07 times greater with every 1-year increase in age. The choice of sperm disposal was significantly related to the banking reason for the case of banking prior to chemotherapy and/or radiation for malignancy. In the case of male death, the decisions of couples undergoing IVF for embryo disposition agreed with choices of male patients for sperm disposition approximately 33% of the time more often than by chance alone.: Conclusion(s)Decisions surrounding disposition of cryopreserved sperm are significantly associated with marital status, age, and reason for banking sperm. Respective choices of sperm and embryo disposition in couples undergoing IVF were similar in the situation of male death. [Copyright &y& Elsevier]

Sperm penetration assay (SPA) scores obtained from cryobanked semen were correlated with therapeutic insemination (TI) fecundity in a group of established sperm donors, thereby evaluating the efficacy of the SPA in screening donors for sperm banking. While the SPA has been used to separate fertile from infertile males, we altered assay conditions to use frozen semen and to distinguish performance among fertile donors. Three frozen ejaculates from 11 pregnancy-proven donors were analysed. Of 905 TI cycles, 275 recipients achieved 95 pregnancies. There were no significant relationships between fecundity and donor semen, washed sperm parameters, sperm recoveries or recipient age. A significant relationship was revealed between mean SPA scores (range 8.7–66.6 penetrations/ovum) and donor fecundity (range 0.04–0.16, P < 0.03). Sperm concentration was varied in an effort to establish the most sensitive test condition. Using 0.25×106 motile spermatozoa/ml, a highly significant relationship was observed (P < 0.002). The four donors with the lowest SPA scores achieved the four lowest fecundities. It is concluded that a modified SPA can be used on frozen donor semen to estimate donor fertility potential. If applied routinely in donor semen banking, poor quality applicants could be excluded, thereby increasing pregnancy rates while decreasing donor screening costs. [ABSTRACT FROM PUBLISHER]

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Simple Summary: Fertility impairment is common among male childhood cancer survivors and negatively impacts quality of life. Sperm banking, before starting cancer treatment, is an established fertility preservation option, yet it remains underutilized at many pediatric centers. Although survivors often report regret about missed banking opportunities, little is known about short-term decisional satisfaction. The aim of this mixed methods study was to examine decisional satisfaction one month after diagnosis by comparing satisfaction among families of adolescents who did or did not attempt to bank. Quantitatively, families reported satisfaction regardless of the banking decision, while qualitatively, families of adolescents who did not attempt to bank reported potential for future regret. Thus, decisional dissatisfaction may not present after one month but could emerge in the future. The findings underscore the importance of longitudinal research to examine satisfaction over time, and why quantitative and qualitative discrepancies exist, as well as psychosocial support across the care continuum as survivors approach their reproductive years. Half of male childhood cancer survivors experience treatment-related fertility impairment, which can lead to distress. Survivors often regret forgoing fertility preservation (FP), and decisional dissatisfaction is associated with a lower quality of life. This mixed methods study examined short-term FP decisional satisfaction among families of male adolescents newly diagnosed with cancer who received an initial fertility consult and completed an FP values clarification tool. One-two months after the FP decision, thirty-nine families completed the Brief Subjective Decision Quality measure. Decisional satisfaction was compared for participants (mothers, fathers, adolescents) who did and did not attempt to bank. Semi-structured interviews included the following question: How do you/your family feel about the banking decision now/in the future? Decisional quality scores were moderate-high (M = 5.74–6.33 out of 7), with no significant differences between non-attempter (n = 15) and attempter (n = 24) families (adolescents: p = 0.83, d = 0.08; mothers: p = 0.18, d = 0.45; fathers: p = 0.32, d = 0.44). Three qualitative themes emerged among non-attempter families: (1) satisfaction with decision (50% of participants), (2) acceptance of decision (60%), and (3) potential for future regret (40%). Satisfaction with decision was the only theme identified in attempter families (93%). Quantitively, short-term decisional satisfaction was high regardless of the banking attempt. However, the qualitative findings suggest that the experiences of families who did not bank may be more nuanced, as several participants discussed a potential for future regret, highlighting the importance of ongoing support. [ABSTRACT FROM AUTHOR]

Background: Approximately half of male childhood cancer survivors experience fertility impairment, which can cause psychological distress. Sperm banking remains underutilized among adolescent males with cancer. Parent recommendation influences banking decisions, yet multi-informant studies have not been conducted to examine fertility preservation (FP) communication and decision making in this population. This study explored FP communication among mothers, fathers, and their male adolescents newly diagnosed with cancer., Procedure: Thirty-three male adolescents, 32 mothers, and 22 fathers completed semi-structured interviews 1-2 months after cancer diagnosis addressing this question: Tell me more about conversations you had about fertility preservation/sperm banking with your health care providers, parents/son, other family members, or anyone else. Interviews were audio-recorded and transcribed verbatim for thematic content analysis., Results: Five process themes emerged: (1) reliance on health care team and social support networks to facilitate FP decisions (only parents); (2) withholding parental opinion and deferring the decision to the adolescent; (3) ease of communication (primarily adolescents); (4) communication barriers/facilitators; (5) not being present or not remembering details of FP conversations with health care providers (primarily fathers and adolescents). Four content themes included: (1) preference for biological (grand)parenthood; (2) consideration of adolescent's future partner's desire for biological parenthood (primarily parents); (3) banking while it is a viable option; (4) openness to alternative parenthood options (e.g., adoption/fostering, primary parents)., Conclusions: Understanding variation in what family members discuss and consider relevant when making FP decisions is an important step toward improving pediatric oncofertility care. Interventions are needed to facilitate family FP-related conversations and optimize decisional satisfaction over time., (© 2021 Wiley Periodicals LLC.)