Preservation Options

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The most common technique to collect sperm is through masturbation. Patients must be sexually mature, at Tanner stage III, or in puberty for 1 to 2 years to collect a semen sample. In the recent study, researchers found that patients were more likely to attempt to bank sperm if they not only recognized the benefits of sperm banking, but also had a history of masturbation and confidence in their ability to collect a sample. Electro-ejaculation can be used as an alternative to masturbation among sexually mature males and is typically performed under general anesthesia during which an electric probe is inserted into the rectum, adjacent to the prostate gland to stimulate ejaculation.

For patients in which semen collection is not possible, other options exist, including testicular tissue cryopreservation, where a sample of testicular tissue containing spermatogonial stem cells is removed from the patient and stored. The idea behind this procedure is that these stem cells can be transplanted back into the seminiferous tubules of the patient’s testicles at a later time when the patient is cancer free, to produce sperm. However, this procedure is still experimental and has not yet been shown to be successful in humans. Other techniques are as simple as gonadal shielding with a clamshell-like lead shield placed over the testes to protect against scatter radiation.

An Essential Conversation

Healthcare professionals have a legal obligation to discuss the impact of cancer treatment and available fertility preservation options with AYA patients. In 2014, there was a successful action against a health service that failed to provide information about fertility preservation options to a 14-year-old male before treatment.2 Furthermore, having discussions with AYA patients about fertility preservation minimizes patient anxiety and future regret, improves their future quality of life, and provides positive emotions during treatment.3  

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The findings of the recent study are consistent with this idea. According to the study, healthcare providers should have discussions as early as possible with AYA patients and their families in regard to the impact of cancer therapy on their fertility. They should also provide patients with access to a trained fertility specialist that can help them navigate available fertility preservation options. “These results highlight factors that providers can target to empower adolescents to actively participate in their own health care. These decisions, which are typically made at the time of diagnosis, have high potential to affect their lives as survivors,” said Dr Klosky.

Other studies have found comprehensive programs, involving teams of pediatric oncologists, hematologists, surgeons, pediatricians, urologists, reproductive endocrinologists, nurses, psychologists, social workers, and bioethicists, to be particularly useful. At the crux of these programs are nurses, which some believe are in a unique position to facilitate fertility discussions with the patient, doctors, and clinics.3

St. Jude Fertility Clinic opened one such comprehensive program in 2014 dedicated to providing patients and long-term cancer survivors access to fertility preservation counseling and information. St. Jude’s clinic also eliminates one of the biggest barriers to sperm banking, cost, by storing sperm free of charge until the patient is 35 years of age.