For young men who wish to have children but who have not yet completed their families, a diagnosis of cancer represents an additional challenge. Whilst sperm banking has been available since the 1970’s, it is only more recently that access to modern techniques of assisted reproduction became widely available. However, there is evidence that fertility issues are not always given high priority by cancer physicians. Survivors often report that they were not given an opportunity to bank sperm before cancer treatment started. This chapter will therefore outline the current state of knowledge and what cancer physicians can do to give their male patients the best opportunities available.
GIVING MEN THE OPPORTUNITY TO BANK SPERM
Many studies have shown that not all men diagnosed with cancer are given the opportunity to bank sperm.1 Cancer physicians are the primary gatekeepers of sperm banking and have historically not always referred men appropriately. Reasons for this include that they: (1) lack knowledge of what services are available; (2) are unsure of the local referral pathways; (3) are embarrassed to bring up the topic; (4) do not feel appropriately trained; or (5) make assumptions about the need for sperm banking based on their perception of the man’s family, relationship status or sexual orientation. Yet, there is evidence that men welcome sperm banking being offered as part of their routine diagnosis and treatment pathway.2 Therefore, it is recommended that cancer physicians make discussions about fertility a standard part of their consultations. If required, then it is important that referrals are made at an early stage. This is because: (1) it is necessary to screen each man for blood borne viruses at the outset so the semen samples of anyone who is viral positive can be stored appropriately; and (2) give the sperm bank enough time to undertake a complicated process of consent for storage as well as possible future use (and all of the legal issues surrounding that). Unfortunately, there is no consensus about the optimum method to approach men about sperm banking or what information resources and decisions aids may help them make a decision. Clearly, some men will decline the offer and there is evidence to suggest that those with poor quality of life at diagnosis may be more likely to refuse.3 There is evidence that in recent years the number of men banking sperm has been slowly increasing,4 but it is not clear whether this is because more offers are being made by cancer physicians or that men are becoming more likely to accept.
WHO TO OFFER SPERM BANKING TO?
The onset of sperm production is an early event in puberty, beginning at about 13.5 years old. As such, sperm production may occur before the male becomes sexually aware. This is important because sperm banking usually requires semen samples to be produced by masturbation ...