Sperm cryopreservation in adolescents and young adults with cancer Results of the French national sperm banking network CECOS

Capsule:
Sperm banking is possible in young adolescents. The discrepancy between cancer incidence and the proportion of adolescents referred for sperm banking highlights the need for a change in care policy.

Authors:
Myriam Daudin, M.D., Nathalie Rives, M.D., Ph.D., Marie Walschaerts, Ph.D., Véronique Drouineaud, M.D., Ph.D., Ethel Szerman, Ph.D., Isabelle Koscinski, M.D., Ph.D., Florence Eustache, M.D., Ph.D., Jacqueline Saïas-Magnan, M.D., Aline Papaxanthos-Roche, M.D., Rosalie Cabry-Goubet, M.D., Florence Brugnon, M.D., Ph.D., Dominique Le Lannou, M.D., Ph.D., Claire Barthélémy, Pharm.D., Jean-Marc Rigot, M.D., Thomas Fréour, Pharm.D., Ph.D., Isabelle Berthaut, Ph.D., Sandrine Giscard d’Estaing, M.D., Ph.D., Françoise Touati, M.D., Marie-Claude Mélin-Blocquaux, M.D., Oxana Blagosklonov, M.D., Ph.D., Claire Thomas, M.D., Mohamed Benhamed, M.D., Ph.D., Françoise Schmitt, M.D., Jean-Marie Kunstmann, M.D., Patrick Thonneau, M.D., Ph.D., Louis Bujan, M.D., Ph.D.

Volume 103, Issue 2, Pages 478-486

Abstract:

Objective:
To determine the feasibility of fertility preservation in adolescent males with cancer.

Design:
Large multicenter retrospective study of male patients ≤20 years from 23 centers of a national network of sperm banks over a 34-year period.

Setting:
Sperm banks.

Patient(s):
A total of 4,345 boys and young men aged 11 to 20 years.

Intervention(s):
Age, cancer diagnosis, feasibility of sperm banking, and sperm parameters.

Main Outcome Measure(s):
Description of patients, and success of their fertility preservation.

Result(s):
We observed a mean yearly increase in referred patients of 9.5% (95% confidence interval, 9.1%–9.8%) between 1973 and 2007. Over the study period, the percentage of younger cancer patients who banked their sperm increased, especially in the 11–14 year age group, rising from 1% in 1986 to 9% in 2006. We found that 4,314 patients attempted to produce a semen sample, 4,004 succeeded, and sperm was banked for 3,616. The mean total sperm count was 61.75 × 106 for the 11–14 year age group, and 138.81 × 106 for the 18–20 year age group. It was noteworthy that intercenter variations in practices involving young patients seeking to preserve their fertility before cancer therapy were observed within this national network.

Conclusion(s):
Our results emphasize the need for decisive changes in public health policy to facilitate the access to reproductive health-care for young cancer patients.

  • In the US where fertility is a privilege and not a right, the costs of cryo-preserving can be quite prohibitive without government assistance/coverage, although there are foundations that can help defer some costs for low-income patients (i.e. Fertile Hope). Consenting minors to something like this can be a legal quagmire since this is an elective process and usually not considered crucial to the overall health and life-preserving treatment of the patient.

    Questions for the authors:
    1. Can you comment as to your pre-pubertal males that did not have sperm in their ejaculate, or those that were unable or unwilling to produce an ejaculated specimen as to how you obtained samples?
    2. How many patients ultimately needed a surgical procedure to extract sperm (TESE)? 3. What are you doing for your very young male patients <10 yo who have not begun spermatogenesis? Are you taking testicular tissue and cryopreserving this for the science to catch up?

  • ranjithrama

    The authors need to be commended for not just their successful fertility preservation program but for convincing children as early as 11 years to bank sperm. Can the authors describe how they went about consenting the parents? assenting the children? The major barrier to sperm banking in young adolescents if often the initial conversation with the parents. Can the authors provide information on how many parents turned down the offer to bank sperm?

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