There are a variety of reasons why a patient may choose not to cryopreserve semen prior to starting cancer treatments, including modesty of both the patient and healthcare provider, privacy, discomfort, cost, urgency to begin treatment, and access to sperm banking facilities. Schover et al.
found that the most common reason patients did not bank sperm was because of the lack of information [Schover et al. 2002a
In 1995, Koeppel reported over 50,000 new cases of cancer in men under the age of 35 and realized that with rising survival rates and the harmful effects of treatment on fertility potential that semen cryopreservation should be offered to these patients [Koeppel, 1995
]. The author acknowledged the controversies regarding the practicality and usage of sperm banking including the challenges faced by healthcare professionals in discussing such sensitive issues with patients. Oncology nurses were identified as key members of the treatment teams who could discuss infertility and sperm banking with patients at the most opportune time, before initiation of chemotherapy. It was recognized that improved knowledge would reinforce the importance of offering sperm banking to circumvent treatment-induced infertility.
Finding a sperm bank for a patient should not be a barrier in discussing the option. Information about sperm banks is readily available online. Most banks will have mail kits available that allow patients to collect sample at home and ship them to the sperm bank. This approach allows for privacy and convenience for the patient.
Cost has been identified as an obstacle for patients. Schover et al.
demonstrated that both physicians and patients are under the impression that sperm cryopreservation is too costly [Schover et al. 2002b
]. Although cost varies by facility, it is estimated that initial processing fees are approximately US$350 with monthly storage fees ranging from US$10 to US$50 per month. Insurance coverage is variable, but some will cover a portion of the cost, particularly in the setting of cancer treatment. National agencies such as the American Cancer Society may also have financial aid programs. Many sperm banks also offer payment plans based on need and income.
Canada and Schover acknowledged the limited time oncologists have with each patient, and the they suggested that training oncology nurses, social workers, and nurse practitioners to discuss infertility with new cancer patients is a reasonable approach to this barrier [Canada and Schover, 2005
]. Educational materials including patient education sheets and interactive computer programs for patients and their families are useful. Educating healthcare providers via lectures, grand rounds, and in-service presentations is encouraged.
Developing an efficient, seamless system to provide this service to cancer patients during such an emotional time is also critical. Phone numbers and protocols should be readily available on inpatient wards and in outpatient clinics. Semen collection rooms should be readily accessible to patients.
Although semen collection is recommended prior to starting treatment, the urgency to start therapy sometimes trumps the ability to provide a sample for cryopreservation. In these cases, collection is possible after starting therapy, however the impact of chemotherapeutic and radiotherapy regimens on the risk of genetic defects in the offspring remains unknown. Patients and their families must be counseled as such. Some authors report that samples collected within 10–14 days of starting treatment may still be safe to use for future ART, based on sperm transit times through the reproductive tract [Chatterjee et al. 2000
Lastly, there may be legal considerations surrounding sperm banking that need to be addressed. As summarized by Leonard et al.
the law surrounding cryopreservation of semen is still uncertain [Leonard et al. 2004
]. It remains unclear whether semen is categorized as property, person, or a unique material that is neither person nor property. In addition, the disposition of cryopreserved specimens in the event of a dispute remains unclear [Schuster et al. 2003
]. Consent forms and contracts are important supporting documents for sperm banking, and they should address to whom the sperm belongs, what will happen in the event of death, and how payments for these services will be handled. Confounding factors may include cases of minors or in instances where there is potential for secondary gains (e.g. inheritance).