A survey-based study of oncologists and hematologists has shown that sperm banking is not routinely offered to U.K. men before potentially fertility-compromising cancer treatments.
Although U.S.-based studies have reported that as few as 50% of men are offered the opportunity to store sperm before cancer treatment (J. Clin. Oncol. 2002;20:1890-7), U.K. national guidelines state clearly that sperm cryostorage should be offered to all men and adolescents before undergoing such treatments. However, the study found, the decision to offer remains, in practice, largely a matter of clinician judgment, with a patient’s age, sexuality and chances of survival factored in.
For their research, published online Oct. 28 in the Annals of Oncology (doi:10.1093/annonc/mdq579), Geraldine Hartshorne, Ph.D., of the University of Warwick (England) and colleagues sent 2357 surveys to U.K. hematologists and oncologists from a national list, and 499 responses were received, 253 from hematologists and 246 from oncologists.
"The idea arose because I work in an IVF unit and we were aware of patients coming through who had had cancer treatment who did not have sperm banked," Dr. Hartshorne said in an interview. "Many had not been offered the opportunity."
Some 42% of oncologists and hematologists responding to Dr. Hartshorne and colleagues’ questionnaire said that they would offer sperm banking to patients whose cancer treatments had already begun, in direct contradiction of national clinical guidelines, the study found. And only 26% of oncologists and 38% of hematologists document their patients’ decisions on whether to have sperm stored.
About 11% of responding oncologists and hematologists said that they would "tend NOT to discuss sperm banking" with a patient who was homosexual, nearly 50% said they might not raise the issue with a patient unlikely to survive treatment, and 10% said they might hesitate with patients whom they would expect to take offense for religious reasons. Nearly 79% said they would tend not to talk about sperm storage with a terminally ill patient. Considerations of patients’ advanced age were also frequently cited as a factor in the decision whether to offer sperm banking (8% would tend not to discuss it with a person 40 or older; 36% would not do so with a patient 50 or older).
"We tried to analyze this in terms of whether doctors are making assumptions on their patients’ best interests, which of course doctors must do. But perhaps in this situation, this is not ideal practice," Dr. Hartshorne said, likening it to "unconscious discrimination."
Dr. Hartshorne and colleagues warned that clinicians who rely on their own judgments to ask patients about sperm banking could find themselves at risk of litigation. "Any set ‘cutoff’ age or personal criteria applied by clinicians could be challenged under human rights or equality legislation. Bearing in mind increasing social trends for second families, delaying parenthood and civil partnerships, an individualized approach is more appropriate. Moreover, posthumous use of banked sperm is legally accepted in the UK," they wrote.
Exacerbating the problem of uptake, Dr. Hartshorne and colleagues wrote, was the inconsistency of Primary Care Trusts in how they handle sperm banking. While most trusts fund sperm storage for cancer patients in some way or another, "there is no standard process," they wrote. "In some areas, sperm banking for cancer patients is not NHS funded, while in others, it is considered on a case-by-case basis. ... A further complexity is that even if PCTs fund the initial banking procedure, their policies then support sperm storage for different lengths of time." After a set period, 5 years, for example, the researchers wrote, patients may have to take on the costs of keeping sperm stored.
The researchers outlined a series of administrative and policy changes that would lessen obstacles to sperm storage and improve communication between sperm banks, PCTs, fertility centers and cancer doctors. While the bureaucratic changes toward improving uptake of sperm banking require some thought and planning, Dr. Hartshorne said, the remedy for clinicians is simple and can be put into place immediately: "Just, A: make the offer to everyone, and B: document that you did."
The study was funded by Cancer Research UK and the U.K. Department of Health; none of its authors declared conflicts of interest.