Fertility counseling in pubertal cancer patients requires more consistent approach

BOSTON — Sperm banking among pubertal boys being treated for cancer is significantly underutilized, according to new research presented here at the 2012 Pediatric Academic Societies Annual Meeting.

Leena Nahata

Leena Nahata, MD, a fellow in Pediatric Endocrinology at Children’s Hospital in Boston, and colleagues, wrote that advances in pediatric oncologic therapy have greatly improved survival rates, which has shifted the focus to the late effects of treatment, such as infertility. Focusing on adolescents who underwent bone marrow transplants (BMT) was of particular interest, they wrote, because total body irradiation prior to transplant and the use of alkylators are known to cause permanent gonadal damage.

“Specifically, in pubertal males, there is a method of fertility preservation that’s known to be safe and effective,” Nahata told Healio.com. “This leads us to ask, ‘Why isn’t this being used more often or more consistently?’”

The researchers analyzed data of 72 male cancer patients aged at least 13 years who had a BMT at the Dana-Farber Cancer Institute from 2003 to 2010. The most common diagnoses, they wrote, were acute lymphoblastic leukemia (n=24), acute myeloid leukemia (n=11), chronic myelogenous leukemia (n=7) and Hodgkin’s disease (n=9).

Four patients were excluded from the study because of inadequate information. Of the remaining 68 patients, only six had attempted to bank sperm before their initial oncologic therapy, suggesting that this cohort was thought to be at low risk for infertility, according to the researchers. Thirty-three patients attempted to bank sperm before BMT. Of those, 39% were azoospermic and 15% were oligospermic. Nineteen patients did not attempt to bank sperm, and in 13 patients, the decision to bank was unclear.

According to Nahata, the study demonstrates that even cancer therapies that may not be known to cause permanent infertility can cause transient gonadal dysfunction, precluding patients from being able to preserve their fertility after treatment has started.

In light of these findings, Nahata said a more consistent approach to fertility counseling is needed for all male adolescent cancer patients. Part of the problem, she added, is that although AAP and American Society of Clinical Oncology strongly recommend fertility counseling for all reproductive-aged patients around the time of initial diagnosis, the decision to counsel is subjective and left to the discretion of the practitioner.

“That leaves a lot of gray area in terms of which patients should be the most strongly encouraged to bank sperm at the time of initial diagnosis,” Nahata said. “Those recommendations can be interpreted in different ways. In what level of detail should we be discussing fertility and risk? Should everyone be encouraged to bank, or only those patients thought to be at highest risk? Further, our study shows that we are underestimating the risk of infertility in many of these patients.”

For more information:

Nahata L. #3855.704. Presented at: the 2012 Pediatric Academic Societies Annual Meeting; April 28-May 1, 2012; Boston.

Disclosure: Dr. Nahata reports no relevant financial disclosures.