The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Cancer. 2018 Sep 1;124(17):3567-3575. doi: 10.1002/cncr.31596. Epub 2018 Jul 5.
Although survivors of adolescent-onset cancers are at risk of infertility, the majority desire children. Fertility preservation options are available for adolescents, but sperm banking remains underused. To the authors' knowledge, patient factors that influence decisions to bank sperm are poorly understood.
A cross-sectional study of 146 adolescent males who were newly diagnosed with cancer and who completed surveys within 1 week of treatment initiation was performed. Participants, 65% of whom were white, were aged 13 to 21 years (mean, 16.49 years; standard deviation, 2.02 years) and were at risk of infertility secondary to impending gonadotoxic treatment. Participating institutions included 8 leading pediatric oncology centers across the United States and Canada.
Of the patients approached, approximately 80.6% participated. Parent recommendation to bank (odds ratio [OR], 4.88; 95% confidence interval [95% CI], 1.15-20.71 [P = .03]), higher Tanner stage (OR, 4.25; 95% CI, 1.60-11.27 [P < .01]), greater perceived benefits (OR, 1.41; 95% CI, 1.12-1.77 [P < .01]), and lower social barriers to banking (OR, 0.88; 95% CI, 0.81-0.96 [P < .01]) were found to be associated with adolescent collection attempts, whereas meeting with a fertility specialist (OR, 3.44; 95% CI, 1.00-11.83 [P = .05]), parent (OR, 3.02; 95% CI, 1.12-8.10 [P = .03]) or provider (OR, 2.67; 95% CI, 1.05-6.77 [P = .04]) recommendation to bank, and greater adolescent self-efficacy to bank (OR, 1.16; 95% CI, 1.01-1.33 [P = .03]) were found to be associated with successful sperm banking.
Adolescents' perceived benefits of sperm banking, higher Tanner stage, and parent recommendation were associated with collection attempts, whereas perceived social barriers decreased this likelihood. Successful banking was associated with greater adolescent self-efficacy, parent and provider recommendation to bank, and consultation with a fertility specialist. Providers should consult with both adolescents and parents regarding fertility preservation, and interventions should be tailored to address barriers to sperm banking while promoting its benefits.
尽管青少年期癌症幸存者有不孕的风险，但大多数人都希望生育孩子。青少年有多种生育力保存选择，但精子库的使用仍然不足。据作者所知，影响患者决定精子库的因素了解甚少。
对 146 名新诊断患有癌症且在开始治疗后 1 周内完成调查的青少年男性进行了横断面研究。参与者中 65%为白人，年龄在 13 至 21 岁之间（平均 16.49 岁，标准差 2.02 岁），由于即将进行性腺毒性治疗，他们有不孕的风险。参与的机构包括美国和加拿大的 8 家领先的儿科肿瘤中心。
在接触的患者中，约 80.6%的患者参与了研究。父母建议进行精子库保存（比值比 [OR]，4.88；95%置信区间 [95%CI]，1.15-20.71 [P = .03]）、较高的 Tanner 分期（OR，4.25；95%CI，1.60-11.27 [P < .01]）、更高的感知益处（OR，1.41；95%CI，1.12-1.77 [P < .01]）和较低的精子库保存社会障碍（OR，0.88；95%CI，0.81-0.96 [P < .01]）与青少年采集尝试相关，而与生育专家会面（OR，3.44；95%CI，1.00-11.83 [P = .05]）、父母（OR，3.02；95%CI，1.12-8.10 [P = .03]）或提供者（OR，2.67；95%CI，1.05-6.77 [P = .04]）建议进行精子库保存、青少年自我效能感更高（OR，1.16；95%CI，1.01-1.33 [P = .03]）与成功的精子库保存相关。
青少年对精子库保存的感知益处、较高的 Tanner 分期和父母的建议与采集尝试相关，而感知到的社会障碍则降低了这种可能性。成功的精子库保存与青少年自我效能感更高、父母和提供者建议进行精子库保存以及与生育专家咨询相关。提供者应与青少年及其父母一起讨论生育力保存问题，干预措施应针对精子库保存的障碍，并同时宣传其益处。
