Fertility Preservation in Males

Childhood malignancy is estimated to affect 1 in 168 Americans between the ages of 15 and 30 years [ 1 ] . Among the 1.75 million people diagnosed with cancer from 2004 to 2008, 9% were younger than 45 years of age, with 1% under 20 years of age [ 2 ] . In addition to the relatively large incidence of cancer diagnoses, young cancer patients are living longer due to ongoing improvements in cancer detection and treatment. The majority of childhood cancer patients experience long-term survival, with 5-year survival rates of 75–80% in patients under 50 years of age [ 2– 6 ] . This results in an estimated prevalence of 1 in 1,300 young US males who have survived childhood cancer [ 7 ] . As approximately 30% of these patients received therapies with secondary effects on fertility, the long-term impact of cancer treatment on reproductive function has become increasingly relevant in recent years [ 8 ] . To address the role of fertility preservation in cancer treatment, both the American Society for Reproductive Medicine (ASRM) and the American Society of Clinical Oncology (ASCO) have established recommendations for clinicians managing malignancy, including childhood cancers [ 9, 10 ] . In these documents, physicians are encouraged to address the topic of fertility preservation at the earliest opportunity, discuss available options, and consider referring patients to a quali fi ed reproductive specialist [ 10 ] . Despite the recognition that fertility preservation is an important survivorship issue, numerous factors continue to hamper its routine integration into clinical practice. These barriers include a lack of knowledge, time constraints, fi nancial concerns, discomfort discussing the topic, and lack of available