Views of male childhood cancer survivors on fertility preservation and restoration

Abstract: In this study, we aimed to uncover the perspectives of male childhood cancer survivors on parenthood, fertility preservation, and potential fertility restoration using their own cryopreserved testicular biopsy. We invited all young men eligible for this study, 27 male cancer survivors over the age of 16 who had undergone a testicular tissue biopsy in the past in Amsterdam, of whom five men (18.5% response rate) decided to participate. In semi-structured interviews, we discussed their views on parenthood, testicular cryopreservation, and potential fertility restoration, specifically through spermatogonial stem cell transplantation (SSCT). All data were pseudonymized before analysis via open coding using MAXQDA software. We found that all five participants (ages 17-24) had actively thought about family planning, and some expressed a very strong wish to experience parenthood, although they were aware of potential fertility issues related to their treatments. However, these participants reported that fertility issues had been minimally discussed at the late effects clinic during checkups, and they therefore had a limited understanding of the potential and restrictions of fertility restoration techniques such as SSCT. Overall, these participants displayed a high willingness to undertake additional steps to achieve biological parenthood and low levels of concern regarding the safety of SSCT. Autonomy and the opportunity of choice were determining factors in their underlying views. Perspectives and needs of these survivors, for whom a testicular biopsy was cryopreserved as a child, predominantly revolved around the importance of having autonomy over their fertility choices and being adequately informed to make those choices. Lay summary: Treatments for childhood cancer may lead to infertility. To safeguard the fertility of young male cancer patients, a testicular biopsy can be frozen that contains spermatogonial stem cells (SSCs), the basis for spermatogenesis. This study focused on SSCT, a new fertility restoration treatment. Through interviews with five male survivors (aged 17-24), we explored their experiences and opinions on fertility preservation and restoration. In general, participants were happy with their parents' decision to freeze a biopsy. The freedom to choose was a key topic for them. They were willing to take the required steps to reach parenthood if desired. They had few concerns about the safety of SSCT but had questions about the chances of success. Their trust in science and healthcare was strong. However, in their experience, fertility was not sufficiently discussed during follow-up care. The results support doctors, former childhood cancer patients, and their parents concerning fertility after childhood cancer.