Sperm cryopreservation is a far more cost-effective fertility preservation strategy than post-treatment surgical sperm extraction and assisted reproductive technology (ART) for men with testis cancer undergoing chemotherapy or radiation therapy, according to an analysis conducted by urologists at Emory University, Atlanta.
“Too often, men with testis cancer are deciding not to cryopreserve sperm because they are being misinformed about the cost of cryopreservation, the recovery of spermatogenic function after cancer therapy, or the success rates for ART. They are being told that sperm cryopreservation is expensive, and microdissection testicular sperm extraction (microTESE) combined with ART is a reliable option if they have no sperm in the ejaculate after completing cancer therapy,” said senior author Akanksha Mehta, MD, MS, of Emory University School of Medicine.
“Our research shows that sperm is not always found at the time of microTESE among testis cancer survivors, and even if it is, banking sperm upfront has a far lower cost-per-pregnancy than microTESE combined with ART, even when sperm is banked for several years. Therefore, we encourage physicians to consistently counsel patients to bank sperm. It is not only more cost-effective, but men will benefit psychologically knowing they have sperm in the bank before beginning gonadotoxic treatment.”
The analysis, presented at the AUA annual meeting, was performed using a decision tree constructed with the TreePlan add-in for Microsoft Excel. Cost-effectiveness of sperm banking and microTESE for chemotherapy and radiation therapy cohorts was calculated as the cost-per-pregnancy. The analyses took into account risk of azoospermia and rate of natural conception associated with each of the two cancer treatment options along with the rates of conception for intrauterine insemination (IUI) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) using data identified from a search of the published literature.