title: Monitoring fertility (semen analysis) by cancer survivors who banked sperm prior to cancer treatment.
abstract: OBJECTIVE
  What medical and psychological variables predict why men with banked sperm do not return for semen analysis after their cancer treatment has ended?
  
  
  CONCLUSIONS
  Men who decline the offer of semen analysis are less likely to have reported adverse side effects during cancer treatment, and have a more negative experience of banking sperm and a more negative attitude towards disposal of their stored semen than those who attend.
  
  
  BACKGROUND
  Previous authors have noted that male cancer survivors seem reluctant to have their fertility tested after their treatment has ended. Moreover, the utilization rates of banked sperm are very low (<10%) and the majority of samples are kept for many years without being used.
  
  
  METHODS
  A cross-sectional study of 499 cancer survivors who were sent a questionnaire about their views on sperm banking, fertility and post-treatment semen analysis between April 2008 and December 2010.
  
  
  METHODS
  Men (aged 18-55 years) who had banked sperm in Sheffield and Nottingham (UK) prior to gonadotoxic treatment for cancer more than 5 years previously.
  
  
  RESULTS
  Completed questionnaires were received from 193 men (38.7% response rate) whose samples had been banked for 9.18 ± 3.70 years (range = 4.94-26.21) and whose current age was 35.08 ± 7.08 years (range = 21.58-54.34; mean ± SD). One-third (35.8%) had never attended for semen analysis. In multivariate analysis, the odds of not attending for semen analysis were significantly greater among men who did not experience adverse treatment side effects [odds ratio (OR) = 5.72, 95% confidence interval (CI) = 2.10-15.56], who reported a more negative experience of banking sperm (OR = 1.82, 95% CI = 1.17-2.82) and a more negative attitude to disposal of their stored semen (OR = 1.56, 95% CI = 1.01-2.42).
  
  
  CONCLUSIONS
  Only 38.7% of those eligible agreed to take part. We do not know the characteristics of men who declined to take part, if they agreed to attend semen analysis without completing the questionnaire or whether they had chosen to have semen analysis performed elsewhere (e.g. private sector). Some of the measures used (e.g. experience of banking sperm) relied on men's recall of events many years previously.
  
  
  CONCLUSIONS
  New strategies are required to encourage these men to engage with fertility monitoring programmes if sperm banks are to be used cost-effectively and men are to be given appropriate fertility advice.
  
  
  BACKGROUND
  This paper was supported by funding from Cancer Research-UK to C.E., A.A.P. and R.R. (C481/A8141). The views expressed are those of the authors. No competing interests declared.
authors.affiliation: Academic Unit of Reproductive and Developmental Medicine, Department of Human Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK. a.pacey@sheffield.ac.uk
authors.forename: A A
authors.initials: AA
authors.lastname: Pacey
authors.forename: H
authors.initials: H
authors.lastname: Merrick
authors.forename: E
authors.initials: E
authors.lastname: Arden-Close
authors.forename: K
authors.initials: K
authors.lastname: Morris
authors.forename: L C
authors.initials: LC
authors.lastname: Barton
authors.forename: A J
authors.initials: AJ
authors.lastname: Crook
authors.forename: M J
authors.initials: MJ
authors.lastname: Tomlinson
authors.forename: E
authors.initials: E
authors.lastname: Wright
authors.forename: R
authors.initials: R
authors.lastname: Rowe
authors.forename: C
authors.initials: C
authors.lastname: Eiser
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015925:Cryopreservation; D004739:England; D059247:Fertility Preservation / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007248:Infertility, Male / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology* / Q000628:therapy; D055101:Semen Analysis / Q000523:psychology / Q000706:statistics & numerical data; D012662:Semen Preservation / Q000523:psychology*; D013074:Sperm Banks; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology*; D055815:Young Adult