You are living one of your worst nightmares: your teenage son was just diagnosed with cancer. To say it is a shock is an understatement, and the discussions are overwhelming and emotionally draining. You know the road ahead is going to be long and grueling. While you don’t want to take the attention away from saving your son’s life, you also can’t seem to shake your concerns about fertility preservation: a conversation that hasn’t yet arisen.
About 50% of people who survive childhood cancer go on to have fertility issues.¹ With increasing survival rates, more young men are facing the hard reality that they may not be able to become biological fathers. Since most children with cancer become survivors, the decisions your son makes about his future are just as important as his cancer treatment.²⁻³
The best time to talk about fertility preservation with your son is now. Infertility can have a negative impact on his identity and overall mental well-being. Many people experience the same amount of stress when they have fertility issues as they do with cancer.⁴ Men with infertility have higher rates of depression and anxiety, and often lose a sense of purpose in their lives.⁵⁻⁶ Infertility can also bring about feelings of loss and grief, as well as psychologically interfere with the ability to develop and maintain romantic relationships.⁵ ⁷ Fertility preservation can help prevent these negative mental health issues and give him peace of mind.
Chances are your son has already thought about future fatherhood. Surprisingly, nearly half of male teenagers say having children is one of their top life goals.⁸ Yet, sperm banking rates amongst teens with cancer remain below 50%, with some reports being as low as 1 in 5.¹ ⁸
Nevertheless, fertility concerns are likely to increase as time goes on for you and your son.⁹ Research shows that 50% of teenage boys who don’t bank their sperm prior to their cancer treatment regret their decision in as little as 1 to 2 months.¹⁰ For teenage boys who did decide to bank, or attempt to bank sperm prior to their treatment, only 7% regretted their decision.¹⁰
Even when survivors of childhood cancer are surveyed years later, fertility remains a predominant concern.⁹ But they aren’t the only ones affected by the lack of fertility-related conversations prior to treatment. Their parents—many of whom desire to become grandparents—also regret not having timely conversations about fertility preservation with their sons.⁹
There are fertility preservation options for all ages, but these conversations should ideally occur before your son’s treatment starts, irrespective of age. For some regimens, even one round of treatment can negatively impact fertility. Therefore, timing is critical—especially since preserving sperm may provide psychological relief and hope for the future.¹¹ ¹²
It’s important to note that not all cancer treatments affect fertility. Make sure you speak with your son’s oncologist to determine how cancer treatment may impact his future plans to have children. This can help you have an informed discussion with your son.
As his parent, you have a positive influence on your son’s decision to freeze his sperm and are likely best suited to have a timely conversation about it. In fact, your son is 4 to 5 times more likely to make a collection attempt if you recommend it.⁵ ¹³ Your son’s life has been turned upside down by his cancer diagnosis. Like you, he is probably feeling emotionally overwhelmed and mentally drained. Nevertheless, walking into his room and saying, “Son, let’s talk about your fertility and banking your sperm” might well be met with a literal teenage eye roll.
Talking with your son about fertility preservation can be sensitive and awkward for both of you, so here are some tips on how to start:
1) Acknowledge both the importance and awkwardness of the conversation.
Your son probably doesn’t want to have the conversation more than you do. He may shy away from talking about it. That’s a normal teen reaction, so let him know this conversation is not easy for either of you, but it’s important.
2) Normalize the process.
Most sperm collection happens through masturbation. Emphasize that this is part of normal sexual development, and that this behavior is not deviant.
The more physically mature your teen is, the more likely he is to understand the process and actually make a collection attempt; therefore, your younger teen may have more questions.⁵ Answer them honestly and non-judgmentally.
3) Validate his feelings.
Cancer is a life-changing event, and most teens aren’t faced with deciding to preserve fertility. You and your son are experiencing a lot of emotions—all of them are normal. Remind him that his feelings are important and that it’s beneficial to recognize and talk about them.
4) Reiterate that this is an ongoing conversation.
This is not a one-time conversation. While a decision needs to happen quickly, it doesn’t need to happen right now. There is time to get all your questions answered with his healthcare team, so derive questions for his doctor(s) together.
Empower him to be an active participant in the conversations about fertility with his healthcare team. Let him know you don’t want him to make a decision until all his questions are answered. Some examples of questions for your son’s doctor(s) are:
How likely is his treatment going to cause infertility?
What does the process look like? Is a fertility specialist available?
How long does the process take? Is there enough time to complete it before his treatment starts?
Fertility preservation can bring peace of mind and protect your son’s future mental health. Though it may not be for everyone, having the discussion together can ensure he makes an intentional decision that is best for him and his overall well-being.
Start the conversation today!
References
1. Olsavsky AL, Theroux CI, Dattilo TM, et al. Family communication about fertility preservation in adolescent males newly diagnosed with cancer. Pediatr Blood Cancer. 2021;68(7):e28978. doi:10.1002/pbc.28978
2. Robison LL, Hudson MM. Survivors of childhood and adolescent cancer: life-long risks and responsibilities. Nat Rev Cancer. 2014;14(1):61-70. doi:10.1038/nrc3634
3. S T, J B. Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod Update. 2009;15(5). doi:10.1093/humupd/dmp015
4. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14 Suppl:45-52.
5. Klosky JL, Lehmann V, Flynn JS, et al. Patient factors associated with sperm cryopreservation among at-risk adolescents newly diagnosed with cancer. Cancer. 2018;124(17):3567-3575. doi:10.1002/cncr.31596
6. Crawshaw MA, Sloper P. ’Swimming against the tide’--the influence of fertility matters on the transition to adulthood or survivorship following adolescent cancer. Eur J Cancer Care (Engl). 2010;19(5):610-620. doi:10.1111/j.1365-2354.2009.01118.x
7. Thompson AL, Long KA, Marsland AL. Impact of childhood cancer on emerging adult survivors’ romantic relationships: a qualitative account. J Sex Med. 2013;10 Suppl 1:65-73. doi:10.1111/j.1743-6109.2012.02950.x
8. Klosky JL, Simmons JL, Russell KM, et al. Fertility as a priority among at-risk adolescent males newly diagnosed with cancer and their parents. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2015;23(2):333-341. doi:10.1007/s00520-014-2366-1
9. Stein DM, Victorson DE, Choy JT, et al. Fertility Preservation Preferences and Perspectives Among Adult Male Survivors of Pediatric Cancer and Their Parents. J Adolesc Young Adult Oncol. 2014;3(2):75-82. doi:10.1089/jayao.2014.0007
10. Theroux CI, Hill KN, Olsavsky AL, et al. Satisfaction with Fertility Preservation Decisions among Adolescent Males with Cancer: A Mixed Methods Study. Cancers. 2021;13(14):3559. doi:10.3390/cancers13143559
11. Ginsberg JP, Ogle SK, Tuchman LK, et al. Sperm banking for adolescent and young adult cancer patients: sperm quality, patient, and parent perspectives. Pediatr Blood Cancer. 2008;50(3):594-598. doi:10.1002/pbc.21257
12. Klosky JL, Wang F, Russell KM, et al. Prevalence and Predictors of Sperm Banking in Adolescents Newly Diagnosed With Cancer: Examination of Adolescent, Parent, and Provider Factors Influencing Fertility Preservation Outcomes. J Clin Oncol Off J Am Soc Clin Oncol. 2017;35(34):3830-3836. doi:10.1200/JCO.2016.70.4767
13. Klosky JL, Flynn JS, Lehmann V, et al. Parental influences on sperm banking attempts among adolescent males newly diagnosed with cancer. Fertil Steril. 2017;108(6):1043-1049. doi:10.1016/j.fertnstert.2017.08.039
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