Journal of Assisted Reproduction and Genetics

, Volume 28, Issue 3, pp 269–277 | Cite as

Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer

  • Tobias S. Köhler
  • Laxmi A. Kondapalli
  • Amul Shah
  • Sarah Chan
  • Teresa K. Woodruff
  • Robert E. BranniganEmail author
Fertility Preservation



Diminished reproductive capacity is a devastating consequence of life-sparing therapies for childhood malignancy. In 2006, the American Society of Clinical Oncology (ASCO) published fertility preservation recommendations (ASCOR) emphasizing the importance of early discussion and intervention for fertility preservation strategies. Using the Survey for Preservation of Adolescent REproduction (SPARE), we sought to determine fertility preservation attitudes and practice patterns post-ASCOR from pediatric oncology specialists nationwide.

Materials and methods

The SPARE survey consists of 22 questions assessing pediatric oncology specialists’ attitudes and practice patterns toward fertility preservation. Broad perspectives on fertility preservation, including a willingness to discuss fertility, knowledge of current fertility preservation methods and awareness of ASCOR, were assessed.


The majority of respondents acknowledged that fertility threats are a major concern for them and agreed that all pubertal cancer patients should be offered a fertility consultation, but only 46% reported they refer male pubertal cancer patients to a fertility specialist prior to cancer treatment >50% of the time, and only 12% reported they refer female pubertal cancer patients to a fertility specialist prior to cancer treatment > 50% of the time. While 44% of respondents were familiar with the 2006 ASCOR, only 39% of those utilized them to guide decision-making in greater than half of their patients.


Our study demonstrates pediatric oncologists’ motivation to preserve fertility in pediatric cancer patients; however, barriers to both gamete cryopreservation and referral to fertility specialists persist. Female pubertal patients are referred to fertility preservation specialists with much less frequency than are male pubertal patients, highlighting a disparity.


Pediatric oncology Cryopreservation Fertility preservation Cancer Survey 


  1. 1.
    Bracken RB, Smith KD. Is semen cryopreservation helpful in testicular cancer? Urology. 1980;15:581–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Sanger WG, Armitage JO, Schmidt MA. Feasibility of semen cryopreservation in patients with malignant disease. JAMA. 1980;244:789–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Zapzalka DM, Redmon JB, Pryor JL. A survey of oncologists regarding sperm cryopreservation and assisted reproductive techniques for male cancer patients. Cancer. 1999;86:1812–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Glaser A, Wilkey O, Greenberg M. Sperm and ova conservation: existing standards of practice in North America. Med Pediatr Oncol. 2000;35:114–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Schover LR, Brey K, Lichtin A, Lipshultz LI, Jeha S. Oncologists’ attitudes and practices regarding banking sperm before cancer treatment. J Clin Oncol. 2002;20:1890–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Schover LR, Brey K, Lichtin A, Lipshultz LI, Jeha S. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. J Clin Oncol. 2002;20:1880–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Fertility preservation and reproduction in cancer patients. Fertil Steril. 2005;83: 1622−1628.Google Scholar
  8. 8.
    Ovarian tissue and oocyte cryopreservation. Fertil Steril. 2006;86: S142−147.Google Scholar
  9. 9.
    Lee SJ, Schover LR, Partridge AH, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24:2917–31.PubMedCrossRefGoogle Scholar
  10. 10.
    Nieman CL, Kinahan KE, Yount SE, et al. Fertility preservation and adolescent cancer patients: lessons from adult survivors of childhood cancer and their parents. Cancer Treat Res. 2007;138:201–17.PubMedCrossRefGoogle Scholar
  11. 11.
    Dilley KJ. Managing fertility in childhood cancer patients. Cancer Treat Res. 2007;138:50–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Gosiengfiao Y. Progress, history and promise of ovarian cryopreservation and transplantation for pediatric cancer patients. Cancer Treat Res. 2007;138:130–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Kinahan KE, Didwania A, Nieman CL. Childhood cancer: fertility and psychosocial implications. Cancer Treat Res. 2007;138:191–200.PubMedCrossRefGoogle Scholar
  14. 14.
    Gracia CR, Ginsberg JP. Fertility risk in pediatric and adolescent cancers. Cancer Treat Res. 2007;138:57–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Goodwin T, Elizabeth Oosterhuis B, Kiernan M, Hudson MM, Dahl GV. Attitudes and practices of pediatric oncology providers regarding fertility issues. Pediatr Blood Cancer. 2007;48:80–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Vadaparampil ST, Clayton H, Quinn GP, King LM, Nieder M, Wilson C. Pediatric oncology nurses’ attitudes related to discussing fertility preservation with pediatric cancer patients and their families. J Pediatr Oncol Nurs. 2007;24:255–63.PubMedCrossRefGoogle Scholar
  17. 17.
    van den Berg H, Langeveld NE. Parental knowledge of fertility in male childhood cancer survivors. Psychooncology 2007.Google Scholar
  18. 18.
    Oosterhuis BE, Goodwin T, Kiernan M, Hudson MM, Dahl GV. Concerns about infertility risks among pediatric oncology patients and their parents. Pediatr Blood Cancer. 2008;50:85–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. 2009;360:902–11.PubMedCrossRefGoogle Scholar
  20. 20.
    Arnon J, Meirow D, Lewis-Roness H, Ornoy A. Genetic and teratogenic effects of cancer treatments on gametes and embryos. Hum Reprod Update. 2001;7:394–403.PubMedCrossRefGoogle Scholar
  21. 21.
    Brannigan RE. Fertility preservation in adult male cancer patients. Cancer Treat Res. 2007;138:28–49.PubMedCrossRefGoogle Scholar
  22. 22.
    Shalet SM. Effect of irradiation treatment on gonadal function in men treated for germ cell cancer. Eur Urol. 1993;23:148–51. discussion 152.PubMedGoogle Scholar
  23. 23.
    Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update. 2001;7:535–43.PubMedCrossRefGoogle Scholar
  24. 24.
    Hoyer PB, Sipes IG. Assessment of follicle destruction in chemical-induced ovarian toxicity. Annu Rev Pharmacol Toxicol. 1996;36:307–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics. CA Cancer J Clin. 1999;49:8–31. 31.PubMedCrossRefGoogle Scholar
  26. 26.
    Ries L, Harkins D, Krapcho M, et al. SEER Cancer Statistics Review, 1975−2004. Available from URL:].
  27. 27.
    Ries L, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975−2004. Available from URL:].
  28. 28.
    Nieman CL, Kazer R, Brannigan RE, et al. Cancer survivors and infertility: a review of a new problem and novel answers. J Support Oncol. 2006;4:171–8.PubMedGoogle Scholar
  29. 29.
    Dolin G, Roberts D, Rodriguez L, Woodruff T. Medical hope, legal pitfalls: potential legal issues in the emerging field of oncofertility Santa Clara Law Review 2009;673−716.Google Scholar
  30. 30.
    Morice P, Castaigne D, Haie-Meder C, et al. Laparoscopic ovarian transposition for pelvic malignancies: indications and functional outcomes. Fertil Steril. 1998;70:956–60.PubMedCrossRefGoogle Scholar
  31. 31.
    Smitz J, Dolmans MM, Donnez J, et al. Current achievements and future research directions in ovarian tissue culture, in vitro follicle development and transplantation: implications for fertility preservation. Hum Reprod Update. 2010;16(4):395–414.PubMedCrossRefGoogle Scholar
  32. 32.
    Blumenfeld Z. How to preserve fertility in young women exposed to chemotherapy? The role of GnRH agonist cotreatment in addition to cryopreservation of embrya, oocytes, or ovaries. Oncologist. 2007;12:1044–54.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Tobias S. Köhler
    • 1
    • 7
  • Laxmi A. Kondapalli
    • 2
    • 7
  • Amul Shah
    • 3
  • Sarah Chan
    • 4
  • Teresa K. Woodruff
    • 5
    • 7
  • Robert E. Brannigan
    • 6
    • 7
    • 8
    Email author
  1. 1.Division of UrologySouthern Illinois University School of MedicineSpringfieldUSA
  2. 2.Division of Reproductive Endocrinology and Infertility, School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  4. 4.Division of UrologyUniversity of Maryland Medical CenterBaltimoreUSA
  5. 5.Department of Obstetrics and Gynecology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  6. 6.Department of Urology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  7. 7.Oncofertility ConsortiumNorthwestern UniversityChicagoUSA
  8. 8.Feinberg School of Medicine, Department of UrologyNorthwestern UniversityChicagoUSA

Personalised recommendations