NATIONAL INPATIENT FERTILITY PRESERVATION PATTERNS

Document Type

Conference Proceeding

Publication Date

12-1-2025

Publication Title

Fertil Steril

Keywords

adult, awareness, conference abstract, cryopreservation, fertility, fertility preservation, hospitalization, human, Likert scale, male, male fertility, microdissection, microsurgical epididymal sperm aspiration, patient referral, practice guideline, survivorship, testicular sperm extraction, therapy, urologist, young adult

Abstract

OBJECTIVE: Fertility preservation is an essential component to cancer survivorship. One third of male survivors experience infertility following gonadotoxic treatments, and expeditious preservation prior to therapy is recommended by oncology guidelines. However, this can be challenging given time constraints, lab expertise, and financial considerations. We describe national practice patterns and identify barriers and facilitators regarding inpatient male fertility preservation. MATERIALS AND METHODS: An anonymous 34-item Qualtrics survey was sent to reproductive Urologists in the United States. Email addresses were obtained from public membership databases. Respondents were queried across several domains, including provider demographics, specific inpatient cryopreservation scenarios, and fertility preservation procedures. RESULTS: Thirty-two (17%, n=32/189) responses were received. The majority of respondents were fellowship-trained reproductive urologists 90.6% (29). The majority (96.9%) of respondents offer microdissection testicular sperm extraction (mTESE) for fertility preservation, and many offer conventional TESE (69%), traditional ejaculated sperm cryopreservation (69%), or microsurgical epididymal sperm aspiration (60%). Only 25% of respondents offer electroejaculation. Respondents rate non-urology provider awareness of male cancer fertility preservation options at 5.5/10 on a Likert scale. Many (68%) respondents provide formal materials or education to non-urology providers to address this deficit. On average, respondents reported 3 inpatient oncofertility preservation consults per month (range 0-25, median=1). Most (66%) of respondents reported that <25% of these patients ultimately complete inpatient preservation. Financial burdens (97%), logistical hurdles (97%), limited awareness (97%), and concern for delay of oncologic care (94%) were identified as the most common barriers for patients precluding fertility preservation. In addition, 81% of respondents also listed difficulty coordinating with other specialists as a barrier. On free-text queries, respondents identified facilitators of fertility preservation as automatically triggered consults, use of an urgent cryopreservation pager, formal fertility preservation pathway within the order set, and utilization of an inpatient coordinator as facilitators that aid in achieving timely fertility preservation prior to gonadotoxic therapies. CONCLUSIONS: Despite all reproductive urologists offering cryopreservation services and education regarding the urgency and priority of inpatient fertility preservation, less than a quarter of patients complete this process during hospitalization prior to initiation of treatment. This remains the consequence of numerous patient, provider and facility level barriers, even in systems with robust referral processes. IMPACT STATEMENT: Inpatient fertility preservation remains an underutilized and often missed opportunity. Multidisciplinary interventions are needed to address ongoing barriers. SUPPORT: No financial support.

Volume

124

Issue

6

First Page

e237

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