Sperm you can bank on

As the scientific head of a sperm bank providing a sperm storage service for men about to undergo treatments such as chemotherapy and radiotherapy I had often pondered with colleagues and friends how I might react if I was ever given a diagnosis of cancer and needed to decide whether to bank sperm. Such discussions invariably ended in the conclusion that I would decline the offer, as for various reasons I have no desire to father children. So imagine my surprise when, aged 35 and facing an orchidectomy after having been given a diagnosis of testicular cancer, I found myself making arrangements to bank sperm as quickly as possible.

Until then I had always been of the view that men requesting sperm banking did so in order to start or complete a family. After my own experience, however, I have questioned this view. Looking back I can only now explain my decision to bank sperm as something positive to do at an otherwise emotionally negative time. Although I had a clear understanding that in my case the risk of infertility was insignificant, this insight had little bearing on my decision making. In spite of what my logical brain was telling me, I think there was a nagging doubt that if I did not bank some sperm I might later regret the decision. That alone was too big a risk to take.

From subsequent discussions with patients I have come to realise that I am not alone in having non-reproductive reasons that strongly influenced my decision. One patient (in his 50s) told me how he asked to bank sperm so as to “wipe the smile off his oncologist's face” when he was told he was going to die and “that there was no point in considering [his] fertility because he did not have a partner.” He then described how he found the whole experience “uplifting” and as “giving him something to live for.” Another patient explained how he only accepted the offer to bank sperm because he was gay and did not want to justify his decision to decline, fearing that to reveal his sexuality could have a negative impact on the subsequent quality of his treatment for cancer. A third patient explained that, like me, he had no desire to father children but felt that by banking sperm he was in some way “preserving his masculinity.” While this is clearly a small sample, if such views are more common than we acknowledge then they may go some way to explain the relatively low numbers of men (10% to 20%) who return to use their frozen sperm to try to have a child.

Maybe simply knowing that their sperm is somewhere safe is a psychological benefit to men

It may seem a waste of resources to provide sperm banking for men who have no obvious desire to start a family and who may never use their stored sperm. This is particularly true when you consider that most banks have been developed as an “add on” to other fertility services and are poorly resourced. The situation is made worse by the many men who do not respond to routine letters from the sperm bank or who seem reluctant to agree to dispose of their samples even when semen analysis has shown that their fertility has been unaffected by their treatment or when they have fathered children naturally. A common perception among professionals and managers in the field is that many samples are being stored needlessly. Given that legally sperm can be stored for up to 40 years, in some cases, the costs can be significant. Yet perhaps we are missing the point. Maybe simply knowing that their sperm is somewhere safe, irrespective of what decisions they may or may not make about fathering, is a psychological benefit to men.

We have little understanding of the decision making processes that men make with regard to sperm banking. There is almost no published literature on the subject, and we are largely guided by our own opinions, experience, and—in some cases—prejudice. It is no surprise, therefore, that staff on the ground sometimes question whether they are providing a good service, both at the time of initial banking and in the many years of follow up.

As for me, I am still confused about what exactly went on in my head at the time of the diagnosis and about what is still going on as I now wrestle with the decision to have my samples destroyed, given that my fertility has now recovered. Nearly three years down the line I feel almost embarrassed by my actions at the time. Yet I have learnt that this is a more complex area than I had previously discussed at dinner parties or in the pub. The issue warrants more of our attention if we are to learn to use sperm banks wisely and how best to help men at such a traumatic time.