Sperm banking in adolescent males with nephrotic syndrome: defining the limits of access to fertility preservation

Improvements in the treatment of cancer have led to increased survival rates among adolescent and young adult (AYA) males. Among oncologists, there has been increasing consensus that fertility preserving techniques such as sperm banking should be offered to AYA males before initiating treatment with gonadotoxic alkylating agents such as cyclophosphamide (CPO).1 This wariness concerning the use of alkylating agents without mitigating their toxic effects stems from the physician's duty to do no harm. Since alkylating agents cause iatrogenic infertility and there is a treatment for that side effect, physicians are obligated to offer access to sperm banking in AYA males treated with alkylating agents. Sperm banking has the advantage of being a low-risk procedure with moderate cost and a reasonable rate of subsequent successful pregnancy in AYA males at Tanner III stage of development or greater.2 Adolescent patients who bank sperm report that they felt positively about attempting to provide a sperm sample regardless of success or failure.2 Individuals who were not offered the opportunity to bank reported subsequent …