Abstract: PD13-11
Sources of Funding: Urology Care Foundation Research Scholars Award

Introduction

Paternity is an important concern among young testicular cancer survivors. Despite this, some affected men elect not to cryopreserve sperm prior to undergoing cancer treatment, because of the perceived costs of cryopreservation and the perceived successes of assisted reproductive technology (ART). The goal of this study investigated the cost-effectiveness of sperm cryopreservation compared to fertility management after undergoing cancer therapy among men with testicular cancer. _x000D_

Methods

We performed a systematic search of the Pubmed database for the following variables: risk of azoospermia after orchiectomy, 2 year surveillance, chemotherapy, RPLND, and radiation therapy (RT); rate of natural conception after cancer therapy, rate of conception with the use of IUI, and IVF/ICSI. Costs of cryopreservation were based on costs published commercial sperm cryobank companies. A decision tree was constructed using the TreePlan add-in for Microsoft Excel (TreePlan Software, San Francisco, California). The cost-effectiveness outcome was determined by the overall weighted cost of a given management branch divided by that branch’s likelihood of pregnancy. A sensitivity analysis was performed for the price of microTESE between $3,000 to $11,000 and banking for a range of 2 to 10 years._x000D_

Results

Of the total 1,113 articles identified, 55 papers were pertinent to the study question, and included. Patients undergoing chemotherapy or active surveillance had the highest chance of azoospermia over a year after treatment, at 18%. The average cost of banking was $402 one time fee with an additional $343/year. In patients undergoing active surveillance, banking had a lower cost-per-pregnancy when storing for less than 4 years and microTESE was $9,000 or greater. Banking prior to chemotherapy is more cost-effective when banking for 6 or fewer years regardless of microTESE price. Patients receiving RPLND, banking was more cost-effective when banking for 4 or fewer years and the cost of microTESE was $7,000 or greater. Banking was more cost-effective when done for 8 or fewer years regardless of price in patients undergoing RT._x000D_

Conclusions

A large proportion of men have recovery of spermatogenesis following chemotherapy or RT for testicular cancer (82% and 94%, respectively). Nevertheless, sperm cryopreservation prior to chemotherapy or RT remains the most cost-effective strategy for fertility preservation, across a range of possible costs associated with surgical sperm retrieval and ART.

Funding

Urology Care Foundation Research Scholars Award