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September 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

Testicular tissue cryopreservation is a neglected topic in the fields of fertility preservation and bioethics not only because reproduction is usually associated with women and girls, but also because sperm banking is an established, easy, and cheap method that works for the majority of male cancer patients. However, norms surrounding fatherhood are changing, with more men interested in active fatherhood, and consequently fertility preservation is becoming and will continue to become increasingly important to male cancer patients.

When compared to the number of studies demonstrating the importance of fertility to female cancer patients, the literature focusing on male cancer patients’ perspectives on fertility is minimal. However, there are more researchers examining the latter topic today than in the past. Contemporary research on gendered perspectives on fertility preservation reveals a shift over time: although older studies generally found that female cancer patients value their fertility more (and in some cases significantly more) than male cancer patients, some newer research suggests that men value their fertility to equal degrees as women. For example, a 2009 study by Schover concluded that men experience similar levels of long-term distress over their impaired fertility as a result of cancer treatments. Likewise, research by Crawshaw and Sloper (2010) showed that, regardless of gender, fertility concerns affected identity, well-being, and life planning. Other studies also did not observe gender-related differences in the distress about fertility or the desire to have children (Schover et al. 1999; Zebrack et al. 2004).

What accounts for the increased value male cancer patients place on biological reproduction? Part of the reasons is that men want to be and are much more active in their children’s lives than even a generation ago. Instead of following the traditional fatherhood cultural trope of the somewhat distant but beneficent breadwinner and disciplinarian, men today are more involved in the everyday and often mundane aspects of childrearing. For instance, in a recent study, 89% of men took some time off after the birth of their child (Nepomnyaschy and Waldfogel 2007). On the more long-term end of child care, the U.S. Census Bureau estimates that there are approximately143,000 stay-at-home dads despite the fact that the concept of a father as the primary caregiver for his children is historically quite new. Men’s growing involvement in their children’s lives shows not only that fatherhood is extremely important for many men, but also that men’s active participation in their children’s lives is becoming more culturally acceptable. Because gender norms surrounding fatherhood have evolved and are continuing to evolve, men’s views on biological reproduction and parenthood have changed. In many ways, fatherhood plays a greater role in men’s identity and their vision of an ideal life. If men’s interest in active fatherhood continues to grow, we can expect that more research will be devoted to the topic of men’s reproduction, including male cancer patients’ views on potential infertility due to cancer treatment, and that the trend of male and female cancer patients equally valuing biological parenthood will strengthen.

In short, current research shows that men often find the threat of infertility from cancer treatment just as devastating as women. Given the importance male cancer patients place on fertility post cancer, as well as changing gender norms surrounding fatherhood that increase the value men place on becoming biological fathers, testicular tissue cryopreservation should be offered prepubescent cancer patients when appropriate and under institutional review board (IRB) approval.

References

Crawshaw, M. A., and P. Sloper. 2010. ‘Swimming against the tide’—The influence of fertility matters on the transition to adulthood or survivorship following adolescent cancer. European Journal of Cancer Care 19(5): 610–620.

Nepomnyaschy, L., and J. Waldfogel. 2007. Paternity leave and fathers’ involvement with their young children: Evidence from the American ECLS-B. Community, Work & Family 10(4): 427–453.

Schover, L. R. 2009. Patient attitudes toward fertility preservation. Pediatric Blood & Cancer 53(2): 281–284.

Schover, L.R., L. A. Rubicki, B. A. Martin, and K. A. Bringelsen. 1999. Having children after cancer. A pilot survey of survivors’ attitudes and experiences. Cancer 86: 697–709.

U.S. Census Bureau. 2006. Press release: Father’s day. June 12. Available at: http://www.census.gov/Press-Release/www/releases/archives/facts for features special editions/006794.html (accessed March 11, 2010).

Zebrack, B. J., J. Casillas, L. Nohr, H. Adams, and L. K. Zelter. 2004. Fertility issues for young adult survivors of childhood cancer. Psychooncology 13: 689–699.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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