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New England Section of the American Urological Association

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Access to Male Fertility Preservation Information and Referrals at National Cancer Institute Cancer Centers
Kenneth A. Softness, MD1, Aaron Perecman, MD4, Taylor P. Kohn, MD3, Robert J. Carrasquillo, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, 2Frank H. Netter, MD School of Medicine, New Haven, CT, 3Johns Hopkins University, Baltimore, MD.

BACKGROUND: Future fertility and sexual function are critical quality-of-life issues for male cancer survivors. Access to subspecialists is not uniform throughout the United States. We sought to identify access gaps in male sexual health and fertility care at National Cancer Institute (NCI)-designated cancer centers (CC) across US Census Regions.
METHODS: 64 NCI center websites (14 CC and 50 comprehensive CC) were examined for language related to male sexual health and fertility. A phone-based survey was used to establish CC referral patterns to andrologists and sperm banks. The Society for the Study of Male Reproduction (SSMR) membership directory was used to determine geographic locations for andrologists relative to each CC. Fisher exact test and ANOVA were used for categorical and continuous univariate comparisons, respectively. Multivariate logistic and linear regression were used to control for region and center type when assessing binary and continuous variables, respectively. Statistical significance was set to p<0.05.
RESULTS: Presence of information regarding fertility preservation, sexual health and male-specific fertility preservation was not associated with region (p=0.18, 0.17, 0.48, respectively), while presence of fellowship-trained andrologists within 5 miles of a CC was associated with region, favoring the Northeast (p=0.014). On logistic regression, centers whose websites discuss fertility were more likely to refer patients to sperm banks (OR 3.48 [1.11-12.29]). On linear regression, comprehensive CC were not more likely to have established referral patterns to andrologists or sperm banks, or be geographically closer to andrologists when compared to non-comprehensive CC (p=0.75). CONCLUSIONS: We demonstrate geographic differences in access to sexual health and fertility care at NCI-designated CC in the United States, with greater representation of andrologists in the Northeast. The association between online information regarding male fertility preservation and referral access to sperm banks suggests that certain centers may greater emphasize fertility and sexual health care compared to others. Our methods of data collection are tools readily available to patients and can be a focus of efforts to improve access to care in this population.

Access to online fertility information, andrology referrals, and sperm banking by US census region
US Census Region (N)Overall Fertility InformationOverall Sexual Health InformationMale Fertility InformationReferral to Specific UrologistReferral to AndrologistReferral to Sperm BankAverage number of andrologists in 5 mile-radius
Northeast (14)50.00%42.85%42.85%85.71%78.57%50.00%2.2
Midwest (14)78.57%56.25%50.00%78.57%78.57%42.86%0.8
South (21)47.61%33.33%28.57%76.19%66.67%71.43%0.5
West (15)40.00%26.67%26.67%85.71%80.00%60.00%0.8


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