To determine the application of fertility preservation (FP) counseling and sperm cryopreservation (SC) amongst reproductive-aged males diagnosed with testicular cancer using a population-level analysis.

We retrospectively assessed 16-49-year-olds diagnosed with testicular cancer and treated with orchiectomy between 2015 and 2025 using a large claims database, TriNetX. Primary outcomes were rates of FP counseling and SC within 180 days of testicular cancer diagnosis (90 days before-90 days after). We secondarily assessed rates of utilization within 90 days prior to orchiectomy, demographic differences in utilization, and whether receiving care at an academic center was associated with utilization. Academic and non-academic cohorts were propensity score matched for age, race, ethnicity, and compared using risk ratios. Z testing and T testing were used to compare categorical and continuous baseline characteristics, respectively.

Between 2015 and 2025, of 5907 16-49-year-olds diagnosed with testicular cancer and treated with orchiectomy, 563 (9.53%) underwent FP counseling and 498 (8.43%) underwent SC within 180 days of diagnosis. Two hundred forty-seven (4.18%) patients underwent FP and 286 (4.84%) underwent SC within 90 days prior to orchiectomy. Significantly more white patients and significantly younger patients underwent these services compared to those who did not. Those from academic centers were significantly more likely to undergo FP counseling (5.82% vs 0.98%, RR = 5.91, 95% CI = [3.14, 11.14]) and SC (5.64% vs 0%).

We found low utilization of FP counseling and SC in a large, national cohort of reproductive-aged testicular cancer patients, with differences in utilization regarding patient demographics and practice setting.

The data that support the findings in this study are available through trinetx.com