Parental Choices Shape Fertility Preservation for Boys With Cancer in China

When a child is diagnosed with cancer, the immediate focus is survival, and understandably so. Modern pediatric oncology has transformed outcomes to a remarkable degree: today, more than eighty percent of children and adolescents with hematologic malignancies are expected to live at least five years after diagnosis. Yet survival carries a quieter, long shadow. The very therapies that save young lives—intensive chemotherapy, pelvic or total body radiation, and bone marrow conditioning regimens—can permanently damage the reproductive system, leaving many survivors facing infertility in adulthood. A new cross-sectional study from West China Second University Hospital of Sichuan University, published in BMC Cancer, examines how parents of young male cancer patients in China decide whether to pursue fertility preservation, and its findings reveal a striking shift in what drives those decisions before and after treatment begins.

The research team, led by Shasha Liu and Fuping Li of the hospital’s Human Sperm Bank together with colleagues in pediatric hematology-oncology nursing, surveyed parents of boys aged zero to twelve years who were being treated for cancer. The study followed the STROBE guidelines for cross-sectional research and divided participants into two distinct groups: those whose sons had not yet started cancer treatment and those whose sons had already undergone therapy. This pre- and post-treatment stratification is more than a methodological nicety. It captures two fundamentally different decision windows. Before treatment, parents face an urgent, often overwhelming choice with a hard deadline, because many fertility preservation options must be pursued before gonadotoxic therapy starts. After treatment, the window has largely closed, and the decision landscape changes entirely.

In total, 134 patients were enrolled, with a mean age of just 6.0 years and a standard deviation of 2.9—meaning most of the boys were far too young to make or even understand reproductive decisions themselves. The responsibility fell entirely on their parents. When asked, 64.9 percent of parents—87 of the 134—expressed willingness to pursue fertility preservation for their sons. That roughly two-thirds figure is notable in itself, but the study’s real analytical power comes from its multivariable logistic regression models, which were run separately for each treatment group to identify which factors independently predicted parental willingness.

The results split cleanly along the treatment timeline. Among parents whose sons had not yet begun cancer therapy, the single significant predictor was a democratic parenting style. Parents who reported involving their children in decisions, listening to their views, and sharing authority were more than three and a half times as likely to be willing to pursue fertility preservation, with an odds ratio of 3.557 and a 95 percent confidence interval running from 1.094 to 11.567. The authors suggest that this parenting orientation reflects a broader openness to considering the child’s future personhood—including his eventual capacity to have his own family—even when that future cannot be discussed with the child directly.

In the post-treatment group, the picture changed. Here, two factors emerged as significant. The first was parental education: parents with higher educational attainment were roughly four times as willing to pursue fertility preservation (odds ratio 4.054, 95 percent confidence interval 1.021 to 16.094). The second was health belief: for each unit increase in parents’ scores on the health belief measures used in the study, willingness rose by 17 percent (odds ratio 1.170, 95 percent confidence interval 1.045 to 1.309). In other words, once treatment was underway or complete, what mattered was no longer how parents parented, but how much they knew and how strongly they believed that cancer treatment threatens fertility and that preservation offers a genuine benefit.

That second finding aligns with the Health Belief Model, the theoretical framework the researchers used to structure their inquiry. Developed in the 1950s to explain why people fail to use preventive health services, the model proposes that health behavior depends on perceived susceptibility to a threat, perceived severity of its consequences, perceived benefits of taking action, perceived barriers to doing so, and internal cues that prompt action. Applied to fertility preservation, the model predicts that a parent who understands that gonadotoxic therapy can cause infertility, who views that infertility as a serious harm to their child’s future quality of life, and who believes preservation is effective and feasible, will be far more likely to act. The post-treatment data bear this out: parents who had lived through the treatment experience, and who had absorbed its implications for reproduction, showed willingness that tracked closely with the strength of those beliefs.

The biology underlying the whole enterprise deserves attention. The germ cells in prepubertal testes—spermatogonial stem cells—are exquisitely vulnerable to alkylating chemotherapy agents and to radiation, both of which deplete the stem cell pool that would otherwise drive spermatogenesis after puberty. For adolescent boys who have already begun producing sperm, the standard of care is straightforward: semen cryopreservation before treatment. For prepubertal boys, however, there is no sperm to freeze, and the field relies on experimental approaches, most notably testicular tissue cryopreservation, in which a small biopsy containing spermatogonial stem cells is frozen with the hope of future reimplantation or in vitro maturation. These techniques remain investigational, but the stakes are high, and the decision to bank tissue must be made in the narrow interval between diagnosis and the first chemotherapy cycle—a window that can be measured in days.

This is why the study’s central conclusion is so pointed: parents’ recognition of cancer treatment’s impact on fertility, and their understanding of what fertility preservation can actually offer, are the key drivers of decision-making. Before treatment, when families are reeling from a new cancer diagnosis, those understandings are often incomplete, and the decision may hinge on temperament and family dynamics—hence the prominence of democratic parenting in the pre-treatment model. After treatment, when the emotional fog has partially lifted and parents have had time to learn, knowledge and belief take over. The asymmetry between the two models is itself the finding: the pre-treatment window, the one that matters most biologically, is the one in which parents are least equipped cognitively to make an informed reproductive choice.

The clinical implications follow directly. The authors argue that healthcare providers should initiate timely, clear communication about fertility preservation options before treatment begins, not after. This means that oncologists, nurses, and reproductive medicine specialists need protocols that bring fertility counseling into the earliest moments of pediatric cancer care, alongside consent discussions for chemotherapy itself. In China, where sperm banks exist in major cities but pediatric fertility preservation services remain unevenly distributed, the logistics are formidable. Testicular tissue cryopreservation is available at only a handful of centers, and many families live far from any facility equipped to perform and store such biopsies. Distance, cost, and the simple scarcity of counseling time during a medical crisis all act as barriers that the Health Belief Model would predict will suppress uptake.

At the policy level, the study’s recommendations are equally concrete: integrate fertility preservation counseling into standard oncology care and provide accessible educational resources for parents. In practice, that could mean decision aids in local languages, standardized counseling scripts for pediatric oncology teams, and formal referral pathways from oncology units to reproductive medicine services. The study was supported by the Sichuan Science and Technology Program, and its authors span the sperm bank, pediatric nursing, and pediatrics departments of the same hospital—an institutional arrangement that itself models the kind of collaboration the recommendations require. For the roughly two-thirds of Chinese parents who already say yes to fertility preservation, and for the third who hesitate, the message from Chengdu is clear: the conversation about a child’s future family should start on the day of diagnosis, not when the treatment is over and the options have narrowed to memory.

Subject of Research: Parental decision-making about fertility preservation for male children and adolescents undergoing cancer treatment in China

Article Title: Fertility preservation in young male adolescents and children before and after treatment with cancer in China: factors influencing the decision of parents

Article References: Fertility preservation in young male adolescents and children before and after treatment with cancer in China: factors influencing the decision of parents. (n.d.). https://doi.org/10.1186/s12885-026-17108-6

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17108-6

Keywords: fertility preservation, pediatric oncology, parental decision-making, China, spermatogonial stem cells, testicular tissue cryopreservation, Health Belief Model, chemotherapy-induced infertility, hematologic malignancies, health communication, reproductive medicine, childhood cancer survivors