Of the roughly 2,800 men that will be diagnosed with cancer each day, fewer than half will have a conversation with their oncologist about preserving their fertility. Fertility preservation has been long recognized by the American Society of Clinical Oncology (ASCO) as a critical principle of cancer care, but in its recent 2025 guideline update, ASCO reinforced that commitment with even clearer language and stronger clinical expectations. The update, informed by 166 studies, urges that fertility counseling occur both at diagnosis and during survivorship, and that timely referrals to reproductive specialists be integrated into coordinated care. Most significantly, sperm cryopreservation is now explicitly defined as standard-of-care—not a discretionary or optional service.
Despite this, sperm cryopreservation remains drastically underutilized. Just over 5% of males aged 18–40 preserve sperm before cancer treatment. When fertility preservation isn’t addressed early, patients often face diminished sperm quality or are left with invasive, lower-success procedures like surgical sperm retrieval.
Where the System Falls Short
While banking more sperm early on can prevent costly and stressful challenges later—particularly for patients who may prefer lower-cost options like intrauterine insemination —a number of structural barriers stand in the way. Oncologists, already pressed for time, often struggle to incorporate fertility preservation into the narrow window between diagnosis and treatment initiation. Barriers cited include lack of nearby cryopreservation facilities and insufficient time to coordinate labs, explain procedures, or navigate consent paperwork that can span 10 pages or more.
Even when fertility is addressed, referrals can be shaped by implicit bias. Age, sexual orientation, illness severity, financial status, and perceived desire for future parenthood can all influence whether a patient is offered preservation options.
Patients face additional barriers of their own. Many are unaware that fertility preservation is even an option. Some are admitted directly to oncology units, bypassing any opportunity for reproductive counseling. Others live in geographic or economic health care deserts, where fertility services are scarce or inaccessible. Even for those who do reach a clinic, the process itself can be a deterrent—especially when it involves high out-of-pocket costs or the discomfort of producing a semen sample in an unfamiliar, clinical setting.
These barriers are not distributed equally—they compound the health inequities already faced by disadvantaged populations. Patients from distressed communities and underserved regions are significantly less likely to access fertility preservation services. Socioeconomic status, insurance coverage, educational attainment, and physical distance from a fertility center have all been independently linked to lower utilization rates.
The result is a wide—and unacceptable—gap between clinical recommendations and real-world implementation. Mail-in sperm cryopreservation offers a promising solution to close that gap.
Expanding Access Without Physician Burden
With mail-in sperm cryopreservation kits, patients collect samples privately at home and ship them to a CLIA-accredited laboratory for processing and storage—eliminating travel, scheduling delays, and much of the administrative burden on clinical teams.
- High completion rates: In a study of more than 1,500 cancer patients aged 18 or older who used Fellow Health’s mail-in cryopreservation kit, nearly 90% returned a sample within six weeks. Among adolescents and young adults, the completion rate was even higher at 93.9%. These outcomes were achieved without the support of a dedicated fertility program coordinator, demonstrating that mail-in approaches can succeed with minimal impact on clinical workflows.
- Durable sample integrity: Research using clinical-grade kits with validated stabilization media shows that total motile sperm counts remain stable—with no clinically significant loss in IVF potential—even after 48 hours at room temperature. Patients with low baseline counts may choose to bank multiple samples for IUI, but overall fertility potential is preserved.
- Reduced disparities: Analysis across diverse ZIP codes found no statistically significant difference in kit return rates by geography or socioeconomic status—effectively neutralizing two of the most persistent barriers to fertility preservation.
ASCO’s updated guidelines are an important step—but they are only as effective as the infrastructure built to carry them out. Without practical solutions that support convenient and equitable access, even the strongest clinical recommendations fall short. Mail-in cryopreservation has proven that it can meet this need—efficiently and at scale.
James F. Smith, MD, MS
James F. Smith, MD, MS, is Chief Medical Officer and New York State Lab Director at Fellow Health, and a Professor of Urology at the University of California, San Francisco.
