Reframing sperm cryopreservation in male cancer survivors: from procedural success to meaningful utilization.

The expert review by Alexander and colleagues addresses a long-standing yet insufficiently interrogated paradox in contemporary oncofertility item: While sperm cryopreservation prior to gonadotoxic cancer therapy is widely endorsed, technically straightforward, and increasingly accessible, its subsequent utilization by male cancer survivors remains consistently low. This discrepancy, persisting across institutions, health-care systems, and decades, suggests that the challenge is no longer primarily technical or educational, but structural, temporal, and psychosocial in nature. The central merit of this review lies in its deliberate shift away from a narrow, procedure-centered conception of fertility preservation toward a longitudinal, survivorship-oriented framework. In doing so, the authors implicitly challenge the field to reconsider what constitutes "success" in oncofertility. If success is defined merely as successful banking prior to treatment, then current practice may appear satisfactory. If, however, success is defined as enabling informed, autonomous, and timely reproductive decision-making across the survivorship trajectory, then the low utilization rates described in this review represent a clear failure of care continuity.