* * *

Orwig sees it as his mission to disabuse doctors of the idea that thinking about fertility has to be a burden. Recently, he stood in front of a hospital conference room full of oncologists working within the University of Pittsburgh Medical Center health-care company system at their quarterly meeting, and explained a gap in care: His team estimates that they could do 1,119 fertility procedures a year, but they expect to do only 144 this year. Harvesting tissue need not delay treatment, he maintains; it can be scheduled to coincide with treatment-related procedures. And oncologists need not help patients decide whether or not to participate. They could merely present the option, give the Fertility-Preservation Program’s hotline number, and step back.

Orwig and his team give patients the option of saving a whole testicle or 20 percent of testicular tissue. The benefit of a whole testicle is that the team has more to work with, but the effects are more obvious. Taking 20 percent only appears as an indentation. In either case, the team keeps a quarter of each sample for future research.

What are the chances a successful procedure for restoring fertility will be available by the time Dylan, who’s now 16, is ready to have children? Sanfilippo and Orwig insist they’d never suggest the procedure to patients if they didn’t foresee progress. Orwig uses egg freezing as a comparable example: In 2011, it was experimental. Now it’s a standard of care. With childhood-cancer survival rates up to 85 percent, they see it as their responsibility to advance treatment.

Orwig also considers it his duty to educate doctors and to push men to think about infertility more generally. According to him, although a roughly equal number of men and women struggle with infertility—about 12 percent—fewer men think about fertility preservation. Their doctors talk less about it, too. Female fertility preservation is more complicated and costs more, both in the moment and in long-term storage fees.

Word is slowly spreading. In July, Donald and Jacqueline Renk took their son Paxton, not quite 2 years old, to the ER because he hadn’t urinated in 24 hours, and a tumor was found in his bladder. When they later sat with Paxton on a hospital bed waiting for his chemo—which his doctors are using to shrink the tumor because it’s too big to be removed—they told his doctor that fertility was the last thing on their minds. The doctor mentioned the procedure, but they were doubtful. He advised them to think about whether it might be worthwhile for Paxton to have the option in the future.

And Paxton has a future for his parents to consider. His cancer is predicted to be gone within a year. The oldest of Donald and Jacqueline’s four other children asked, “So he won’t be able to adopt kids?” When they said he would, he replied, “Well, then what’s the big deal?” Donald and Jacqueline loved that this is how their children think. And they decided that if Paxton might have the opportunity to have a biological child in the future and it wouldn’t delay his treatment, then there was really no reason not to do it. At the very least, they reasoned, his sample could help others.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.