Fertility preservation in patients receiving cyclophosphamide therapy for renal disease

Abstract

Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to wellestablished methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.

In vitrodifferentiation of rat spermatogonia into round spermatids in tissue culture

“…It involves methods and procedures to retain fertility for those who are at high risk to lose it (Anderson et al ., 2015; Jahnukainen et al ., 2015). Indications for fertility preservation in males include any of the conditions that require gonadotoxic treatment such as cancer, systemic lupus erythematosus, sickle cell anemia, Fanconi anemia, multiple sclerosis and renal diseases (Silva and Brunner, 2007; Mersereau and Dooley, 2010; Miller et al ., 2012; Estes, 2015; Gajjar et al ., 2015; Jahnukainen et al ., 2015). Furthermore, spontaneous conditions that can cause failure in spermatogenesis are also considered an indication for fertility preservation or restoration, such as cryptorchidism or Klinefelter's syndrome (Jahnukainen and Stukenborg, 2012; Goossens et al ., 2013; Rives et al ., 2013; Picton et al ., 2015).…”

European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides – the SHARE initiative

“…MESNA was recommended to be co-administered with IV CYC(59). Sperm cryopreservation should be considered for all post-pubertal males prior to receiving CYC, although the complexity of achieving this in sick patients was acknowledged (60). There was insufficient evidence and lack of agreement amongst experts to recommend routine ovarian protection using triptorelin.…”

A short report on current fertility preservation strategies for boys

“…Most of these patients had planned treatment that was considered at moderate to high risk of infertility (>30% risk of infertility). Four patients had died (patient 8,16,17,20), while forty are still alive. Table 2 shows the detailed characteristics of patients who underwent TTCP.…”

“…Preconditioning treatment regimens prior to bone marrow transplantation for nonmalignant conditions such as aplastic anaemia or immunodeficiencies can also involve use of gonadotoxic chemotherapy. Cyclophosphamide in potentially gonadotoxic doses is also used in treatment of renal diseases such as glomerulonephritis and steroid resistant nephrotic syndrome …”