Evaluation of ovarian and testicular tissue cryopreservation in children undergoing gonadotoxic therapies

Abstract

Objective Ovarian and testicular tissue cryopreservation are the only fertility preservation options for sexually immature individuals. Because of their experimental nature, it is important to determine safety and possible bundling with other medicallyindicated procedures. Study design Prospective observational. Results Cryopreservation indications included cancer in 75 % of females and 50 % of males, while non-cancer indications included various hematological conditions. Similar numbers of females (12/28) and males (3/9) underwent prior chemotherapy. Females underwent laparoscopic (27/28) or robotic (1/28) approaches while incisional biopsy was used in males. Bundling of ovarian and testicular harvesting with other medicallyindicated procedures was performed in 42 % and 22 %, respectively. The operative time inclusive of bundled procedures was similar (1.6 ± 0.1 vs. 0.9 ± 0.3 h) but the discharge time was significantly longer for females than males (10.4±0.6 vs. 4.6±0.6 h, p<0.05) due to frequent bundling of medically-indicated procedures in females. All procedures were successfully completed without complications or significant blood loss. Conclusions Pediatric gonadal tissue cryopreservation can be combined with other medically-indicated procedures to minimize the potential inconvenience, additional anesthetic risks, and costs.Keywords Hematology/oncology . Children . Cryopreservation . Fertility preservationCapsule Ovarian and testicular cryopreservation is feasible alone or in combination with other procedures in children.S. Babayev and E. Arslan contributed equally to this work.

Ovarian tissue cryopreservation for fertility preservation in 418 girls and adolescents up to 15 years of age facing highly gonadotoxic treatment. Twenty years of experience at a single center

“…The mean age of patients was 6.9 years (range 0. [3][4][5][6][7][8][9][10][11][12][13][14][15]. The most frequent diagnoses in this cohort included neuroblastoma, acute leukemia and hemoglobinopathies; neuroblastoma being the most common diagnosis in very young patients.…”

“…Since preservation of ovarian tissue was proposed in 1996, girls of a very young age, between 0.6 and 5 years, have been reported in several series . The most frequent types of cancer presented in young patients in those cohorts are leukemias, bone tumors (Ewing's sarcoma and osteosarcomas), Hodgkin lymphoma and neuroblastoma …”

Fertility Preservation for Prepubertal Girls: Update and Current Challenges

“…Pediatric gonadal tissue cryopreservation can be combined with other medically indicated procedures such as central line placement to minimize the potential inconvenience, additional anesthetic risks, and costs [29-31]. In one study involving 28 female patients, 42 % were able have ovarian cryopreservation performed concurrently with another procedure [32•]. …”

Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed With Cancer

“…However, the immature gametes in the testicular tissue from pre-pubertal males have yet to be matured for fertility preservation purposes (Keros et al, 2007). Similar to females, there may be a risk to re-seeding malignant cells if the malignant tissue is reimplanted (Babayev et al, 2013). Three articles discussed this method in the literature (Table 7).…”

“…This procedure is feasible for tissue cryopreservation (Keros et al, 2007). This FP method can be bundled with another procedure such as a central line placement, and does not significantly increase operation or anesthesia time (Babayev et al, 2013). In addition, the testicular tissue cryopreservation is available at centers throughout the world (Glaser et al, 2004).…”