Fertility preservation for young adults, adolescents, and children with cancer

Abstract

Options for fertility preservation (FP) through cryopreservation methods are currently available for young adults, adolescents, and children. Guidelines for FP have been provided by international clinical societies, and emergency procedures aimed at FP have been implemented into clinical practice worldwide. In this article, we review the current data on clinical standards of emergency FP in patients who are facing gonadotoxic effects of cancer treatment, and we also describe the methods that are still under development, usually denoted as experimental. In Sweden, programmes for FP have been established at large university hospitals, thus covering the whole country. The Swedish publicly financed health care covers both assisted reproduction for treatment of infertility and the cryopreservation of gametes or gonadal tissue when there is a medical indication, such as the risk to become infertile due to oncologic treatment; hence the access to FP is ensured for the whole population. At our centre at Karolinska University Hospital in Stockholm, methods for FP have been offered since 1988. In this article, we also review the oncologic indications for FP in our patient cohort of >3000 individuals during the period 1988-2018.

A prospective study on the long‐term outcome of prepubertal and pubertal boys undergoing testicular biopsy for fertility preservation prior to hematologic stem cell transplantation

“…Our FP program had been running for over 10 years, and postpubertal adolescents with cancer were offered the possibility to bank sperms from semen samples. 13 This had been an established option for several decades for FP of patients with cancer. 8,10,11 However, broad inclusion of very sick children of prepubertal or pubertal age in studies offering an eventual option of achieving reproduction at adult age is difficult, as well as ethically debatable.…”

“…For over three decades, postpubertal adolescent patients aged 14 or older at our center have provided semen samples to bank sperms before gonadotoxic treatments. 13 For prepubertal patients, testicular tissue cryopreservation has been proposed, 12,[14][15][16][17][18] aimed at preserving spermatogonic stem cells present in the tissue. Recent research has demonstrated the integrity, survival, and proliferative ability of cryopreserved spermatogonia.…”

Fertility-related information received by young women and men with cancer – a population-based survey

“…Infertility can result directly from the cancer disease [3] or from cancer treatments such as chemotherapy, irradiation, and surgery [4,5]. Several fertility preservation (FP) methods, including cryopreservation of gametes and gonadal tissue [6,7] can improve the chances of having biological children in the future. Sperm banking is a quick process, while embryo and oocyte freezing requires 2-3 weeks to complete and may not be possible if initiation of cancer treatment cannot be delayed.…”

Hot Topics on Fertility Preservation for Women and Girls—Current Research, Knowledge Gaps, and Future Possibilities

“…In the case of pre-pubertal children, this method is their current only option to cryopreserve reproductive potential [ 11 , 12 ]. In adolescents, additional methods to cryopreserve mature gametes can be practiced, similarly to as in adults, if they have completed puberty development [ 13 ]. As evidenced in an increasing number of publications, fertility preservation in prepubertal children is a specifically demanding area for research due to the naturally immature status of the gonads.…”