Fertility Preservation in Children and Adolescents during Oncological Treatment—A Review of Healthcare System Factors and Attitudes of Patients and Their Caregivers

Abstract

Oncofertility is any therapeutic intervention to safeguard the fertility of cancer patients. Anti-cancer therapies (chemotherapy, radiation therapy, etc.) entail the risk of reproductive disorders through cytotoxic effects on gamete-building cells, especially those not yet fully developed. This literature review analyzes the available data on securing fertility in pediatric and adolescent populations to identify the methods used and describe aspects related to financing, ethics, and the perspective of patients and their parents. Topics related to oncofertility in this age group are relatively niche, with few peer-reviewed articles available and published studies mostly on adults. Compared to pubertal individuals, a limited number of fertility preservation methods are used for prepubertal patients. Funding for the procedures described varies from country to country, but only a few governments choose to reimburse them. Oncofertility of pediatric and adolescent patients raises many controversies related to the decision, parents’ beliefs, having a partner, ethics, as well as the knowledge and experience of healthcare professionals. As the fertility of young cancer patients is at risk, healthcare professionals should make every effort to provide them with an opportunity to fulfill their future reproductive plans and to have a family and offspring. Systemic solutions should form the basis for the development of oncofertility in pediatric and adolescent populations.

Fertility Preservation in the Era of Immuno-Oncology: Lights and Shadows

“…However, in order to retrieve mature eggs this procedure employs estrogen boosters to promote multiple follicular growth and needs a time-dependent maturation of oocytes requiring up to two weeks. Thus, for the intrinsic oncogenic effect, this is a risky procedure, particularly in adolescent patients with hormone-sensitive cancers [6] and is inconvenient in cases of urgent neoadjuvant treatments required for aggressive tumors [7], or in those of a prepubertal age [8]. Other strategies include autologous transplantation of cryopreserved cortical tissue strips after completion of cancer treatment [9], as well as the collection of immature oocytes at their germinal vesicle stage for subsequent in vitro maturation (IVM) and IVF [10].…”