Fertility Preservation in Pediatric Oncology Patients: New Perspectives

Abstract

Over the past 30 years, advances in antineoplastic treatment led to a significant increase in the survival of patients with childhood cancer. In Europe and the United States, 82% of children, adolescents, and young adults survive 5 years from the cancer diagnosis and the majority achieves long-term survival into adulthood. The impact of cancer therapy on fertility is related to the age of the patient and to the duration, dose/intensity, and type of treatment. Exposure to chemotherapy or to radiation to gonads or pituitary brings long-term complications of cancer-directed therapies that include effects on reproductive capacity. Different methods to preserve fertility can be offered. In prepubertal women, ovarian tissue freezing, in vitro maturation, and surgical movement of ovaries outside the field of irradiation are still experimental. In pubertal and postpubertal women, oocyte-embryo freezing is an established option. In men, the options are sperm cryopreservation, gonadal transposition, and testicular tissue or spermatogonial cryopreservation and reimplantation. Fertility risks and provision of strategies to minimize cancer treatment impact fertility include discussion of the tail of the option before cancer treatment. Having to make a decision in a limited time, while still coming to terms with a potentially life-threatening diagnosis, can cause patients to feel overwhelmed. To date, there are no uniform guidelines on how to approach this problem, so it is important to be aware of it for proper clinical practice.

Fertility Preservation in Pediatric Age: Future Perspective among Andrological Diseases

“…After understanding all the fundamental passages of spermatogenesis and its regulation, it is possible to understand how various alterations created by external pathologies can affect the correct mechanism. Hormonal alterations will be the cause of the failure of Sertoli and Leydig cells to function, and alterations in temperature and the production of free radicals directly generated by stress on the testis will be the cause of the failure of spermatozoa to mature, and genetic alterations will be associated with more or less complete alterations in molecular regulatory mechanisms [ 2 , 3 , 4 , 5 , 6 , 7 ].…”

“…It is therefore essential to raise awareness around parents and doctors who care for pediatric patients suffering from cancer regarding the risks of infertility [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ].…”

“…Male infertility is, in addition, associated with several medical conditions—in particular the association between infertility and testicular cancer, cardiovascular disease, autoimmune diseases, and genetic disorders is well known. Male infertility is a condition that has always been less studied and known than female infertility; the problem of infertility often becomes apparent in adulthood, following tests performed in cases of failure to conceive naturally, when the only viable strategy is through medically-assisted procreation techniques [ 1 , 2 , 3 , 4 , 5 , 6 ].…”

“…Any disease that can be related to hypogonadotropic hypogonadism, with a deficiency of hypothalamic/pituitary function, can result in a defect in spermatogenesis, failing stimulation with GnRH on the pituitary or gonadotropins on the testis. The consequence of this is the absence of hormonal stimulation on the testis related to spermatogenesis [ 3 , 4 , 5 , 6 , 7 ].…”

Sperm count and future challenges for cancer patients

“…8 The other options are gonadal transposition, and testicular tissue cryopreservation and re-implantation. 9 It is imperative to preserve the fertility of male cancer patient, as it is a basic human right. 10 Successful pregnancies and deliveries have been reported after use of cryopreserved semen from cancer patients.…”