Fertility preservation options for children and adolescents with cancer

Abstract

Introduction: Cancer in children and adolescents has seen a stark rise in survival rates in the last decades; overall survival in excess of 80% can be reasonably expected for many newly diagnosed patients with malignancies in this age group. Survivorship has unfolded several specific issues faced by these patients, including fertility concerns. Hence, fertility preservation efforts have been discussed and undertaken with increased frequency. Methods: In this article, the authors provide a broad overview of the current recommendations surrounding fertility preservation in this patient population. Reasons to offer fertility preservation, target groups for interventions, and methods available based on age group and gender are discussed in detail. Results: The medical literature and patient advocates strongly support a discussion about fertility preservation at the time of diagnosis; the risk of infertility is real and parents and families wish to be informed about it. In postpubertal males, sperm-banking is relatively straightforward and should be attempted by most newly diagnosed patients, ideally before commencement of treatment. Cryopreservation of testicular tissue in higher-risk prepubertal males is feasible, but still experimental. Female fertility preservation is more complex, requires more invasive procedures, and can delay initiation of treatment due to the requirement for hormone stimulation of follicles prior to harvesting. Conclusions: Oncofertility initiatives in children and youth are still in their early days and will continue to expand; urologists should be prepared to offer counselling and interventions when appropriate to this growing vulnerable population.

Fertility education for adolescent cancer patients: Gaps in current clinical practice in Europe

“…Previous studies have also shown lower utilisation rates of fertility preservation for female compared with male patients among adolescent and young adult cancer patients (Bann et al., 2015; Benedict et al., 2016; Shnorhavorian et al., 2015). This difference may be explained by the fact that sperm cryopreservation is a safe, reliable and easily available method of fertility preservation in post‐pubertal males (Romao & Lorenzo, 2017; Skinner et al., 2017). In contrast, cryopreservation of oocytes in post‐pubertal females requires hormonal stimulation and therefore delays the start of cancer treatment, which can be prohibitive with most adolescent malignancies (Dittrich et al, 2018; Romao & Lorenzo, 2017).…”

“…Fertility preservation should be pursued prior to cancer treatment. Sperm cryopreservation is a well‐established method for post‐pubertal male patients (American Society for Reproductive Medicine et al., 2013; Romao & Lorenzo, 2017; Skinner et al., 2017). Options for females include cryopreservation of unfertilised or fertilised oocytes for post‐pubertal patients, or surgical transposition of the ovaries outside of the pelvic radiation field (American Society for Reproductive Medicine et al., 2013; Dittrich et al, 2018; Lobo, 2005).…”

Making gametes from alternate sources of stem cells: past, present and future

“…Semen preservation prior to oncotherapy in male cancer patients is advocated for fertility preservation and testicular tissue biopsies are cryopreserved for young pre-pubertal boys [ 63 ]. The field of using cryopreserved testicular tissue for fertility restoration has not developed as impressively as restoring fertility in females from cryopreserved ovarian tissue.…”

Impact of legislation and public funding on oncofertility: a survey of Canadian, French and Moroccan pediatric hematologists/oncologists

“…Finally, guidelines for best practices in counseling are critical to an ethical offer of OTC. Discussion with a fertility specialist should ensure all relevant information is disclosed to promote informed consent and assent [44,48]. Required general anesthesia, minor surgical procedure, need for research participation, experimental nature, and uncertainty of long-term efficacy should be discussed.…”