Fertility preservation options in pediatric and adolescent patients with cancer

Abstract

The incidence of childhood cancer has steadily increased since the 1950s, with approximately 16,000 children diagnosed each year. However, with the advent of more effective multimodal therapies, childhood cancer survival rates have continued to improve over the past 40 years, with >80% of patients now surviving into adulthood. Fertility preservation (FP) has become an important quality-of-life issue for many survivors of childhood cancer. As a result, the therapeutic options have become less gonadotoxic over time and more patients are being offered FP options. This review examines the indications for consultation, male and female FP options both in the prepubertal patient and adolescent patient, and the unique ethical issues surrounding FP in this vulnerable population. Cancer 2018;124:1867-76. © 2018 American Cancer Society.

The perceived impact of infertility on romantic relationships and singlehood among adult survivors of childhood cancer

“…In pediatric oncology, developmental stages and maturity of patients vary greatly, as does risk for infertility . Additionally, fertility preservation options vary by a child's age and sex, and remain experimental for young children . Families can also be overwhelmed by fertility‐related and cancer‐related information, or parents may choose not to share such information with their child .…”

“…7 Additionally, fertility preservation options vary by a child's age and sex, and remain experimental for young children. [8][9][10] Families can also be overwhelmed by fertility-related and cancer-related information, or parents may choose not to share such information with their child. 11,12 Due to the interplay of such factors, some survivors grow up knowing that they could be at-risk for infertility, whereas others may be surprised to learn about such risk in survivorship.…”

Recent advances in fertility preservation

“…Cancer incidence in children, adolescents and young adults has seen a slight increase since the 1970s, but death rates in patients aged 0–19 years have continued to fall. Current 5‐year overall survival estimates for childhood cancer exceed 83% (around 90% for most hematological malignancies), which translates into a growing population of adult survivors . It is widely known that most cancer treatments like chemotherapy, radiotherapy or a combination of both are highly toxic to the gonads, putting girls and women of reproductive age at risk of premature ovarian insufficiency (POI) and subsequent infertility .…”

Fertility preservation in pediatric and young adult female cancer patients

“…The protocol for medical ovarian stimulation via multiple hormonal injections and transvaginal oocyte retrieval in OC is quite similar to that of embryo cryopreservation. Its eventual use will require in vitro fertilization and clinical pregnancy rates (CPRs) range from 4% to 12%, with 36% to 61% of CPRs per subsequent transfer of frozen embryo [ 24 ]. As such, recent studies have demonstrated that transfer of embryos originated from frozen-thawed oocytes had comparable pregnancy rates compared to those using fresh oocytes [ 25 - 27 ].…”