Oncofertility in adult and pediatric populations: options and barriers

Halpern, Joshua A.; Das, Arighno; Faw, Cory A; Brannigan, Robert E.

doi:10.21037/tau.2019.09.27

Cited by 30 publications

(40 citation statements)

References 111 publications

(115 reference statements)

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“…Fertility preservation techniques include cryopreservation of semen for young adults and men, and spermatogonial stem cells/testicular tissue cryopreservation for prepubertal boys [71]. The latter is still experimental [71], may not be widely available, and to date, no children have been conceived after spermatogonial stem cell or testicular tissue transplant. Despite the concerns regarding the psychological impact of reduced fertility after cancer treatment, the use of sperm banking for young patients with cancer varies.…”

Section: Menmentioning

confidence: 99%

Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments

Anderson

Clatot²,

Demeestere

et al. 2021

European Journal of Cancer

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It is well established that cancer and its treatment, whether by chemotherapy, radiotherapy, hormone therapy, or surgery, can adversely impact reproductive function in both women and men. The effects of cancer treatment on reproductive function in both sexes may lead to loss of fertility, sexual desire and function, and hormone deficiency, which results in additional long-term morbidity in more than a third of patients. Given the importance of reproductive function to most people, and the often devastating effect of cancer treatment on it, we propose that proactive assessment of the functional and endocrinological impact of treatment be made a vital component of the assessment of modern cancer treatment, and should be a routine part of discussions with patients before and after treatment, both in trials and in routine care. Reproductive counselling should be proactive and encouraged, as implementation of such counselling has been shown to be beneficial to patient mental health, quality of life, and adherence to treatment. Similarly, efforts should be made to provide more adequate and accurate information to patients, as well as to offer appropriate fertility

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Section: Menmentioning

confidence: 99%

Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments

Anderson

Clatot²,

Demeestere

et al. 2021

European Journal of Cancer

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“…3-6 Despite these longstanding clinical guidelines, oncofertility care is not routinely provided in pediatric and adult oncology settings due to multi-level barriers, such as incomplete patient-provider communication, 7 lack of clear referral pathways, 8-10 limited access to fertility programs, 11 and parental unwillingness to discuss reproduction with children. 12…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Despite these longstanding clinical guidelines, oncofertility care is not routinely provided in pediatric and adult oncology settings due to multi-level barriers, such as incomplete patient-provider communication, 7 lack of clear referral pathways, 8-10 limited access to fertility programs, 11 and parental unwillingness to discuss reproduction with children. 12 A consistent theme across these multi-level barriers is the need to systemize processes for clinics and providers to improve routine patient engagement in oncofertility care. Interventions to address these barriers within health systems are limited in initial design to systematically address multi-level barriers, evaluation of efficacy, and scaling beyond single institutions.…”

Section: Introductionmentioning

confidence: 99%

A Multi-Component Telehealth Intervention to Improve Oncofertility Care Delivery among Young Cancer Patients: A Pilot Study

Yang

Dornisch

Nerb

et al. 2022

Preprint

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Purpose: Oncofertility care for pediatric, adolescent, and young adult cancer patients remains under-implemented across adult and pediatric oncology settings. We pilot tested an electronic health record (EHR)-enabled multi-component oncofertility intervention (including screening, referral, and fertility consult) in an adult academic oncology program and systematically assessed intervention fit to pediatric and community oncology programs. Methods: Using surveys (n=33), audits (n=143), and interviews (n=21) guided by implementation science frameworks, we pilot tested the EHR-enabled intervention for oncofertility care in young cancer patients at an adult oncology program and evaluated implementation outcomes. We interviewed healthcare providers from seven regional oncology and fertility programs about intervention fit to their clinical contexts. Results: We recruited 33 healthcare providers from an adult oncology setting and 15 healthcare providers from seven additional oncology and fertility settings. At the adult oncology setting, the intervention was found to be appropriate, acceptable, and feasible and improved the screening of fertility needs (from 30% pre- to 51% post-intervention), yet some patients did not receive appropriate referrals to fertility consults. Providers across all settings suggested content and context modifications, such as adding options to the intervention or allowing the screening component to pop up at a second visit, to improve and adapt the intervention to better fit their clinical care contexts. Conclusions: We found that the EHR-enabled intervention increased the rate of goal-concordant oncofertility care delivery at an adult oncology program. We also identified facilitators, barriers, and needed adaptations to the intervention required for implementation and scaling up across diverse oncology settings.

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“…Cancer treatments such as radiation, chemotherapy, and surgery, while life preserving, can threaten fertility in men, women, and children 1‐3 . Thus, numerous strategies to preserve fertility have been and continue to be developed 4‐6 .…”

Section: Introductionmentioning

confidence: 99%

A decellularized oocyte‐derived scaffold provides a “sperm safe” to preserve mammalian spermatozoa

et al. 2021

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Background Although only one spermatozoon is needed to create a zygote, a significant challenge is the storage and recovery of germ cells when sperm counts are extremely low. Objectives We engineered an oocyte‐derived biomaterial—the zona pellucida (ZP)—as a “sperm safe” for storing spermatozoon. The ZP is a glycoprotein matrix that surrounds the mammalian oocyte. Materials and Methods We made a hole in the ZPs using a Piezo drill and mechanically separated them from the oocyte cytoplasm. A subset of ZPs were further purified through decellularization. Using a modified ICSI approach, we injected sperm heads into purified ZPs and tested the efficacy of cryopreservation and recovery of spermatozoon as well as function. Results Between 1–6 sperm heads were injected into purified ZPs (average 2.7 ± 1.7 sperm heads/ZP), which were then cryopreserved. Upon thawing, an average of 2.5 ± 1.4 sperm heads/ZP were observed, and in 11 of 12 thawed “sperm safes,” we recovered all spermatozoa. Decellularized “sperm safes” maintained their three‐dimensional structure and had a denser matrix relative to untreated controls as assessed by scanning and transmitted electron microscopy. The efficacy of “sperm safe” derived spermatozoon was evaluated by ICSI. Spermatozoon stored in either untreated or decellularized “sperm safes” elicited egg activation‐associated calcium transients and zinc sparks when injected into eggs. Of the resulting zygotes, >80% of them formed pronuclei irrespective of the sperm source. 26.8 ± 4.6% and 18.1 ± 7.0% of the pre‐implantation embryos generated from spermatozoon recovered from untreated or decellularized “sperm safes” developed to the blastocyst stage, respectively. Although this development was lower than that using fresh spermatozoon (59.3 ± 19.3%) or conventionally frozen‐thawed spermatozoon (28.4 ± 1.7%), these differences were not significant. Discussion and Conclusion Purified ZPs represent a natural biomaterial for the efficient preservation and recovery of small sperm numbers.

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Oncofertility in adult and pediatric populations: options and barriers

Cited by 30 publications

References 111 publications

Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments

Cancer survivorship: Reproductive health outcomes should be included in standard toxicity assessments

A Multi-Component Telehealth Intervention to Improve Oncofertility Care Delivery among Young Cancer Patients: A Pilot Study

A decellularized oocyte‐derived scaffold provides a “sperm safe” to preserve mammalian spermatozoa

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