Regional air transportation of ovarian tissue for cryopreservation in a prepubertal female with cancer

Abstract

Ovarian tissue cryopreservation is the only fertility preservation (FP) option available to prepubescent females receiving gonadotoxic therapy, but it has limited availability. A 6-year-old female was diagnosed with high-risk rhabdomyosarcoma, and the planned treatment carried an 80% risk of ovarian failure. Her parents desired FP, but the nearest center was 500 miles away. The patient underwent oophorectomy at the cancer center with air transport of the tissue to the oncofertility center, where it was successfully cryopreserved. Formation of networks between full-service and limited oncofertility centers in a hub-and-spoke model would increase access to FP services, particularly in children. K E Y W O R D Sfertility preservation, oncofertility, ovarian tissue cryopreservation INTRODUCTIONAs survival in pediatric oncology has improved, greater emphasis has been placed on survivorship, including fertility preservation (FP)for those undergoing gonadotoxic therapies. 1,2 Discussion of fertility prognosis and preservation is the standard of care. [3][4][5] Risk prediction models for ovarian failure in children with cancer exist. 6,7 Historically, FP for females has been limited to oocyte and embryo cryopreservation, which is impossible before puberty. The only FP option for prepubertal females is ovarian tissue cryopreservation (OTC), which involves harvesting ovarian tissue for future autotransplantation or in Abbreviations: FP, fertility preservation; OTC, ovarian tissue cryopreservation.vitro maturation and fertilization. This technique has been trialed over the past two decades, resulting in 130 live births and touting pregnancy rates of 29-41% after autotransplantation, 2,8 at least two of which occurred after prepubertal OTC. 9,10 It is expected that more pregnancies after prepubertal OTC will soon occur, as these women are now reaching the age of desired fertility, and work on in vitro maturation and fertilization continues to progress. The American Society for Reproductive Medicine recently designated OTC as standard rather than experimental therapy 8,11 ; however, other groups continue to advocate that OTC in children should remain under institutional review board oversight. 12 Although the majority of survivors of childhood cancer desire fertility, FP services are underutilized due to multiple barriers, including

Fertility preservation in children and young adults with cancer

“…Protocols that are implemented when at-risk patients are identified as such and may increase the rates of those who pursue cryopreservation [38]. Air transportation of tissue to a cryopreservation facility is a possibility for patients unable to seek treatment at a larger center [39]. Surgical technique should be continued to be optimized as ultrasonic surgical devices may cause less estradiol production and higher rates of folliculogenesis compared with sharp cold dissection of the ovary [40].…”