Fertility preservation in children and young adults with cancer

Abstract

Purpose of reviewThe issue of fertility preservation has become increasingly relevant as survival rates of children with cancer exceeds 80% at 5 years. Fertility preservation options are being utilized alongside less gonadotoxic therapeutic regimens in the treatment of these patients. The purpose of this review is to summarize the recent advances in fertility preservation in the pediatric, adolescent, and young adult population. Recent findingsEducation research involves both patient and provider; to increase understanding on both sides for improved adoption of techniques and higher rates of posttreatment fertility. Basic science research, specific to the pediatric population, has worked to further understanding of protective techniques and cryopreserved tissue transfer. Research on the techniques of preservation confirms the safety of surgical gonadal (ovarian and testicular) tissue retrieval for cryopreservation but a viable pathway for testicular tissue utilization, as it has for ovarian, has yet to be realized. Outcomes may be improving but it is apparent that robust registries are necessary to track patients long-term. Possibly the largest advancement in the recent past are group efforts, such as by PanCareLIFE, to create guidelines for these issues using larger cohorts and registries than were available.

Fertility Preservation in Children and Adolescents during Oncological Treatment—A Review of Healthcare System Factors and Attitudes of Patients and Their Caregivers

“…Other challenges connected with OTC and OTT include previous chemotherapy and the risks of reintroducing malignant cells together with frozen-thawed ovarian tis-sue [79,[82][83][84]. While it was suggested that OTC should be performed before chemotherapy starts [21,79], a study performed by Dolmans et al found that chemotherapy before OTC did not alter the results of OTT, and the authors suggested that it should no longer be considered a contraindication.…”

Current Gaps in Fertility Preservation for Men: How Can We do Better?

“…[57][58][59][60] The Pan-CareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group provide a review for anyone having this discussion with patients and consensus guidelines on fertility preservation. 52 We recommend consideration of early referral to reproductive specialists with communication regarding the type of cancer and stage, anticipated treatment, including CED/ alkylating dose, and the recommended timeline for the patient to initiate treatment. Automating this step may be accomplished by implementing an electronic health record advisory that flags the charts of patients with newly diagnosed cancer.…”

“…Certain malignancies, such as central nervous system and hematologic cancers, carry a higher risk of infertility than certain solid tumors. 52 In general, alkylating agents and heavy metals are likely to affect spermatogenesis. 53 Witt and Bishop 54 demonstrated the mutagenic profile of 21 anticancer drugs in murine models and found that certain drugs are more likely to cause cell damage than others.…”

“…57-60 The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group provide a review for anyone having this discussion with patients and consensus guidelines on fertility preservation. 52…”

“…Interestingly, Green et al 15 found that boys under age 5 years at diagnosis were more likely to conceive than those who were adolescents at diagnosis, perhaps reflecting that the prepubertal testis is less sensitive to gonadotoxic treatment. Most adolescent and young adult patients and their families desire fertility preservation counseling 52 and consequently benefit from recommendations from both oncologists and reproductive specialists highlighted above.…”