Fertility preservation in pediatric healthcare: a review

Chen, Lin; Dong, Zirui; Chen, Xiaoyan

doi:10.3389/fendo.2023.1147898

Cited by 7 publications

(4 citation statements)

References 313 publications

(608 reference statements)

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“…Many patients also express dissatisfaction with the information provided by healthcare professionals regarding fertility risks and available options. Nevertheless, a significant obstacle that hampers the implementation of ideal fertility preservation practices is the absence of a structured and co-ordinated program ( Brannigan et al , 2021 ; Chen et al , 2023 ). Some institutions have successfully implemented formal fertility preservation programs, which has led to a rise in the number of patients receiving fertility preservation consultations and using sperm cryopreservation services ( Behl et al , 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Fertility preservation in adult male patients with cancer: a systematic review and meta-analysis

Li,

Lan,

Zhu

et al. 2024

Human Reproduction Open

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STUDY QUESTION Does sperm cryopreservation serve as a feasible and effective method for preserving fertility in adult male patients with cancer? SUMMARY ANSWER Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. WHAT IS KNOWN ALREADY Sperm cryopreservation is the only way to efficiently preserve male fertility. It is an important procedure in ART. Recently, due to remarkable advances in cancer treatment, an increasing number of studies have reported the outcomes of sperm cryopreservation in patients with cancer. STUDY DESIGN, SIZE, DURATION We conducted an extensive literature search for relevant studies published through December 31, 2021, in the following databases: CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science. The search terms used were “(cryopreservation OR freeze OR freezing OR banking OR cryostorage OR storage) AND (sperm OR semen OR spermatozoon) AND (cancer OR tumor OR malignancy OR neoplasm). PARTICIPANTS/MATERIALS, SETTING, METHODS We included all studies that reported offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment. We evaluated the eligibility of all data in each study. The major exclusion criteria were as follows: non-cancer patients; pediatric and adolescent cancer patients; not reporting the use of cryopreserved sperm; use of fresh semen for ART; not reporting the number of patients with cancer offered sperm cryopreservation or attempting to do so before or during treatment; using an experimental fertility preservation technique such as preservation of testicular tissue or spermatogonial stem cells; duplicate data; abstracts, case report, comments, reviews, or editorials; insufficient data reported. The quality of the included studies was assessed using the Newcastle–Ottawa scale and the Methodological Index for Non-Randomized Studies. MAIN RESULTS AND THE ROLE OF CHANCE This meta-analysis included 69 non-randomized studies, with 32,234 patients referred for sperm analysis and 23,178 patients cryopreserving at least one sperm sample. The pooled failed-to-cryopreserve rate was 10% (95% CI, 8–12%), and the sperm disposal and sperm use rates were 23% (95% CI, 16–30%) and 9% (95% CI, 8–10%), respectively. The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22–33%), 13% (95% CI, 10–17%), and 20% (95% CI, 15–25%), respectively. Subgroup analysis showed higher pregnancy and delivery rates, as well as a lower failed-to-cryopreserve rate, in recent studies compared to those released a decade ago. The studies from Asia reported higher sperm disposal and pregnancy rates than in other continents. Our analysis showed clinical pregnancy rates per cycle of 34% (27–41%), 24% (14–35%), and 9% (5–15%) and delivery rates per cycle of 23% (17–30%), 18% (11–26%), and 5% (1–9%) for ICSI, IVF, and IUI, respectively. LIMITATIONS, REASONS FOR CAUTION As with all meta-analyses, some limitations should be considered. The first limitation of our study is that the data span 36 years. During this time, the World Health Organization has revised its sperm analysis standards, and other important changes have been made. There is also a limitation in that the outcome does not analyze the correlation between the type of cancer and sperm quality. Many of the earlier studies were limited by small sample sizes and a lack of control groups. Furthermore, almost all of studies did not consider severity of the disease, which could potentially have a substantial impact on the results. Consequently, further research should evaluate the effect of the type of cancer and, in particular, the severity of the condition on sperm quality in order to draw more precise conclusions. Similarly, it is inappropriate that most studies failed to differentiate between patients with different types of tumor and instead drew generalized conclusions that are presumed to apply to all patients with cancer. In the present analysis we did not have in-depth information on patients’ disease, and although extensive efforts were made to conduct a thorough systematic review and meta-analysis of the outcomes for patients with various types of tumor, the results must be acknowledged as being subject to bias. However, the use of average results obtained in each study, without the patient-level data, might also represent a source of bias. WIDER IMPLICATIONS OF THE FINDINGS Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. The observed utilization rate of frozen sperm at 9% may underestimate the actual usage, as the short follow-up period is inadequate for obtaining comprehensive data on the use of frozen sperm in young cancer survivors. ART plays an important role in fertility preservation and the achievement of pregnancy, with this meta-analysis showing that ICSI delivers better clinical outcomes than IVF or IUI in patients with cancer undergoing fertility preservation. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Natural Science Foundation of China (Grand No. 82001634), and the China Postdoctoral Science Foundation (2019M661521). There are no competing interests to declare. REGISTRATION NUMBER CRID 42022314460

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Section: Discussionmentioning

confidence: 99%

Fertility preservation in adult male patients with cancer: a systematic review and meta-analysis

Li,

Lan,

Zhu

et al. 2024

Human Reproduction Open

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“…The significance of fertility preservation for pediatric cancer patients has been increasingly recognized, not only globally but also within the Nordic regions, particularly given the growing population of childhood and adolescent cancer survivors [13,14]. This surge in awareness is largely due to the potential adverse effects of gonadotoxic treatments on fertility [5].…”

Section: Discussionmentioning

confidence: 99%

A 12-year overview of fertility preservation practice in Nordic pediatric oncology centers

Asadi-Azarbaijani,

Oskam,

Jahnukainen

2024

J Cancer Surviv

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Purpose Fertility preservation is the only option to safeguard fertility following gonadotoxic treatments. This study aimed to provide an updated status on fertility preservation for pediatric cancer patients in the Nordic countries. Methods A questionnaire consisting of 14 questions was sent to directors of 18 main pediatric oncology centers in the Nordic countries in 2010 and 2022. We received information regarding indications, guidelines, counseling, and available fertility preservation options. Results The response rates were 89% in 2010 and 72% in 2022. The results reveal an increase in clinical practice guidelines on fertility preservation for cancer patients, from 25% in 2010 to 70% in 2022. Counseling on fertility preservation options in 2022 was more specific and offered to most patients who fulfilled indications for fertility preservation (from 19 to 77%). Sperm cryopreservation continues to be the predominant fertility preservation method for pubertal boys in the Nordic countries. However, there has been a notable increase in the availability of testicular tissue preservation for prepubertal boys (0 to 62%). A similar increase in the offer of ovarian tissue preservation for prepubertal girls (0 to 92%) was observed among pediatric cancer patients. Conclusions The past decade has shown commendable advancements in fertility preservation for pediatric cancer patients in the Nordic countries. Implications for Cancer Survivors As fertility care evolves globally, continuous assessment of regional practices and challenges is imperative to enhance the quality of care and life for pediatric cancer survivors in the Nordic regions.

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“… 6 While there have been significant strides in adult oncofertility, the literature remains scant regarding the effects of pediatric and adolescent cancer treatments on fertility. 7 , 8 Most pediatric cancer survivors are expected to reach adulthood, and many will have fertility as one of their chief long-term concerns. 1 , 9 …”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Treatment-Related Amenorrhea in Female Survivors of Childhood and Adolescent Cancer: 10-Year Experiences at Oncofertility Clinic in Korean Tertiary Center

Park,

Choi,

Kang

et al. 2024

Journal of Adolescent and Young Adult Oncology

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Purpose: This study investigates the impact of gonadotoxic cancer treatment on treatment-related amenorrhea (TRA) and hormonal status in pediatric and adolescent females who underwent fertility preservation (FP) consultation. Methods: A retrospective review was conducted on 143 females under 21 with cancer referred to the FP clinic at Seoul National University Hospital between 2011 and 2022. We analyzed variables, including age, menarche status, cancer type, and treatment. Subsequently, subjects were evaluated to identify clinical factors affecting TRA at 1-year intervals following the completion of treatment. Upon cancer diagnosis, all patients received FP counseling and underwent semiannual evaluations for menstrual resumption and hormonal status. Results: The median age at diagnosis was 15; menarche was reported in 76.9%. Bone sarcoma (16.1%) and acute lymphoblastic leukemia (14.7%) were predominant. Most consultations (74.8%) occurred pretreatment. After FP consultations, 9.8% of patients underwent oocyte cryopreservation, and 99.3% used gonadotropin-releasing hormone agonists during systemic chemotherapy. One year after treatment completion, TRA was shown in 29.4% of this cohort. Cyclophosphamide-equivalent dose >4000 mg/m 2 (adjusted odds ratio [aOR], 2.279; 95% confidence interval [CI]; 1.018–5.105, p = 0.045) and pelvic irradiation (aOR, 16.271; 95% CI, 1.545–171.408; p = 0.020) were independent clinical factors predicting TRA. Conclusion: The study delineates the clinical factors affecting TRA in pediatric and adolescent cancer survivors, revealing the significant impact of specific treatment. The data highlight the critical role of personalized oncofertility consultations in this demographic, offering valuable insights for designing targeted FP strategies at tertiary centers.

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Fertility preservation in pediatric healthcare: a review

Cited by 7 publications

References 313 publications

Fertility preservation in adult male patients with cancer: a systematic review and meta-analysis

Fertility preservation in adult male patients with cancer: a systematic review and meta-analysis

A 12-year overview of fertility preservation practice in Nordic pediatric oncology centers

Risk Factors for Treatment-Related Amenorrhea in Female Survivors of Childhood and Adolescent Cancer: 10-Year Experiences at Oncofertility Clinic in Korean Tertiary Center

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