Fertility preservation in female pediatric patients prior to gonadotoxic therapy: predictive factors for receiving fertility preservation treatment

Abstract

To identify predictive factors for receiving fertility preservation treatment among female pediatric patients. Retrospective analysis. We performed an analysis of female pediatric patients seen for fertility preservation consultation at an academic fertility center prior to gonadotoxic treatment from 2002-2014. Multivariate logistic regression models were constructed to identify factors associated with receiving fertility preservation treatment. Adjusted odds ratios (OR) with 95%confidence intervals (CI) were calculated. Over 12 years, 102 females ages 6-21 years old were seen for fertility preservation consultation with a mean age of 16.7 years old; 14.7% were prepubertal. Diagnoses included the following malignancies: hematologic (61.8%, n=63), neurologic (10.8%, n=11), orthopedic tumors or sarcomas (9.8%, n=10), ovarian (8.8%, n=9) and gastrointestinal (4.9%, n=5). Remaining patients had medical conditions requiring gonadotoxic treatment (3.9%, n=4). Of those seen for consultation, 25.5% (n=26 pursued fertility preservation. The most utilized treatment modality was ovarian tissue cryopreservation (65.4%, n=17) followed by oocyte cryopreservation (34.6%, n=9). In comparing patients who pursued ovarian tissue cryopreservation and oocyte cryopreservation, there was no significant difference in age or pubertal status. After adjustment, a history of prior chemotherapy was associated with decreased odds of receiving fertility preservation treatment (OR=0.03, 95% CI 0.01-0.04). Age, race, pubertal status and type of cancer were not statistically associated with odds of receiving fertility preservation treatment. Ovarian tissue cryopreservation emerged as the most utilized fertility preservation treatment modality in this patient population. Future work is needed to investigate techniques to use cryopreserved ovarian tissue for fertility for this group as they reach adulthood. The finding that prior chemotherapy is negatively associated with fertility preservation in pediatric patients undergoing gonadotoxic chemotherapy underscores the importance of earlier referral and education regarding fertility preservation in newly diagnosed pediatric cancer patients.