Abstract
Children that undergo treatment for cancer are at risk of suffering from subfertility or hormonal dysfunction due to the detrimental effects of radiotherapy and chemotherapeutic agents on the gonads. Cryopreservation of ovarian tissue prior to treatment offers the possibility of restoring gonadal function after resumption of therapy. Effective counseling and management of pediatric patients is crucial for preserving their future reproductive potential. The purpose of this article is to review recent literature and to revise recommendations we made in a 2007 article. Pediatric hemato-oncology, reproductive endocrinology, surgery, anesthesia and bioethics perspectives are discussed and integrated to propose guidelines for offering ovarian cryopreservation to premenarcheal girls with cancer.
Highlights
Ovarian cryopreservation has been offered to patients for more than a decade and, to date, more than 15 babies have been born worldwide after successful transplantation of ovarian tissue [1, 2]
The efficacy of the procedure in this setting is unclear, and it remains to be shown that ovarian tissue harvested from prepubertal girls can yield a successful pregnancy when retransplanted after puberty
Identifying the patients most likely to benefit from the procedure is complex, because of the difficulty in evaluating the risk for fertility impairment in young patients, especially when the time interval between administration of chemotherapy and clinical presentation of premature ovarian insufficiency is measured in years [3]
Summary
Ovarian cryopreservation has been offered to patients for more than a decade and, to date, more than 15 babies have been born worldwide after successful transplantation of ovarian tissue [1, 2]. The success of ovarian cryopreservation in adult women at risk for infertility secondary to exposure to chemotherapy and radiation therapy has led pediatric oncologists to consider ovarian tissue cryopreservation in prepubertal girls undergoing potentially gonadotoxic therapy. Offering ovarian cryopreservation to young girls raises major medical, ethical, and legal issues unique to this age group that must be addressed. The efficacy of the procedure in this setting is unclear, and it remains to be shown that ovarian tissue harvested from prepubertal girls can yield a successful pregnancy when retransplanted after puberty. The purpose of this article is to review recent literature and to revise our recommendations from the article published in 2007 [4]
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