Abstract
In the face of excellent survival rates for pediatric and adolescent cancer, preserving the opportunity to have biological children is an important component of long term quality of life. Yet, modern chemotherapeutic regimens continue to pose a threat to fertility. The only fertility preservation methods available to pre-pubertal children of both genders is cryopreservation of gonadal tissue, a highly experimental intervention, or shielding/re-location of reproductive tissue in the setting of radiation. These techniques are available in the post pubertal population as well, but post pubertal patients also have the option for cryopreservation of gametes, a process that is much simpler in males than females. For this reason, prior to the initiation of therapy, sperm banking should be considered standard of care for males, while consideration of embryo or oocyte cryopreservation should be limited to those females at risk of developing ovarian failure. Attention to reproductive health and fertility preservation should continue after the completion of therapy. Establishing programs that streamline access to current fertility preservation techniques will assist in ensuring that all eligible patients can avail themselves of current options.
Highlights
The refinement of therapeutic interventions and supportive care has resulted in cure rates upwards of 80% in children and adolescents diagnosed with cancer, with subsequent estimates that 1 in 530 young adults between the ages of 20 and 39 is a survivor of a childhood cancer [1]
This change in status removes what had previously been a barrier for fertility preservation in adolescents as there is no requirement for partner or donor sperm
Women felt that pursuing fertility preservation options was discouraged and that conversations strongly emphasized the risk of delaying therapy
Summary
The refinement of therapeutic interventions and supportive care has resulted in cure rates upwards of 80% in children and adolescents diagnosed with cancer, with subsequent estimates that 1 in 530 young adults between the ages of 20 and 39 is a survivor of a childhood cancer [1]. Multiple organizations internationally have recommended that, at a minimum, all individuals of reproductive age receive information about fertility risk, options for fertility preservation and referrals to the appropriate health care providers [9,10,11,12,13,14,15,16]. Putting these recommendations into practice has remained a challenge. This article will summarize risks for infertility and options for preservation in male and female patients diagnosed with a childhood cancer
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