Fertility Preservation in the Pediatric Cancer Patient

Richard N. Yu

Disclosures

Curr Opin Urol. 2019;29(5):477-480. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Long-term survival rates from childhood cancers approach 85% with many of these patients now reaching adulthood and facing the consequences of prior cancer treatment including infertility. This highlights the importance of discussing fertility risk and presenting fertility preservation options prior to initiation of cancer treatment. This article reviews the current literature on fertility preservation in adolescents, young adults, and prepubertal patients.

Recent findings: Sperm banking remains the gold standard for fertility preservation in adolescents and young adults. Testicular sperm extraction and electroejaculation may also be utilized in patients that are unable to produce a semen sample. Fertility preservation options for prepubertal patients remain experimental but recent data illustrate the potential to restore spermatogenesis using spermatogonial stem cells.

Summary: Fertility risk and fertility preservation options for pediatric patients should be routinely discussed at the time of cancer diagnosis. Sperm preservation should be routinely offered to adolescents and young adults at risk for infertility from cancer treatment. Preservation of prepubertal spermatogonial stem cells can be offered as an experimental option.

Introduction

A new cancer diagnosis leads to a tremendous amount of parental and patient stress related to active symptoms and cancer evaluation, deliberation of treatment options, and anticipation of long-term care. Fortunately, 5-year relative survival rates from childhood cancers currently approach 85% with many of these patients now reaching adulthood.[1] Since survival rates have substantially improved over the last 4 decades, childhood cancer survivors are now facing the consequences of prior treatment resulting in chronic health issues including infertility.[2] Discussion of fertility risk and fertility preservation options should occur at the time of diagnosis and most importantly before treatment initiation. This article reviews the current literature on fertility preservation in adolescents, young adults, and prepubertal patients.

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