Fertility Preservation in the Pediatric Cancer Patient

Richard N. Yu

Disclosures

Curr Opin Urol. 2019;29(5):477-480. 

In This Article

Consensus Statements

The American Society of Clinical Oncology (ASCO) initially published practice guidelines for fertility preservation in 2006 and updated their statement in 2013.[3,4] The most recent update was released in 2018.[5] The recommendations that pertain to male pediatric patients cover three primary topics: first, provider communication; second, sperm cryopreservation; and third, testicular tissue preservation. Discussion of fertility risk and fertility preservation should take place before the start of cancer treatment, and discussions should be documented in the medical record. Furthermore, providers should refer patients to reproductive specialists for those families that express an interest in fertility preservation.

The recommendations for adult men apply to the adolescent and young adult (AYA) population. Sperm cryopreservation remains the gold standard for those receiving cancer treatment and should be discussed with patients at risk for infertility. Parent or guardian consent and patient assent should be obtained. Due to the potentially higher risk of genetic damage to sperm after initiation of therapy, families should be advised accordingly. Sperm preservation prior to initiation of treatment is strongly recommended and is emphasized heavily in the updated guidelines. Of note, in a recent study examining semen analysis results in a cohort of cancer patients, azoospermia was found in about 17% of patients who had not received any prior cancer treatment. In patients who had received prior treatment, azoospermia was found in 84%.[6]

Ideally, sperm for banking should be obtained by masturbation. If the patient is unable or unwilling to produce an ejaculate, testicular biopsy and sperm extraction, or electro-ejaculation can be utilized to obtain sperm suitable for cryopreservation. Testicular tissue cryopreservation and grafting of testicular tissue for prepubertal or AYA patients are considered experimental and should only be performed as part of a clinical trial or approved research protocol.

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