Fertility Preservation in the Pediatric Cancer Patient

Richard N. Yu


Curr Opin Urol. 2019;29(5):477-480. 

In This Article

Factors That Impact Sperm Banking Rates

Multiple factors are associated with improved banking outcomes: consultation with a fertility specialist, parent recommendation to bank, and higher Tanner stage were important among those who attempted to bank sperm.[7] Factors associated with those who completed sperm banking included adolescent history of masturbation, banking self-efficacy, and recommendation to bank from parents and the medical team.[7] It is essential that providers obtain a detailed sexual history and perform a thorough genital exam to determine Tanner stage. All providers involved the care of these patients can have a significant impact on whether fertility preservation occurs. Provider comfort with discussing fertility and referrals to fertility specialists are associated with significantly increased banking rates.[8]

A panel of fertility specialists within the European Society for Blood and Marrow Transplantation recently published guidelines aiming to address ongoing fertility preservation issues.[9] Consensus was reached on the following items: a team trained to provide fertility counseling should be available at all transplantation centers; patients should be assessed for pubertal status, sexual function and activity, genital status, and hormonal status; all patients should receive information regarding fertility risk and preservation options; fertility preservation options should be considered in the context of fertility status before transplantation, patient performance scores and clinical condition, and patient/family expectations and wishes; and informed consent should be obtained from all patients and/or parents. Based on pubertal status and testis volume, a flowchart was developed and agreed on by the panel (Figure 1). This flowchart is applicable to all patients at risk for infertility.

Figure 1.

Male fertility preservation algorithm [9]. Options for fertility preservation are based on pubertal status and testicular volume. The options are further impacted by prior exposure to chemotherapy and intrinsic male factor infertility. Sperm banking remains the gold standard for fertility preservation, whereas tissue preservation is considered experimental.