Access to Fertility Preservation Services for Children With Cancer

Priscilla Lynch 

September 22, 2021

There is marked variation in the provision and funding of fertility preservation services for children and adolescents with cancer across the UK, particularly in England, finds the first study of its kind published online in the  Archives of Disease in Childhood.

Current clinical guidelines recommend that freezing/storage of ovarian tissue/eggs (oocyte) and testicular tissue/sperm is offered to children and adolescents whose future fertility is likely to be impaired as a consequence of their disease and treatment.

Between July and August 2019, the study authors surveyed all 20 UK Paediatric Oncology Principal Treatment Centres on current provision and funding arrangements for fertility preservation in cancer patients under the age of 18 years, with 18 services (90%) responding.

Every responding centre had referred patients for fertility preservation in the preceding 12 months, corresponding to a total of 479 individual referrals, with an estimated range of 338-620 cases.

All 18 centres had referred patients for ovarian tissue collection/storage, 17 had referred for sperm banking (one centre was excluded because of the age range of their patients), 15 (83%) had referred for testicular tissue storage and six (35%) had done so for mature oocyte collection (one centre was excluded because of the age range of their patients).

Most regional variation was seen for mature oocyte and testicular tissue storage. With regards to mature oocyte storage, no centres in the Midlands and East of England, 25% in the South of England, 50% in the North of England and 60% of centres located in the Devolved Nations had referred at least one patient, whereas for testicular tissue storage, 75% of centres in the North of England, 80% in the South of England and Devolved Nations and all centres in the Midlands and East of England had referred one or more patients.

This reported variation may simply reflect the type of clinical cases treated during the study period, note the study authors.

With regards to funding, around half of the centres said that ovarian and testicular tissue storage was funded by charitable sources, with centres in England much more likely to report this than centres in the rest of the UK.

Among all the cases estimated to have been referred for some form of fertility preservation during the preceding 12 months, approximately 20% reportedly relied on funding from charitable sources.

The length of time funding was available for each technique also varied, with respondents citing a period of under five years to ‘indefinite’; but few respondents were certain of the exact length of time.

“With approximately 1800 new cases of cancer diagnosed each year in the UK in those aged under 18 years of age, these results estimate that approximately 25% of patients were offered fertility preservation [in 2019],” the study authors said.

“Urgent action is required to ensure that NHS funding is available for all to provide the appropriate security and hope for these individuals while permitting delivery of accepted and NHS mandated standards of care,” they concluded.

Newton HL, Picton HM, Friend AJ, Hayden CM, Brougham M, Cox R, Grandage V, Kwok-Williams M, Lane S, Mitchell RT, Skinner R, Wallace WH, Yeomanson D, Glaser AW; on behalf of the Children’s Cancer and Leukaemia Group Late-effects Working Group. Inconsistencies in fertility preservation for young people with cancer in the UK. Arch Dis Child. 2021;0:1-6 [Epub ahead of print]. doi: 10.1136/archdischild-2021-321873.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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