Children treated for cancer are living longer than ever before as a result of advances in treatment, but often those treatments come with the risk of infertility.
The American Academy of Pediatrics, in a clinical report published in the March 2020 issue of Pediatrics, describes fertility preservation options for pediatric and adolescent patients with cancer.
The report, “Fertility Preservation for Pediatric and Adolescent Cancer Patients: Medical and Ethical Considerations”, emphasizes the need for counseling with family members as early as feasible after a cancer diagnosis is made – and prior to any initiation of cancer treatment, if possible.
Treatments for childhood cancer, including chemotherapy, radiation therapy and hematopoietic stem cell transplant, can affect future fertility. When medically effective fertility preservation options exist, patients and their families should be offered timely referrals to specialists offering these options, according to the AAP. When counseling families, physicians should be clear about which options have been proven effective or are experimental in nature.
The fertility preservation options for patients who have not yet started puberty are more limited and many are currently experimental in both boys and girls. However, some experimental techniques - such as ovarian tissue cryopreservation - have shown great promise in young girls and have resulted in successful pregnancies.
More options are available to adolescents post puberty, such as sperm cryopreservation in males and oocyte cryopreservation in females, which is more invasive and expensive. The costs of fertility preservation are often not covered by insurance. The clinical report also discusses the ethical considerations that should be taken into account when considering fertility preservation options.