The vast majority of pediatric cancer patients live full and vibrant lives after cure – lives that need not be limited by side effects of life-saving treatments. Female patients may be at risk for infertility as a result of cancer treatment, including chemotherapy, radiation, or surgery. It is difficult to determine exactly when a patient may be left infertile due to treatment, but research in adult patients suggests that infertility may occur very early in treatment. Therefore, plans to preserve future fertility are ideally made at the time of diagnosis, not after treatment has begun.
There are several fertility preservation options available to females – some are experimental and some are not experimental. Determining which method is appropriate for a patient depends upon the age of the patient, the treatment she is scheduled to receive, how soon treatment must start, and the family’s wishes. Cost, insurance coverage, and proximity to a reproductive medicine clinic may impact the decision to pursue fertility preservation. Since the treatment for pediatric cancer must usually begin as soon as possible after diagnosis, time is short for a fertility preservation procedure.
Experimental Options for Pre-pubertal and Post-pubertal Females
Ovarian Tissue Cryopreservation (“freezing”)
This requires a surgical procedure to remove part or the entire ovary, which is then frozen. The ovary contains immature eggs called follicles. Research is ongoing to develop a method to mature the follicles into eggs, which could be fertilized for pregnancy. Another potential use of the ovarian tissue is to replant the tissue back into the woman once the treatment is completed. This may stimulate the body to make female hormones such as estrogen. Replanting tissue may not be appropriate for every woman, as there is the possibility of re-seeding the cancer. Ideally, the procedure to remove ovarian tissue is performed prior to the patient receiving any cancer treatment. To minimize exposure to anesthesia, this surgery may be performed with another procedure such as central line placement or tumor resection.
This option is experimental and should only be performed at a hospital with Institutional Review Board approval. Families should consider this option if oocyte harvesting and freezing is not appropriate or if the patient needs to begin treatment emergently.
When Treatment is Completed
Because the cryopreservation procedure is relatively new, there is limited information regarding the use of ovarian tissue when treatment is completed. Research examining the use of replanted ovarian tissue is ongoing. To date, there is one report of a healthy baby born with ovarian tissue replanted in a pediatric patient, 13 years after her ovarian tissue was cryopreserved.
Live births following replanting cryopreserved ovarian tissue are reported in adult women. These are published reports of adult women resuming menses after tissue replanting, as well as a patient who used replanted ovarian tissue to start puberty development.
Research is ongoing for the use of cryopreserved tissue for normal hormone health, as well as eventual pregnancy. The following hospitals are part of the Oncofertility Research Consortium and are fully prepared to enroll children in this study. The contact person at each hospital can be contacted by the treating oncologist, or directly by parents.
Ann & Robert H. Lurie Children’s Hospital of Chicago
Contact: Laura Erickson, MSN, APN, CPNP — firstname.lastname@example.org — (312) 227-5535
PORF encourages parents to learn more about fertility preservation before making a final decision. The LEARN section of the website gives an overview of current research relevant to pediatric patients. The PREPARE section suggests questions that parents may pose to medical care providers and to each other. The CONNECT section shows parents how to best connect to the closest medical facility that participates in Pediatric Oncofertility Research. This section also connects parents with others who have made fertility preservation decisions before them.