Medical research provides the foundation for decisions about treatment and procedures for patient care. The reports of research are published in research journals and distributed to the medical community. For this reason, research articles are frequently filled with medical terminology and tedious descriptions of methods used to conduct the research. PORF is providing three ways to find pertinent information that may inform parents and patients who are interested in preserving fertility after cancer treatment: 1) a brief overview of the literature related to pediatric Oncofertility research; 2) a short annotation for each article that is referenced on this website; and 3) a link to the complete article.
The literature related to preservation of sperm for those who are able to produce sperm, is well established. Of all pediatric patients who are interested in fertility preservation, the adolescent male who is able to produce sperm is the most likely to be successful. The research related to adult male sperm preservation is the same as for the younger sperm producer. That being said, male cancer patients may have additional difficulty securing sperm for donation. Research has found that sometimes male sperm count is affected by the cancer itself, not just the treatment for cancer. While questions remain about the cause of diminished sperm count in young boys diagnosed with cancer, it is a real threat to sperm production and harvest.
Unfortunately, the potential for pre-pubertal boys to preserve fertility is considerably more difficult. The harvesting of testicular tissue in the hope of replanting that tissue at a later date holds the best hope for the young boy undergoing cancer treatment. To date, only a few medical facilities in the world are equipped to harvest the tissue. Further, use of tissue after cryopreservation is also the topic of early research efforts. There is potential for the tissue to be used to fertilize eggs in vitro. Also, there is potential for using the immature cells found in the tissue to generate in vivo use of the tissue. While promising studies have evidenced successful use of preserved testicular tissue in mice, human studies are only now ready to begin.
A major concern for researchers has to do with the nature of the cancer diagnosis and its potential impact on the tissue preserved for Oncofertility use. If the cancer is systemic, such as leukemia, there is a danger that cancer cells may be contained in the preserved tissue. For this reason, researchers are currently developing bioengineering techniques to eliminate this risk. This has the potential for allowing the essential ingredients of fertility to be implanted in the patient without the danger of reintroducing cancer cells.
Because of the groundbreaking studies currently being conducted, researchers recommend that testicular tissue be harvested and preserved prior to cancer treatment.
Two of the researchers who are advancing this important work are Dr. Robert Brannigan at Northwestern University Medical Center in Chicago and Dr. London Trost at the Mayo Foundation in Rochester, MN.
“Fertility preservation for young patients with cancer: who is at risk and what can be offered?”
W Harrish, B Wallace, Richard A. Anderson, D. Steward Irvine
http://oncology.thelancet.com vol 6 April 2005
This article, published in 2005, is an overview of options available to boys and girls facing treatment for cancer. It is not a report of primary research. Since the article is at least ten years old, it is more historical in its significance for families making decisions about fertility preservation today.
The article is easily understood by the non-medical reader. However, some of the medical jargon can be a bit daunting. The reader should understand that some of the information presented has become dated.
One of the most important points addressed in this article has to do with the ethics of fertility preservation. The authors make the following important points:
- Attempts to preserve fertility should not promote unrealistic expectations.
- Attempts to preserve fertility should not have undue adverse effects to the patient.
- Attempts to preserve fertility should not have undue adverse effects to subsequent offspring of the patient.
The authors also stress the legal and ethical importance of securing informed consent. They point to the emotional stress of the circumstances surrounding the cancer diagnosis and treatment plan as complicating the fertility preservation decision.
PORF recommends this article for its historical value, as well as for the important ethical and legal issues that it addresses.
“For patients who have not yet started puberty, options for fertility preservation remain entirely experimental at present. Optimism for these patients in the future lie with continuing research efforts.”
“Pediatric and Young Adult Patients and Oncofertility”
Katherine E. Dillon, BA, Clarisa R. Gracia, MD, MSCE
This article reviews the state of pediatric fertility preservation as of 2012. While it is intended for health care providers, the article reinforces the position that in-depth discussion of fertility should be standard of care for all children contemplating cancer treatment. The article goes so far as to precede the review with an “Opinion Statement,” fairly unusual for an article of this nature.
One important dimension of this review is its discussion of the potential for birth defects and for pregnancy problems from either the cancer, or it treatment. While the discussion is relatively technical and cannot be generalized, the question it poses is certainly important to the overall discussion of fertility that should be had before treatment begins.
All sections of this article are worthy of review by the non-medical reader. However, readers should not allow themselves to be intimidated by technical jargon. The final paragraphs under each subsection in the following sections are particularly important: “Treatment effects in females,” and “Treatment effects in males.”
PORF recommends this article as a reinforcement to the literature that has been reviewed in this section.
“Importantly, the ability to have biological children greatly effects the quality of life of childhood cancer survivors in adulthood; it has been demonstrated that a perceived loss of fertility is associated with lower marriage rates and increased divorce rates in this population.”
“Evidence-Based Recommendations for Fertility Preservation Options for Inclusion in Treatment Protocols for Pediatric and Adolescent Patients Diagnosed with Cancer”
Allison Fernbach, MSN, RN, CPNP, Barbara Lockart, MSN, RN, CPNP, CPON, Cheryl L. Armus, MSN, RN. FNP, Lisa M. Bashore, PhD, RN, CPNP, CPON, Jennifer Levine, MD, MSW, Leah Kroon, MN, RN, Genevieve Sylvain, RN, CPHON, and Cherly Rodgers, PhD, RN CPNP, CPON
This is a comprehensive article that consolidates the professional literature relative to fertility preservation as of 2014. It is user friendly to non-medical readers and thorough in its review of the literature. However, the full article, published in the Journal of Pediatric Oncology Nursing, is only available through subscription. The content of this article, albeit more comprehensive in scope, is consistent with the literature review contained on this website.
“It is important to consider and discuss all available fertility options with patients at the time of diagnosis.”
“Oncofertility: a grand collaboration between reproductive medicine and oncology”
Teresa K. Woodruff
This article chronicles the history of Oncofertility. It is an important overview of the blending of two disciplines in modern medicine. PORF recommends that all persons interested in the fertility side effects of pediatric cancer treatment read this article in it entirety. Only one section, “Advances in ovarian follicle culture,” will prove challenging to the non-medical reader. The pdf of this article can be found at: http://www.reproduction-online.org/content/150/3/S1.full.pdf
“It is remarkable to think that less than a decade ago, I presented this kind of multidisciplinary collaborative effort to improve patient care as the future of medicine. For many of our cancer survivors, that future is now, and they are the proud parents of children they thought they might never not be able to have.”