Cancer treatment and gonadal function: experimental and established strategies for fertility preservation in children and young adults

Preservation of gonadal function,is an important priority for the long-term health of cancer survivors of both sexes and all ages at treatment.. The loss of an opportunity for fertility is a prime concern in both male and female cancer survivors, however the endocrine consequences of gonadal damage are also central to long-term health and wellbeing. Some fertility preservation techniques, such as semen and embryo cryopreservation for the adult man and woman respectively, are established and successful and the recent development of oocyte vitrification has greatly improved the potential to cryopreserve unfertilised oocytes from women. Despite being recommended for all pubertal males, sperm banking is not universally practised in Paediatric Oncology centres, and there are very few ‘adolescent-friendly’ facilities. All approaches to fertility preservation have particular challenges in children and teenagers, including ethical, practical and scientific issues. For the young female, cryopreservation of ovarian cortical tissue with later replacement has now resulted in at least 35 live births, but is still regarded as experimental in most countries. For pre-pubertal males, testicular biopsy cryopreservation is offered in some centres, but it is unclear how that tissue might be used in the future, and to date there is no evidence that fertility can be restored. For both sexes these approaches require an invasive procedure, and there is an uncertain risk of tissue contamination in haematological and other malignancies. Decision making for all these approaches requires an assessment of the individual’s risk of loss of fertility, and is being made at a time of emotional distress. The development of this field requires better provision of information for patients and their medical teams as well as improvements in service provision, to match technical and scientific advances.

Search strategy and selection criteria
We searched Medline between Jan 1, 1990, and Sept 1, 2014, for reports published in English using the search terms “fertility preservation”, “cancer”, “childhood cancer”, “gonadotoxic”, and “cancer treatment” in several disjunctive and conjunctive combinations. We mainly selected publications in English from the past 5 years, but did not exclude older, significant publications. We also checked the reference lists of articles identified by this search strategy.