No AccessJournal of UrologyPediatric Urology1 Jul 2017

Fertility Preservation for Pediatric Patients: Current State and Future Possibilities

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    This review provides an overview of pediatric fertility preservation. Topics covered include the patient populations who could benefit, the current state of fertility preservation options and research, and considerations related to ethics and program development.

    Materials and Methods:

    A broad Embase® and PubMed® search was performed to identify publications discussing investigational, clinical, ethical and health care delivery issues related to pediatric fertility preservation. Relevant publications were reviewed and summarized.


    Populations who could benefit from fertility preservation in childhood/adolescence include oncology patients, patients with nononcologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development and transgender individuals. Peripubertal and postpubertal fertility preservation options are well established and include cryopreservation of oocytes, embryos or sperm. Prepubertal fertility preservation is experimental. Multiple lines of active research aim to develop technologies that will enable immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision making and the fact that fertility preservation procedures can be considered not medically necessary. Successful multidisciplinary fertility preservation care teams emphasize partnerships with adult colleagues, prioritize timely consultations and use standardized referral processes. Some aspects of fertility preservation are not covered by insurance and out-of-pocket costs can be prohibitive.


    Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide pediatric fertility preservation services, an appreciation for relevant ethical issues and cost.


    • 1 : Fertility preservation and adolescent cancer patients: lessons from adult survivors of childhood cancer and their parents. Cancer Treat Res2007; 138: 201. Google Scholar
    • 2 : Fertility preservation preferences and perspectives among adult male survivors of pediatric cancer and their parents. J Adolesc Young Adult Oncol2014; 3: 75. Google Scholar
    • 3 : Long-term outcome and adjustment among patients with DSD born with testicular differentiation and masculinized external genital genitalia. Pediatr Endocrinol Rev2012; 10: 140. Google Scholar
    • 4 : Reproductive wish in transsexual men. Hum Reprod2012; 27: 483. Google Scholar
    • 5 : Experimental testicular tissue banking to generate spermatogenesis in the future: a multidisciplinary team approach. Methods2016; 99: 120. Google Scholar
    • 6 : Fertility of male survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol2010; 28: 332. Google Scholar
    • 7 : Male infertility in long-term survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study. J Cancer Surviv2014; 8: 437. Google Scholar
    • 8 : Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol2013; 14: 873. Google Scholar
    • 9 : Life after childhood cancer: marriage and offspring in adult long-term survivors—a population-based study in the Piedmont region, Italy. Eur J Cancer Prev2009; 18: 425. Google Scholar
    • 10 : The cyclophosphamide equivalent dose as an approach for quantifying alkylating agent exposure: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer2014; 61: 53. Google Scholar
    • 11 : Leukemia after therapy with alkylating agents for childhood cancer. J Natl Cancer Inst1987; 78: 459. Google Scholar
    • 12 : Cumulative alkylating agent exposure and semen parameters in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study. Lancet Oncol2014; 15: 1215. Google Scholar
    • 13 : Fertility in males treated for Hodgkins disease with COPP/ABV hybrid. Pediatr Blood Cancer2005; 44: 193. Google Scholar
    • 14 : Male gonadal function after chemotherapy for solid tumors in childhood. J Clin Oncol1989; 7: 304. Google Scholar
    • 15 : Gonadal and sexual function in men treated for childhood cancer. Med Pediatr Oncol2000; 35: 52. Google Scholar
    • 16 : Fertility of female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol2009; 27: 2677. Google Scholar
    • 17 : Ovarian failure and reproductive outcomes after childhood cancer treatment: results from the Childhood Cancer Survivor Study. J Clin Oncol2009; 27: 2374. Google Scholar
    • 18 : Gonadal function in males after chemotherapy for early-stage Hodgkin's lymphoma treated in four subsequent trials by the European Organisation for Research and Treatment of Cancer: EORTC Lymphoma Group and the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol2007; 25: 2825. Google Scholar
    • 19 : Aspermia following lower truncal irradiation in Hodgkin's disease. Cancer1973; 32: 692. Google Scholar
    • 20 : Vulnerability of the human Leydig cell to radiation damage is dependent upon age. J Endocrinol1989; 120: 161. Google Scholar
    • 21 : Influence of sickle cell disease and treatment with hydroxyurea on sperm parameters and fertility of human males. Haematologica2008; 93: 988. Google Scholar
    • 22 : Gonadal dysfunction and infertility in kidney transplant patients receiving sirolimus. Int Urol Nephrol2010; 42: 493. Google Scholar
    • 23 : The genetics of disorders of sex development in humans. Sex Dev2014; 8: 262. Google Scholar
    • 24 : The feasibility of fertility preservation in adolescents with Klinefelter syndrome. Hum Reprod2013; 28: 1468. Google Scholar
    • 25 : Feasibility of fertility preservation in young females with Turner syndrome. Reprod Biomed Online2009; 18: 290. Google Scholar
    • 26 : Pregnancy in true hermaphrodites and all male offspring to date. Obstet Gynecol2009; 113: 534. Google Scholar
    • 27 : Guidelines for pubertal suspension and gender reassignment for transgender adolescents. Child Adolesc Psychiatr Clin N Am2011; 20: 725. Google Scholar
    • 28 : Serum levels of antimüllerian hormone in early maturing girls before, during, and after suppression with GnRH agonist. Fertil Steril2012; 98: 1326. Google Scholar
    • 29 : Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend2012; 13: 165. Google Scholar
    • 30 : Access to fertility services by transgender persons: an Ethics Committee opinion. Fertil Steril2015; 104: 1111. Google Scholar
    • 31 : Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer. Gynecol Endocrinol2014; 30: 868. Google Scholar
    • 32 : Successful pregnancy and delivery after radiation with ovarian shielding for acute lymphocytic leukemia before menarche. J Pediatr Hematol Oncol2015; 37: e292. Google Scholar
    • 33 : Gonadal shielding to irradiation is effective in protecting testicular growth and function in long-term survivors of bone marrow transplantation during childhood or adolescence. Bone Marrow Transplant2007; 39: 483. Google Scholar
    • 34 : Gonadotropin-releasing hormone agonists for ovarian function preservation in premenopausal women undergoing chemotherapy for early-stage breast cancer: a systematic review and meta-analysis. JAMA Oncol2016; 2: 65. Google Scholar
    • 35 : Gonadotropin-releasing hormone agonist cotreatment during chemotherapy may increase pregnancy rate in survivors. Oncologist2015; 20: 1283. Google Scholar
    • 36 : Attitudes regarding fertility preservation in female adolescent cancer patients. J Pediatr Hematol Oncol2006; 28: 350. Google Scholar
    • 37 : Fertility preservation in women with cancer. Lancet2014; 384: 1302. Google Scholar
    • 38 : Ovarian tissue cryopreservation for fertility preservation in cancer patients: successful establishment and feasibility of a multidisciplinary collaboration. J Assist Reprod Genet2012; 29: 495. Google Scholar
    • 39 : Case report: stimulation of puberty in a girl with chemo- and radiation therapy induced ovarian failure by transplantation of a small part of her frozen/thawed ovarian tissue. Eur J Cancer2013; 49: 911. Google Scholar
    • 40 : Ovarian cortex transplantation: 60 reported live births brings the success and worldwide expansion of the technique towards routine clinical practice. J Assist Reprod Genet2015; 32: 1167. Google Scholar
    • 41 : Improving ovarian tissue cryopreservation for oncologic patients: slow freezing versus vitrification, effect of different procedures and devices. Fertil Steril2014; 101: 775. Google Scholar
    • 42 : Is transplantation of a few leukemic cells inside an artificial ovary able to induce leukemia in an experimental model?. J Assist Reprod Genet2015; 32: 597. Google Scholar
    • 43 : Evidence of residual disease in cryopreserved ovarian cortex from female patients with leukemia. Fertil Steril2010; 94: 2186. Google Scholar
    • 44 : Occasional involvement of the ovary in Ewing sarcoma. Hum Reprod2010; 25: 1708. Google Scholar
    • 45 : In vitro follicle growth supports human oocyte meiotic maturation. Sci Rep2015; 5: 17323. Google Scholar
    • 46 : Secondary follicle growth and oocyte maturation during encapsulated three-dimensional culture in rhesus monkeys: effects of gonadotrophins, oxygen and fetuin. Hum Reprod2011; 26: 1061. Google Scholar
    • 47 : Initiation of puberty in mice following decellularized ovary transplant. Biomaterials2015; 50: 20. Google Scholar
    • 48 : Preservation of fertility in patients with cancer. N Engl J Med2009; 360: 902. Google Scholar
    • 49 : Sperm banking in the United Kingdom is feasible in patients 13 years old or older with cancer. J Urol2012; 188: 594. LinkGoogle Scholar
    • 50 : “Onco-tese”: testicular sperm extraction in azoospermic cancer patients before chemotherapy—new guidelines?. Urology2003; 61: 421. Google Scholar