Fertility preservation options for children and adolescents with cancer

INTRODUCTION: Cancer in children and adolescents has seen a stark rise in survival rates in the last decades; overall survival in excess of 80% can be reasonably expected for many newly diagnosed patients with malignancies in this age group. Survivorship has unfolded several specific issues faced by these patients, including fertility concerns. Hence, fertility preservation efforts have been discussed and undertaken with increased frequency. METHODS: In this article, the authors provide a broad overview of the current recommendations surrounding fertility preservation in this patient population. Reasons to offer fertility preservation, target groups for interventions, and methods available based on age group and gender are discussed in detail. RESULTS: The medical literature and patient advocates strongly support a discussion about fertility preservation at the time of diagnosis; the risk of infertility is real and parents and families wish to be informed about it. In postpubertal males, sperm-banking is relatively straightforward and should be attempted by most newly diagnosed patients, ideally before commencement of treatment. Cryopreservation of testicular tissue in higher-risk prepubertal males is feasible, but still experimental. Female fertility preservation is more complex, requires more invasive procedures, and can delay initiation of treatment due to the requirement for hormone stimulation of follicles prior to harvesting. CONCLUSIONS: Oncofertility initiatives in children and youth are still in their early days and will continue to expand; urologists should be prepared to offer counselling and interventions when appropriate to this growing vulnerable population.