ABSTRACT
Study Objectives
To describe the structure of a pediatric fertility preservation (FP) program and to
share safety and patient satisfaction data.
Design
The FP program operates under prospective research protocols approved by the Mayo
Clinic Institutional Review Board (IRB).
Setting
The FP program is a multidisciplinary effort between pediatric gynecology, reproductive
endocrinology, pediatric urology, pediatric surgery, and laboratory medicine.
Participants
The FP program enrolls patients between 0-17 years of age who have been diagnosed
with a fertility-threatening condition and/or are scheduled to undergo gonadotoxic
treatment.
Interventions
FP is offered in the form of ovarian tissue cryopreservation (OTC) and testicular
(TTC) tissue cryopreservation.
Main Outcome Measures
The outcome measures are the safety of the procedure and results of patient surveys
conducted by phone using a standard list of questions to assess attitudes towards
FP.
Results
To date, we have enrolled 38 OTC and 37 TTC patients. The median age (range) of OTC
and TTC patients was 11 years (0.83-17 years) and 10 years (0.92-17 years) at the
time of enrollment, respectively. Childhood cancers currently represent 88% of the
fertility-threatening diagnoses. Meanwhile, patients with non-malignant conditions
include those with gender dysphoria, aplastic anemia, and Turner's syndrome. To date,
no serious adverse events (SAEs) have been reported following surgery. According to
n = 34 one-year follow-ups, 100% of parents felt that FP was a good decision.
Conclusion
Consistent with the literature, our data suggests FP is safe and improves the quality
of care provided to pediatric patients for their fertility-threatening diagnoses and/or
treatments.
Trial Registration
NCT02872532, NCT02646384.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2018.CA Cancer J Clin. 2018; 68: 7
- Survivors of childhood and adolescent cancer: life-long risks and responsibilities.Nat Rev Cancer. 2014; 14: 61
- Medical assessment of adverse health outcomes in long-term survivors of childhood cancer.JAMA. 2007; 297: 2705
- Hormone and sperm analyses after chemo- and radiotherapy in childhood and adolescence.Klin Padiatr. 2010; 222: 145
- American Society of Clinical Oncology recommendations on fertility preservation in cancer patients.J Clin Oncol. 2006; 24: 2917
- Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update.J Clin Oncol. 2013; 31: 2500
- Fertility preservation in patients with cancer: ASCO clinical practice guideline update.J Clin Oncol. 2018; 36: 1994
- Preservation of fertility in pediatric and adolescent patients with cancer.Pediatrics. 2008; 121: 1461
- Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion.Fertil Steril. 2019; 112: 1022
- Challenges and considerations in optimizing ovarian stimulation protocols in oncofertility patients.Front Public Health. 2014; 2: 246
- Pediatric and Adolescent Oncofertility: Best Practices and Emerging Technologies.Springer, New York2017
- Embryo transfer following in vitro maturation and cryopreservation of oocytes recovered from antral follicles during conservative surgery for ovarian cancer.J Assist Reprod Genet. 2012; 29: 779
- Ovarian cortex transplantation: time to move on from experimental studies to open clinical application.Fertil Steril. 2015; 104: 1097
- Ovarian cortex transplantation: 60 reported live births brings the success and worldwide expansion of the technique towards routine clinical practice.J Assist Reprod Genet. 2015; 32: 1167
- Fertility preservation in women.N Engl J Med. 2017; 377: 1657
- Evidence for limiting ovarian tissue harvesting for the purpose of transplantation to women younger than 40 years of age.J Clin Endocrinol Metab. 2002; 87: 1907
- Livebirth after orthotopic transplantation of cryopreserved ovarian tissue.Lancet. 2004; 364: 1405
- Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy.N Engl J Med. 2005; 353: 318
- The first woman to give birth to two children following transplantation of frozen/thawed ovarian tissue.Hum Reprod. 2010; 25: 1280
- Twins born after transplantation of ovarian cortical tissue and oocyte vitrification.Fertil Steril. 2010; 93: 211
- Live birth after ovarian tissue autograft in a patient with sickle cell disease treated by allogeneic bone marrow transplantation.Fertil Steril. 2010; 93: 2413
- Children born after autotransplantation of cryopreserved ovarian tissue. a review of 13 live births.Ann Med. 2011; 43: 437
- Pregnancy and live birth after autotransplantation of frozen-thawed ovarian tissue in a patient with metastatic disease undergoing chemotherapy and hematopoietic stem cell transplantation.Fertil Steril. 2011; 95: 1787
- Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation.Fertil Steril. 2012; 97: 387
- Fertility preservation for age-related fertility decline.Lancet. 2015; 385: 506
- Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates.Hum Reprod. 2016; 31: 2031
- Transplantations of frozen-thawed ovarian tissue demonstrate high reproductive performance and the need to revise restrictive criteria.Fertil Steril. 2016; 106: 467
- Re-implantation of cryopreserved ovarian cortex resulting in restoration of ovarian function, natural conception and successful pregnancy after haematopoietic stem cell transplantation for Wilms tumour.J Assist Reprod Genet. 2016; 33: 1615
- Ovarian tissue cryopreservation and transplantation among alternatives for fertility preservation in the Nordic countries–compilation of 20 years of multicenter experience.Acta Obstet Gynecol Scand. 2016; 95: 1015
- 86 Successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children.J Assist Reprod Genet. 2017; 34: 325
- Germline transmission of donor haplotype following spermatogonial transplantation.Proc Natl Acad Sci U S A. 1994; 91: 11303
- Transplantation of male germ line stem cells restores fertility in infertile mice.Nat Med. 2000; 6: 29
- Production of transgenic rats by lentiviral transduction of male germ-line stem cells.Proc Natl Acad Sci U S A. 2002; 99: 14931
- Fertility and germline transmission of donor haplotype following germ cell transplantation in immunocompetent goats.Biol Reprod. 2003; 69: 1260
- Irradiation enhances the efficiency of testicular germ cell transplantation in sheep.Biol Reprod. 2009; 81: 898
- Spermatogonial stem cell transplantation into rhesus testes regenerates spermatogenesis producing functional sperm.Cell Stem Cell. 2012; 11: 715
- Progeny from sperm obtained after ectopic grafting of neonatal mouse testes.Biol Reprod. 2003; 68: 2331
- Accelerated maturation of primate testis by xenografting into mice.Biol Reprod. 2004; 70: 1500
- Generation of macaques with sperm derived from juvenile monkey testicular xenografts.Cell Res. 2016; 26: 139
- Generation of live piglets for the first time using sperm retrieved from immature testicular tissue cryopreserved and grafted into nude mice.PLoS One. 2013; 8: e70989
- Autologous grafting of cryopreserved prepubertal rhesus testis produces sperm and offspring.Science. 2019; 363: 1314
- Experimental methods to preserve male fertility and treat male factor infertility.Fertil Steril. 2016; 105: 256
Gassei K, Cannon GM, Meacham LR, et al: In: Gosiengfiao YC, Woodruff TK, eds. Pediatric and Adolescent Oncofertility. New York: Springer; 2017:119-142
- Basic and clinical approaches for fertility preservation and restoration in cancer patients.Trends Biotechnol. 2018; 36: 199
- Tissue engineering to improve immature testicular tissue and cell transplantation outcomes: one step closer to fertility restoration for prepubertal boys exposed to gonadotoxic treatments.Int J Mol Sci. 2018; : 19
- Cryopreservation of testicular tissue or testicular cell suspensions: a pivotal step in fertility preservation.Hum Reprod Update. 2016; 22: 744
- Patient counselling on the risk of infertility and its impact on childhood cancer survivors: results from a national survey.J Psychosoc Oncol. 2011; 29: 274
- Barriers and facilitators towards fertility preservation care for cancer patients: a meta-synthesis.Eur J Cancer Care (Engl). 2018; : 27
- Fertility preservation for transgender adolescents.J Adolesc Health. 2017; 61: 120
- Ethics Committee of the American Society for Reproductive Medicine: Access to fertility services by transgender persons: an Ethics Committee opinion.Fertil Steril. 2015; 104: 1111
- Fertility Risk with Cancer Therapy.in: Woodruff Teresa K. Gosiengfiao Yasmin C. Pediatric and Adolescent Oncofertility. Springer International Publishing, 2017: 1-16
- Ovarian tissue freezing, thawing, labeling, and testing.2017 (Available at:) (Access Year: 2021)
- Improving access to standardized fertility preservation information for older adolescents and young adults with cancer: using a user-centered approach with young adult patients, survivors, and partners to refine fertility knowledge transfer.J Cancer Educ. 2018; 33: 528
- Concerns about infertility risks among pediatric oncology patients and their parents.Pediatr Blood Cancer. 2008; 50: 85
- Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients.J Surg Oncol. 2017; 115: 116
- Sperm banking for adolescent and young adult cancer patients: sperm quality, patient, and parent perspectives.Pediatr Blood Cancer. 2008; 50: 594
- Fertility preservation and adolescent cancer patients: lessons from adult survivors of childhood cancer and their parents.Cancer Treat Res. 2007; 138: 201
- Young males' experiences of sperm banking following a cancer diagnosis–a qualitative study.Hum Fertil (Camb). 2008; 11: 238
- Male and female experiences of having fertility matters raised alongside a cancer diagnosis during the teenage and young adult years.Eur J Cancer Care (Engl). 2009; 18: 381
- Results from the Survey for Preservation of Adolescent Reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer.J Assist Reprod Genet. 2011; 28: 269
- Consult and procedure incidence outcomes following establishment of a fertility preservation program for children with cancer.J Assist Reprod Genet. 2021; 38: 495
- Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377
Article info
Publication history
Published online: April 25, 2021
Accepted:
April 9,
2021
Received in revised form:
March 26,
2021
Received:
January 7,
2021
Footnotes
The authors declare that they have no competing interests.
No funding was received to assist with the preparation of this manuscript.
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
