Skip to main content
Log in

Pediatric and Young Adult Patients and Oncofertility

  • Oncofertility (JS Jeruss, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

With improving survival rates for pediatric and young adult cancer patients, considerations regarding the long-term effects of therapy have become more important. Cancer therapies are known to pose reproductive risks, though the effects may be unpredictable. All at-risk patients should have a discussion about potential treatment-related infertility before the onset of cancer therapy, and should be offered appropriate fertility preservation options. Embryo and sperm cryopreservation are considered standard therapy, though oocyte cryopreservation is gaining acceptance. Ovarian tissue cryopreservation, while still experimental, is showing great promise. It is the only option currently available to prepubertal girls. No fertility preservation options exist for prepubertal boys though some institutions may offer experimental testicular tissue cryopreservation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Stat bite: Childhood cancer survival, 1975–2003. J Natl Cancer Inst. 2006;98:883.

    Google Scholar 

  2. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol Biol Sci Med Sci. 2003;58:82–91.

    Article  Google Scholar 

  3. Wallace WH, Thomson AB, Kelsey TW. The radiosensitivity of the human oocyte. Hum Reprod. 2003;18:117–21.

    Article  PubMed  CAS  Google Scholar 

  4. Wallace WH, Thomson AB, Saran F, Kelsey TW. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys. 2005;62:738–44.

    Article  PubMed  Google Scholar 

  5. Critchley HO, Wallace WH. Impact of cancer treatment on uterine function. J Natl Cancer Inst Monogr. 2005;34:64–8.

    Article  PubMed  Google Scholar 

  6. Holm K, Nysom K, Brocks V, Hertz H, Jacobsen N, Muller J. Ultrasound B-mode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood. Bone Marrow Transplant. 1999;23:259–63.

    Article  PubMed  CAS  Google Scholar 

  7. Wo JY, Viswanathan AN. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys. 2009;73:1304–12.

    Article  PubMed  Google Scholar 

  8. Green DM, Kawashima T, Stovall M, Leisenring W, Sklar CA, Mertens AC, Donaldson SS, Byrne J, Robison LL. Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2009;27:2677–85.

    Article  PubMed  CAS  Google Scholar 

  9. Sudour H, Chastagner P, Claude L, Desandes E, Klein M, Carrie C, Bernier V. Fertility and pregnancy outcome after abdominal irradiation that included or excluded the pelvis in childhood tumor survivors. Int J Radiat Oncol Biol Phys. 2010;76:867–73.

    Article  PubMed  Google Scholar 

  10. Larsen EC, Muller J, Schmiegelow K, Rechnitzer C, Andersen AN. Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer. J Clin Endocrinol Metab. 2003;88:5307–14.

    Article  PubMed  CAS  Google Scholar 

  11. Letourneau JM, Ebbel EE, Katz PP, Oktay KH, McCulloch CE, Ai WZ, Chien AJ, Melisko ME, Cedars MI, Rosen MP. Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer. Cancer. 2011.

  12. Signorello LB, Mulvihill JJ, Green DM, Munro HM, Stovall M, Weathers RE, Mertens AC, Whitton JA, Robison LL, Boice Jr JD. Stillbirth and neonatal death in relation to radiation exposure before conception: a retrospective cohort study. Lancet. 2010;376:624–30.

    Article  PubMed  Google Scholar 

  13. Signorello LB, Cohen SS, Bosetti C, Stovall M, Kasper CE, Weathers RE, Whitton JA, Green DM, Donaldson SS, Mertens AC, Robison LL, Boice Jr JD. Female survivors of childhood cancer: preterm birth and low birth weight among their children. J Natl Cancer Inst. 2006;98:1453–61.

    Article  PubMed  Google Scholar 

  14. Green DM, Nolan VG, Kawashima T, Stovall M, Donaldson SS, Srivastava D, Leisenring W, Robison LL, Sklar CA. Decreased fertility among female childhood cancer survivors who received 22–27 Gy hypothalamic/pituitary irradiation: a report from the Childhood Cancer Survivor Study. Fertil Steril. 2011;95:1922–7, 1927.e1.

    Article  PubMed  Google Scholar 

  15. Familiari G, Caggiati A, Nottola SA, Ermini M, Di Benedetto MR, Motta PM. Ultrastructure of human ovarian primordial follicles after combination chemotherapy for Hodgkin’s disease. Hum Reprod. 1993;8:2080–7.

    PubMed  CAS  Google Scholar 

  16. van Beek RD, van den Heuvel-Eibrink MM, Laven JS, de Jong FH, Themmen AP, Hakvoort-Cammel FG, van den Bos C, van den Berg H, Pieters R. de Muinck Keizer-Schrama SM. Anti-Mullerian hormone is a sensitive serum marker for gonadal function in women treated for Hodgkin’s lymphoma during childhood. J Clin Endocrinol Metab. 2007;92:3869–74.

    Article  PubMed  Google Scholar 

  17. Wallace WH. Oncofertility and preservation of reproductive capacity in children and young adults. Cancer. 2011;117:2301–10.

    Article  PubMed  Google Scholar 

  18. Jadoul P, Anckaert E, Dewandeleer A, Steffens M, Dolmans MM, Vermylen C, Smitz J, Donnez J, Maiter D. Clinical and biologic evaluation of ovarian function in women treated by bone marrow transplantation for various indications during childhood or adolescence. Fertil Steril. 2011;96:126–133.e3.

    Article  PubMed  CAS  Google Scholar 

  19. Thibaud E, Rodriguez-Macias K, Trivin C, Esperou H, Michon J, Brauner R. Ovarian function after bone marrow transplantation during childhood. Bone Marrow Transplant. 1998;21:287–90.

    Article  PubMed  CAS  Google Scholar 

  20. Sanders JE. Growth and development after hematopoietic cell transplant in children. Bone Marrow Transplant. 2008;41:223–7.

    Article  PubMed  CAS  Google Scholar 

  21. Sanders JE, Hawley J, Levy W, Gooley T, Buckner CD, Deeg HJ, Doney K, Storb R, Sullivan K, Witherspoon R, Appelbaum FR. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood. 1996;87:3045–52.

    PubMed  CAS  Google Scholar 

  22. Ash P. The influence of radiation on fertility in man. Br J Radiol. 1980;53:271–8.

    Article  PubMed  CAS  Google Scholar 

  23. Sklar CA, Robison LL, Nesbit ME, Sather HN, Meadows AT, Ortega JA, Kim TH, Hammond GD. Effects of radiation on testicular function in long-term survivors of childhood acute lymphoblastic leukemia: a report from the Children Cancer Study Group. J Clin Oncol. 1990;8:1981–7.

    PubMed  CAS  Google Scholar 

  24. Green DM, Kawashima T, Stovall M, Leisenring W, Sklar CA, Mertens AC, Donaldson SS, Byrne J, Robison LL. Fertility of male survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2010;28:332–9.

    Article  PubMed  Google Scholar 

  25. Hansen PV, Hansen SW. Gonadal function in men with testicular germ cell cancer: the influence of cisplatin-based chemotherapy. Eur Urol. 1993;23:153–6.

    PubMed  CAS  Google Scholar 

  26. Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: damage and recovery. J Natl Cancer Inst Monogr. 2005;34:12–7.

    Article  PubMed  CAS  Google Scholar 

  27. Anserini P, Chiodi S, Spinelli S, Costa M, Conte N, Copello F, Bacigalupo A. Semen analysis following allogeneic bone marrow transplantation. Additional data for evidence-based counselling. Bone Marrow Transplant. 2002;30:447–51.

    Article  PubMed  CAS  Google Scholar 

  28. Quinn GP, Vadaparampil ST, Lee JH, Jacobsen PB, Bepler G, Lancaster J, Keefe DL, Albrecht TL. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol. 2009;27:5952–7.

    Article  PubMed  Google Scholar 

  29. Letourneau JM, Ebbel EE, Katz PP, Katz A, Ai WZ, Chien AJ, Melisko ME, Cedars MI, Rosen MP. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer. 2011.

  30. Janson C, Leisenring W, Cox C, Termuhlen AM, Mertens AC, Whitton JA, Goodman P, Zeltzer L, Robison LL, Krull KR, Kadan-Lottick NS. Predictors of marriage and divorce in adult survivors of childhood cancers: a report from the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev. 2009;18:2626–35.

    Article  PubMed  Google Scholar 

  31. Ethics Committee of the American Society for Reproductive Medicine. Fertility preservation and reproduction in cancer patients. Fertil Steril. 2005;83:1622–8.

    Article  Google Scholar 

  32. Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, Beck LN, Brennan LV, Oktay K. American Society of Clinical Oncology. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24:2917–31.

    Article  PubMed  Google Scholar 

  33. Lobo RA. Potential options for preservation of fertility in women. N Engl J Med. 2005;353:64–73.

    Article  PubMed  CAS  Google Scholar 

  34. Ginsburg ES, Yanushpolsky EH, Jackson KV. In vitro fertilization for cancer patients and survivors. Fertil Steril. 2001;75:705–10.

    Article  PubMed  CAS  Google Scholar 

  35. Noyes N, Porcu E, Borini A. Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. Reprod Biomed Online. 2009;18:769–76.

    Article  PubMed  CAS  Google Scholar 

  36. Rudick B, Opper N, Paulson R, Bendikson K, Chung K. The status of oocyte cryopreservation in the United States. Fertil Steril. 2010;94:2642–6.

    Article  PubMed  Google Scholar 

  37. Cobo A, Meseguer M, Remohi J, Pellicer A. Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod. 2010;25:2239–46.

    Article  PubMed  Google Scholar 

  38. Donnez J, Silber S, Andersen CY, Demeestere I, Piver P, Meirow D, Pellicer A, Dolmans MM. Children born after autotransplantation of cryopreserved ovarian tissue. a review of 13 live births. Ann Med. 2011;43:437–50.

    Article  PubMed  Google Scholar 

  39. Ting AY, Yeoman RR, Lawson MS, Zelinski MB. In vitro development of secondary follicles from cryopreserved rhesus macaque ovarian tissue after slow-rate freeze or vitrification. Hum Reprod. 2011;26:2461–72.

    Article  PubMed  Google Scholar 

  40. Xu M, Barrett SL, West-Farrell E, Kondapalli LA, Kiesewetter SE, Shea LD, Woodruff TK. In vitro grown human ovarian follicles from cancer patients support oocyte growth. Hum Reprod. 2009;24:2531–40.

    Article  PubMed  CAS  Google Scholar 

  41. Dolmans MM, Marinescu C, Saussoy P, Van Langendonckt A, Amorim C, Donnez J. Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe. Blood. 2010;116:2908–14.

    Article  PubMed  CAS  Google Scholar 

  42. Morice P, Juncker L, Rey A, El-Hassan J, Haie-Meder C, Castaigne D. Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination. Fertil Steril. 2000;74:743–8.

    Article  PubMed  CAS  Google Scholar 

  43. Chen H, Li J, Cui T, Hu L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women. Cochrane Database Syst Rev. 2011;11:CD008018.

    PubMed  Google Scholar 

  44. Piccioni P, Scirpa P, D’Emilio I, Sora F, Scarciglia M, Laurenti L, De Matteis S, Sica S, Leone G, Chiusolo P. Hormonal replacement therapy after stem cell transplantation. Maturitas. 2004;49:327–33.

    Article  PubMed  CAS  Google Scholar 

  45. Castelo-Branco C, Rovira M, Pons F, Duran M, Sierra J, Vives A, Balasch J, Fortuny A, Vanrell J. The effect of hormone replacement therapy on bone mass in patients with ovarian failure due to bone marrow transplantation. Maturitas. 1996;23:307–12.

    Article  PubMed  CAS  Google Scholar 

  46. Schmiegelow ML, Sommer P, Carlsen E, Sonksen JO, Schmiegelow K, Muller JR. Penile vibratory stimulation and electroejaculation before anticancer therapy in two pubertal boys. J Pediatr Hematol Oncol. 1998;20:429–30.

    Article  PubMed  CAS  Google Scholar 

  47. Nicopoullos JD, Gilling-Smith C, Almeida PA, Ramsay JW. The results of 154 ICSI cycles using surgically retrieved sperm from azoospermic men. Hum Reprod. 2004;19:579–85.

    Article  PubMed  CAS  Google Scholar 

  48. Levron J, Madgar I, Shefi S, Meirow D, Wiser A, Bider D, Dor J, Raviv G. IVF outcome with cryopreserved testicular sperm. Andrologia. 2011;43:48–51.

    Article  PubMed  CAS  Google Scholar 

  49. Ginsberg JP, Carlson CA, Lin K, Hobbie WL, Wigo E, Wu X, Brinster RL, Kolon TF. An experimental protocol for fertility preservation in prepubertal boys recently diagnosed with cancer: a report of acceptability and safety. Hum Reprod. 2010;25:37–41.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Clarisa R. Gracia MD, MSCE.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dillon, K.E., Gracia, C.R. Pediatric and Young Adult Patients and Oncofertility. Curr. Treat. Options in Oncol. 13, 161–173 (2012). https://doi.org/10.1007/s11864-012-0183-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-012-0183-7

Keywords

Navigation