Fertility Preservation in Adolescents with Cancer

  • Lenore Omesi
  • Jennifer LevineEmail author


Major advances in the field of pediatric oncology have resulted in improved survival rates for children and adolescents diagnosed with malignancies. From these successes, the field of survivorship has emerged with attention to the late effects of cancer therapy including infertility. Studies have shown that survivors of childhood cancers consider fertility preservation an important part of their treatment and long-term quality of life. The American Society of Clinical Oncology (ASCO) updated published guidelines in 2013 addressing fertility preservation at the time of a new cancer diagnosis as standard of care. For young males who have achieved puberty, obtaining sperm for cryopreservation through masturbation is the most common method. However, for adolescents, developmental concerns present additional challenges to obtaining sperm compared to their young adult counterparts. Alternatives for obtaining sperm exist for those for whom masturbation is not an option. For prepubertal males, only experimental methods exist. Studies have also shown that oncologists who treat children and adolescents are aware of the effects of cancer treatments on fertility but that barriers and difficulties exist that prevent adequate attention to this topic. This chapter emphasizes the special considerations that exist in fertility preservation in adolescent males with a focus on sperm banking.


Adolescence Pediatric cancer Fertility Late effects Survivorship 


  1. 1.
    Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):83–103.CrossRefPubMedGoogle Scholar
  2. 2.
    Phillips SM, Padgett LS, Leisenring WM, et al. Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiol Biomarkers Prev. 2015;24(4):653–63.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Wasilewski-Masker K, Seidel KD, Leisenring W, et al. Male infertility in long-term survivors of pediatric cancer: a report from the childhood cancer survivor study. J Cancer Surviv. 2014;8(3):437–47.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Schover LR, Rybicki LA, Martin BA, Bringelsen KA. Having children after cancer. A pilot survey of survivors’ attitudes and experiences. Cancer. 1999;86(4):697–709.CrossRefPubMedGoogle Scholar
  5. 5.
    Wyns C, Collienne C, Shenfield F, et al. Fertility preservation in the male pediatric population: factors influencing the decision of parents and children. Hum Reprod. 2015;30(9):2022–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Picton HM, Wyns C, Anderson RA, et al. A European perspective on testicular tissue cryopreservation for fertility preservation in prepubertal and adolescent boys. Hum Reprod. 2015;30(11):2463–75.CrossRefPubMedGoogle Scholar
  7. 7.
    Quinn GP, Vadaparampil ST, Lee JH, et al. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol. 2009;27(35):5952–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Klosky JL, Randolph ME, Navid F, et al. Sperm cryopreservation practices among adolescent cancer patients at risk for infertility. Pediatr Hematol Oncol. 2009;26(4):252–60.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Neal MS, Nagel K, Duckworth J, et al. Effectiveness of sperm banking in adolescents and young adults with cancer: a regional experience. Cancer. 2007;110(5):1125–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Kohler TS, Kondapalli LA, Shah A, Chan S, Woodruff TK, Brannigan RE. 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(3):269–77.CrossRefPubMedGoogle Scholar
  11. 11.
    Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Coccia PF, Pappo AS, Altman J, et al. Adolescent and young adult oncology, version 2.2014. J Natl Compr Canc Netw. 2014;12(1):21–32. quiz 32CrossRefPubMedGoogle Scholar
  13. 13.
    Ethics Committee of American Society for Reproductive Medicine. Fertility preservation and reproduction in patients facing gonadotoxic therapies: a committee opinion. Fertil Steril. 2013;100(5):1224–31.CrossRefGoogle Scholar
  14. 14.
    O’Flaherty C, Vaisheva F, Hales BF, Chan P, Robaire B. Characterization of sperm chromatin quality in testicular cancer and Hodgkin’s lymphoma patients prior to chemotherapy. Hum Reprod. 2008;23(5):1044–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Tempest HG, Ko E, Chan P, Robaire B, Rademaker A, Martin RH. Sperm aneuploidy frequencies analysed before and after chemotherapy in testicular cancer and Hodgkin’s lymphoma patients. Hum Reprod. 2008;23(2):251–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Williams DH, Karpman E, Sander JC, Spiess PE, Pisters LL, Lipshultz LI. Pretreatment semen parameters in men with cancer. J Urol. 2009;181(2):736–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Paoli D, Rizzo F, Fiore G, et al. Spermatogenesis in Hodgkin’s lymphoma patients: a retrospective study of semen quality before and after different chemotherapy regimens. Hum Reprod. 2016;31(2):263–72.PubMedGoogle Scholar
  18. 18.
    Hussein AA, Tran ND, Smith JF. Fertility preservation for boys and adolescents facing sterilizing medical therapy. Transl Androl Urol. 2014;3(4):382–90.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Rueffer U, Breuer K, Josting A, et al. Male gonadal dysfunction in patients with Hodgkin’s disease prior to treatment. Ann Oncol. 2001;12(9):1307–11.CrossRefPubMedGoogle Scholar
  20. 20.
    Kenney LB, Laufer MR, Grant FD, Grier H, Diller L. High risk of infertility and long term gonadal damage in males treated with high dose cyclophosphamide for sarcoma during childhood. Cancer. 2001;91(3):613–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Shafford EA, Kingston JE, Malpas JS, et al. Testicular function following the treatment of Hodgkin’s disease in childhood. Br J Cancer. 1993;68(6):1199–204.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Green DM, Kawashima T, Stovall M, et al. Fertility of male survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2010;28(2):332–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Aubier F, Flamant F, Brauner R, Caillaud JM, Chaussain JM, Lemerle J. Male gonadal function after chemotherapy for solid tumors in childhood. J Clin Oncol. 1989;7(3):304–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Kenney LB, Cohen LE, Shnorhavorian M, et al. Male reproductive health after childhood, adolescent, and young adult cancers: a report from the Children’s Oncology Group. J Clin Oncol. 2012;30(27):3408–16.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Charpentier AM, Chong AL, Gingras-Hill G, et al. Anti-Mullerian hormone screening to assess ovarian reserve among female survivors of childhood cancer. J Cancer Surviv. 2014;8(4):548–54.CrossRefPubMedGoogle Scholar
  26. 26.
    Gwendolyn P, Quinn STV. Reproductive health and cancer in adolescents and young adults, vol. 732. Netherlands: Springer; 2012.Google Scholar
  27. 27.
    Kort JD, Eisenberg ML, Millheiser LS, Westphal LM. Fertility issues in cancer survivorship. CA Cancer J Clin. 2014;64(2):118–34.CrossRefPubMedGoogle Scholar
  28. 28.
    Lee SJ, Schover LR, Partridge AH, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24(18):2917–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Fallat ME, Hutter J, American Academy of Pediatrics Committee on Bioethics, American Academy of Pediatrics Section on Hematology/Oncology, American Academy of Pediatrics Section on Surgery. Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics. 2008;121(5):e1461–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Ginsberg JP, Li Y, Carlson CA, et al. Testicular tissue cryopreservation in prepubertal male children: an analysis of parental decision-making. Pediatr Blood Cancer. 2014;61(9):1673–8.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Rosen A, Rodriguez-Wallberg KA, Rosenzweig L. Psychosocial distress in young cancer survivors. Semin Oncol Nurs. 2009;25(4):268–77.CrossRefPubMedGoogle Scholar
  32. 32.
    Cella D, Najavits L. Letter to the editor: denial of infertility in patients with Hodgkin’s disease. Psychosomatics. 1986;27:71.CrossRefGoogle Scholar
  33. 33.
    Klosky JL, Simmons JL, Russell KM, et al. Fertility as a priority among at-risk adolescent males newly diagnosed with cancer and their parents. Support Care Cancer. 2015;23(2):333–41.CrossRefPubMedGoogle Scholar
  34. 34.
    Ginsberg JP, Ogle SK, Tuchman LK, et al. Sperm banking for adolescent and young adult cancer patients: sperm quality, patient, and parent perspectives. Pediatr Blood Cancer. Mar 2008;50(3):594–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Levine J. Fertility preservation in children and adolescents with cancer. Minerva Pediatr. 2011;63(1):49–59.PubMedGoogle Scholar
  36. 36.
    Oosterhuis BE, Goodwin T, Kiernan M, Hudson MM, Dahl GV. Concerns about infertility risks among pediatric oncology patients and their parents. Pediatr Blood Cancer. 2008;50(1):85–9.CrossRefPubMedGoogle Scholar
  37. 37.
    de Vries MC, Bresters D, Engberts DP, Wit JM, van Leeuwen E. Attitudes of physicians and parents towards discussing infertility risks and semen cryopreservation with male adolescents diagnosed with cancer. Pediatr Blood Cancer. 2009;53(3):386–91.CrossRefPubMedGoogle Scholar
  38. 38.
    Crawshaw M, Sloper P. A qualitative study of the experiences of teenagers and young adults when faced with possible or actual fertility impairment following cancer treatment. executive summary. York: University of York; 2006.Google Scholar
  39. 39.
    Reinmuth S, Liebeskind AK, Wickmann L, et al. Having children after surviving cancer in childhood or adolescence––results of a Berlin survey. Klin Padiatr. 2008;220(3):159–65.CrossRefPubMedGoogle Scholar
  40. 40.
    Pacey AA, Eiser C. Banking sperm is only the first of many decisions for men: what healthcare professionals and men need to know. Hum Fertil (Camb). 2011;14(4):208–17.CrossRefGoogle Scholar
  41. 41.
    Edge B, Holmes D, Makin G. Sperm banking in adolescent cancer patients. Arch Dis Child. 2006;91(2):149–52.CrossRefPubMedGoogle Scholar
  42. 42.
    Daudin M, Rives N, Walschaerts M, et al. Sperm cryopreservation in adolescents and young adults with cancer: results of the French national sperm banking network (CECOS). Fertil Steril. 2015;103(2):478–486.e471.CrossRefPubMedGoogle Scholar
  43. 43.
    Bahadur G, Ling KL, Hart R, et al. Semen production in adolescent cancer patients. Hum Reprod. 2002;17(10):2654–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Keene DJ, Sajjad Y, Makin G, Cervellione RM. Sperm banking in the United Kingdom is feasible in patients 13 years old or older with cancer. J Urol. 2012;188(2):594–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Quinn GP, Murphy D, Knapp C, et al. Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature. J Adolesc Health. 2011;49(4):337–46.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Muller J, Sonksen J, Sommer P, et al. Cryopreservation of semen from pubertal boys with cancer. Med Pediatr Oncol. 2000;34(3):191–4.CrossRefPubMedGoogle Scholar
  47. 47.
    Kliesch S, Behre HM, Jurgens H, Nieschlag E. Cryopreservation of semen from adolescent patients with malignancies. Med Pediatr Oncol. 1996;26(1):20–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Hagenas I, Jorgensen N, Rechnitzer C, et al. Clinical and biochemical correlates of successful semen collection for cryopreservation from 12-18-year-old patients: a single-center study of 86 adolescents. Hum Reprod. 2010;25(8):2031–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Meacham RB. Sperm cryopreservation in the teenage male: technical and psychological considerations. J Androl. 2004;25(4):466–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Wallace WH, Anderson RA, Irvine DS. Fertility preservation for young patients with cancer: who is at risk and what can be offered? Lancet Oncol. 2005;6(4):209–18.CrossRefPubMedGoogle Scholar
  51. 51.
    Deepinder FA, Ashok A. Approach to fertility preservation in adult and pre-pubertal males. In: Seli E, Ashok A, editors. Fertility preservation. New York: Springer; 2012. p. 353–61.CrossRefGoogle Scholar
  52. 52.
    Livestrong. Fertility preservation options for men. 2016. Accessed 18 Oct 2016.
  53. 53.
    Wu AK, Odisho AY, Washington SL 3rd, Katz PP, Smith JF. Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort. J Urol. 2014;191(2):427–32.CrossRefPubMedGoogle Scholar
  54. 54.
    Schover LR, Brey K, Lichtin A, Lipshultz LI, Jeha S. Oncologists’ attitudes and practices regarding banking sperm before cancer treatment. J Clin Oncol. 2002;20(7):1890–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Nahata L, Cohen LE, Lehmann LE, Yu RN. Semen analysis in adolescent cancer patients prior to bone marrow transplantation: when is it too late for fertility preservation? Pediatr Blood Cancer. 2013;60(1):129–32.CrossRefPubMedGoogle Scholar
  56. 56.
    Anderson RA, Weddell A, Spoudeas HA, et al. Do doctors discuss fertility issues before they treat young patients with cancer? Hum Reprod. 2008;23(10):2246–51.CrossRefPubMedGoogle Scholar
  57. 57.
    Goodwin T, Elizabeth Oosterhuis B, Kiernan M, Hudson MM, Dahl GV. Attitudes and practices of pediatric oncology providers regarding fertility issues. Pediatr Blood Cancer. 2007;48(1):80–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Quinn GP, Vadaparampil ST, King L, et al. Impact of physicians’ personal discomfort and patient prognosis on discussion of fertility preservation with young cancer patients. Patient Educ Couns. 2009;77(3):338–43.CrossRefPubMedGoogle Scholar
  59. 59.
    Achille MA, Rosberger Z, Robitaille R, et al. Facilitators and obstacles to sperm banking in young men receiving gonadotoxic chemotherapy for cancer: the perspective of survivors and health care professionals. Hum Reprod. 2006;21(12):3206–16.CrossRefPubMedGoogle Scholar
  60. 60.
    Schover LR, Brey K, Lichtin A, Lipshultz LI, Jeha S. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. J Clin Oncol. 2002;20(7):1880–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Quinn GP, Vadaparampil ST, Gwede CK, Reinecke JD, Mason TM, Silva C. Developing a referral system for fertility preservation among patients with newly diagnosed cancer. J Natl Compr Canc Netw. 2011;9(11):1219–25.CrossRefPubMedGoogle Scholar
  62. 62.
    Shnorhavorian M, Kroon L, Jeffries H, Johnson R. Creating a standardized process to offer the standard of care: continuous process improvement methodology is associated with increased rates of sperm cryopreservation among adolescent and young adult males with cancer. J Pediatr Hematol Oncol. 2012;34(8):e315–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Pediatric Hematology, Oncology, and Stem Cell TransplantNew York-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Medical CenterNew YorkUSA
  2. 2.Division of Pediatric Hematology and OncologyWeill Cornell MedicineNew YorkUSA

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