Available online 9 February 2024, 102742

Author links open overlay panelAbstract

Cancer is a life-threatening event for pediatric patients. Treatment advancements in pediatric cancer have improved prognosis, but some of these treatments have gonadotoxic potential and may affect fertility in different ways. Due to the growing interest of the research community in the life prospects of young cancer survivors, there has been a demand to intersect reproductive medicine and oncology, which is referred to as “oncofertility”. There are various fertility preservation options according to gender and pubertal status, and shared decisions must take place at the time of diagnosis. This study aims to provide a critical review of current and emerging strategies for preserving and restoring fertility in prepubertal females, ranging from established methods to experimental approaches that can be offered before, during, and after anticancer therapies. Additionally, the author aims to review how clinicians' awareness of oncofertility options and the latest advancements in this field, timely referral, and proper consultations with patients and their families are vital in addressing their concerns, providing emotional support, and guiding them through the decision-making process, as well as potential barriers that may hinder the fertility preservation process.

Section snippetsBackground

Cancer is a life-threatening event for pediatric patients [1]. Leukemia accounts for approximately 29% of total malignancies in prepubertal females, with acute lymphoblastic leukemia (ALL) being the most common subtype [2,3]. Central nervous system (CNS) tumors are the second most common type of cancer in prepubertal girls, followed by lymphomas and renal cancer [2,3]. In the United States, a child (aged 0–15 years) has a 0.24% chance of developing cancer [1].

Cancer treatment includes surgery,

Materials and methods

A narrative review study was conducted to investigate current and emerging strategies for preserving fertility in prepubertal females, from established methods to experimental approaches. A literature search was conducted using combinations of the following Mesh-based (Medical Subject Heading) terms: fertility perseveration, oncofertility, gonadotoxicity, ovarian tissue cryopreservation, gonadal shielding, oophoropexy, in vitro maturation, neoadjuvant pharmacotherapy, artificial ovary, stem

Fertility perseveration options in prepubertal females (0-14 years old)

In this section, the author discusses in detail current and emerging strategies for preserving and restoring fertility in prepubertal females that can be offered before, during, and after anticancer therapies. A summary of perseveration options based on the time of anticancer therapy is provided in Table 1.

Ovarian tissue freezing

Ovarian tissue cryopreservation is an ideal strategy and standard of care to preserve reproductive function in prepubertal females [22,23,29]. This procedure can be carried out at any time

Conclusion

The growing number of cancer cases diagnosed and further gonadotoxic anticancer regimens can lead to substantial iatrogenic fertility loss. The increasing number of cancer treatments with favorable outcomes justified the emergence of the oncofertility program to mitigate devastating gonadotoxic risks and offer different options for preserving fertility. Over the past two decades, numerous organizations have published guidelines and recommendations regarding fertility preservation in cancer

Declaration of competing interest

The authors declare that they have no competing interests.

Acknowledgments

Not applicable.

References (136)SB Jia et al.Evaluation of the effectiveness of testicular shielding in rectal cancer radiotherapy

Radiation Physics and Chemistry

(2023)

L Eijkenboom et al.Strategies to safely use cryopreserved ovarian tissue to restore fertility after cancer: a systematic review

Reproductive Biomedicine Online

(2022)

MM Laronda et al.Initiation of puberty in mice following decellularized ovary transplant

Biomaterials

(2015)

O Durak et al.Human induced pluripotent stem cells: now open to discovery

Cell Stem Cell

(2014)

KM Grieve et al.The controversial existence and functional potential of oogonial stem cells

Maturitas

(2015)

AM Truman et al.Ovarian regeneration: the potential for stem cell contribution in the postnatal ovary to sustained endocrine function

Molecular and cellular endocrinology

(2017)

E Ward et al.Childhood and adolescent cancer statistics, 2014

CA: a cancer journal for clinicians

(2014)

RL Siegel et al.Cancer statistics, 2018

CA: a cancer journal for clinicians

(2018)

AC. SocietyCancer facts & figures 2020

(2020)

B Yalçin et al.High-dose chemotherapy and autologous haematopoietic stem cell rescue for children with high-risk neuroblastoma

Cochrane Database of Systematic Reviews

(2013)

A Vora et al.Influence of cranial radiotherapy on outcome in children with acute lymphoblastic leukemia treated with contemporary therapy

Journal of Clinical Oncology

(2016)

X Hu et al.Radiotherapy for diffuse brainstem glioma in children and young adults

Cochrane Database of Systematic Reviews

(2016)

C Kline et al.Survival outcomes in pediatric recurrent high-grade glioma: results of a 20-year systematic review and meta-analysis

Journal of neuro-oncology

(2018)

S Reinmuth et al.Impact of chemotherapy and radiotherapy in childhood on fertility in adulthood: the FeCt—survey of childhood cancer survivors in Germany

Journal of cancer research and clinical oncology

(2013)

L Coker Appiah et al.Disparities in female pediatric, adolescent and young adult oncofertility: a needs assessment

Cancers

(2021)

JS Jeruss et al.Preservation of fertility in patients with cancer

New England Journal of Medicine

(2009)

CA Sklar et al.Premature menopause in survivors of childhood cancer: a report from the childhood cancer survivor study

Journal of the National Cancer Institute

(2006)

W Chemaitilly et al.Acute ovarian failure in the childhood cancer survivor study

The Journal of Clinical Endocrinology & Metabolism

(2006)

J Hirshfeld-Cytron et al.Animal age, weight and estrus cycle stage impact the quality of in vitro grown follicles

Human Reproduction

(2011)

BP. AlterDiagnosis, genetics, and management of inherited bone marrow failure syndromes

ASH Education Program Book

(2007)

TK. WoodruffOncofertility: a grand collaboration between reproductive medicine and oncology

Reproduction

(2015)

MA Smith et al.Outcomes for children and adolescents with cancer: challenges for the twenty-first century

Journal of clinical oncology

(2010)

J Ferlay et al.Global cancer observatory: cancer today

(2020)

KA. Rodriguez-WallbergPrinciples of cancer treatment: impact on reproduction

(2012)

TK. WoodruffThe emergence of a new interdiscipline: oncofertility

(2007)

TK. WoodruffThe Oncofertility Consortium—addressing fertility in young people with cancer

Nature reviews Clinical oncology

(2010)

Medicine PCotASfRFertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion

Fertility and sterility

(2019)

L Nahata et al.Ovarian tissue cryopreservation as standard of care: what does this mean for pediatric populations?

Journal of assisted reproduction and genetics

(2020)

EK Donovan et al.The role of oophoropexy in patients with gynecological cancer who need radiation therapy

International Journal of Gynecologic Cancer

(2022)

K Oktay et al.Fertility preservation in patients with cancer: ASCO clinical practice guideline update

J Clin Oncol

(2018)

B Hu et al.Prospects for fertility preservation: the ovarian organ function reconstruction techniques for oogenesis, growth and maturation in vitro

Frontiers in Physiology

(2023)

VG Wesevich et al.In Vitro Gametogenesis in Oncofertility: A Review of Its Potential Use and Present-Day Challenges in Moving toward Fertility Preservation and Restoration

Journal of Clinical Medicine

(2023)

J Chen et al.Ovarian tissue bank for fertility preservation and anti-menopause hormone replacement

Frontiers in Endocrinology

(2022)

F Cariati et al.Cryopreservation of ovarian tissue: the biggest challenge of oncofertility

Minerva Obstetrics and Gynecology

(2022)

EC Rivas Leonel et al.Cryopreservation of human ovarian tissue: a review

Transfusion medicine and hemotherapy

(2019)

J Donnez et al.Children born after autotransplantation of cryopreserved ovarian tissue. A review of 13 live births

Annals of medicine

(2011)

M Xu et al.In vitro grown human ovarian follicles from cancer patients support oocyte growth

Human Reproduction

(2009)

EE Telfer et al.A two-step serum-free culture system supports development of human oocytes from primordial follicles in the presence of activin

Human Reproduction

(2008)

F Pacheco et al.Current success and efficiency of autologous ovarian transplantation: a meta-analysis

Reproductive Sciences

(2017)

H Khattak et al.Fresh and cryopreserved ovarian tissue transplantation for preserving reproductive and endocrine function: a systematic review and individual patient data meta-analysis

Human reproduction update

(2022)

View full text

© 2024 Elsevier Masson SAS. All rights reserved.