Fertility preservation for young adults, adolescents, and children with cancer

Abstract

Options for fertility preservation (FP) through cryopreservation methods are currently available for young adults, adolescents, and children. Guidelines for FP have been provided by international clinical societies, and emergency procedures aimed at FP have been implemented into clinical practice worldwide. In this article, we review the current data on clinical standards of emergency FP in patients who are facing gonadotoxic effects of cancer treatment, and we also describe the methods that are still under development, usually denoted as experimental. In Sweden, programmes for FP have been established at large university hospitals, thus covering the whole country. The Swedish publicly financed health care covers both assisted reproduction for treatment of infertility and the cryopreservation of gametes or gonadal tissue when there is a medical indication, such as the risk to become infertile due to oncologic treatment; hence the access to FP is ensured for the whole population. At our centre at Karolinska University Hospital in Stockholm, methods for FP have been offered since 1988. In this article, we also review the oncologic indications for FP in our patient cohort of >3000 individuals during the period 1988–2018.

Keywords:

• Cancer survivorship
• cryopreservation
• fertility preservation
• gonadotoxicity
• premature gonadal failure
• young adults and children

Acknowledgements

The personnel at the Departments of Reproductive Medicine, Oncology, Pediatric Endocrinology and Pediadric Oncology of Karolinska University Hospital are gratefully acknowledged.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Swedish Cancer Society, The Swedish Childhood Cancer Fund, Radiumhemmets Forskningsfonder, Stockholm County Council, and Karolinska Institutet.

Notes on contributors

Kenny A. Rodriguez-Wallberg

Kenny A. Rodriguez-Wallberg, MD, PhD, Associate professor and Associate senior lecturer at the Department of Oncology-Pathology of Karolinska Institutet; Senior consultant at the Department of Reproductive Medicine, Karolinska University Hospital.

Amandine Anastacio

Amandine Anastacio, PhD, Postdoctoral Fellow at the Department of Oncology-Pathology of Karolinska Institutet, Stockholm, Sweden.

Emelie Vonheim

Emelie Vonheim, MD, Karolinska Institutet and University Hospital.

Sandra Deen

Sandra Deen, MD, Karolinska Institutet and University Hospital.

Johan Malmros

Johan Malmros, MD, PhD, Senior consultant at the Department of Paediatric Oncology, Karolinska University Hospital.

Birgit Borgström

Birgit Borgström, MD, PhD, Senior consultant at the Department of Paediatric Endocrinology, Karolinska University Hospital.