Fertility Preservation for Pediatric Patients: Current State and Future Possibilities.
J Urol. 2017 Feb 09;:
Authors: Johnson EK, Finlayson C, Rowell EE, Gosiengfiao Y, Pavone ME, Lockart B, Orwig KE, Brannigan RE, Woodruff TK
Abstract
PURPOSE: This review provides an overview of pediatric fertility preservation (FP). Topics covered include: patient populations who could benefit, current state of FP options and research, and considerations related to ethics and program development.
MATERIALS AND METHODS: A broad Embase® and Pubmed® search was performed to identify publications discussing investigational, clinical, ethical and healthcare delivery issues related to pediatric FP. Relevant publications were reviewed and summarized.
RESULTS: Populations who can benefit from FP in childhood/adolescence include: oncology patients, patients with non-oncologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development (DSD), and transgender individuals. Peri- and post-pubertal FP options are well established, and include cryopreservation of oocytes, embryos or sperm. Pre-pubertal FP is experimental; multiple lines of active research aim to develop technologies that will allow immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision-making, and the fact that FP procedures can be considered not "medically necessary." Successful multidisciplinary FP care teams emphasize partnerships with adult colleagues, prioritize timely consultations, and utilize standardized referral processes. Some aspects of FP are not covered by insurance; out-of-pocket costs can be prohibitive.
CONCLUSIONS: Pediatric FP is an emerging, evolving field. Although FP options for pre-pubertal patients with fertility-altering conditions such as cancer and DSD are currently limited, multiple lines of active research hold promise for the future. Key considerations include: establishing a multidisciplinary team to provide pediatric FP services, an appreciation for relevant ethical issues, and cost.
PMID: 28189577 [PubMed - as supplied by publisher]