Fertility Preservation for Children Diagnosed with Cancer

Starting the Conversation

Information for Providers

Many adult survivors of childhood cancer feel fertility preservation and the ability to have a future family are important. Understanding there may be fertility preservation options available and referring children and their parents in a timely manner to reproductive specialists can improve their future quality of life.

Introduction

Parents may not be aware there are options for preserving fertility in their child diagnosed with cancer. However,

  • Parents may be focused on cancer treatment and their child’s immediate health.
  • Parents may feel uncomfortable discussing issues of reproduction with their children.

Fertility Preservation - Where Does It Fit?

a) See table below
b) See figure below

Starting the Conversation

Discussing fertility preservation is important. These key points can help start the conversation:

  • Cancer and cancer treatment may affect your child’s fertility.
  • Based on your child’s treatment plan, his/her risk of infertility is [high, moderate, low] (see table on reverse).
  • There are options to try to preserve your child’s fertility before he/she begins cancer treatment (see figure to right).
  • I can refer you to a fertility preservation specialist if you would like to discuss your child’s options further. 

Options for Fertility Preservation

  • The following diagram gives a brief description of fertility preservation options available to children diagnosed with cancer before and after treatment.
  • There are several resources listed on the reverse that can help you and your patients locate a fertility preservation specialist to discuss tissue banking.

a Not an option if there is a high risk of ovarian metastases.

b Experimental—only performed as part of a clinical study approved by an IRB.

Cancer Therapy and the Risk of Infertility

The following table classifies various cancer therapies and regimens based on their known infertility risk. While this table provides general guidelines, each patient is different and treatment may impair their fertility differently.

High Risk
  • Total body irradiation (TBI)
  • Whole abdominal or pelvic radiation doses >15 Gy in pre-pubertal girls or >10 Gy in post-pubertal girls
  • Testicular radiation dose ≥3 Gy in boys
  • Cranial/brain irradiation >40 Gy
  • Spinal irradiation 24–36 Gy
  • Total cyclophosphamide > 5g/m2 in boys
  • Total cyclophosphamide > 15g/m2 in girls
  • Alkylating chemotherapy (e.g., cyclophosphamide, busulfan, melaphan) conditioning for transplant
  • Any alkylating agent (e.g., cyclophosphamide, ifosfamide, busulfan, carmustine, lomustine) + TBI, pelvic radiation, or testicular radiation
  • Protocols containing procarbazine
  • Surgical removal of both gonads
Intermediate Risk
  • Whole abdominal or pelvic radiation 10 to <15 Gy in pre-pubertal girls
  • Whole abdominal or pelvic radiation 5 to <10 Gy in post-pubertal girls
  • Spinal radiation doses 18–24 Gy
  • Testicular radiation dose 1–2 Gy (due to scatter from abdominal/pelvic radiation)
  • Cumulative cisplatin dose of about 500 mg/m2 (boys only)
Low Risk
  • Testicular radiation dose <1.0 Gy
  • Nonalkylating chemotherapy
Very Low / No Risk
  • Radioactive iodine
  • Methotrexate/5-FU
  • Vincristine
  • Interferon-α
Unknown Risk
  • Monoclonal antibodies, e.g., cetuximab  (Erbitux), trastuzumab (Herceptin)
  • Tyrosine kinase inhibitors, e.g., erlotinib (Tarceva), imatinib (Gleevec)

Table adapted from LIVESTRONG;  Nieman CL, et al. Cancer Treat Res. 2007;138:201-217; and Chow EJ, et al. Lancet Oncol. 2016;17:567-76.

Resources

For more information about infertility risk and fertility preservation options for children diagnosed with cancer:

References