Infrastructure of Fertility Preservation Services for Pediatric Cancer Patients: A Report From the Children's Oncology Group

PURPOSE Fertility preservation (FP) services are part of comprehensive care for those newly diagnosed with cancer. The capacity to offer these services to children and adolescents with cancer is unknown. METHODS A cross-sectional survey was sent to 220 Children's Oncology Group member institutions regarding institutional characteristics, structure and organization of FP services, and barriers to FP. Standard descriptive statistics were computed for all variables. The association between site-specific factors and selected outcomes was examined using multivariable logistic regression. RESULTS One hundred forty-four programs (65.5%) returned surveys. Fifty-three (36.8%) reported a designated FP individual or team. Sperm banking was offered at 135 (97.8%) institutions, and testicular tissue cryopreservation at 37 (27.0%). Oocyte and embryo cryopreservation were offered at 91 (67.9%) and 62 (46.6%) institutions, respectively; ovarian tissue cryopreservation was offered at 64 (47.8%) institutions. The presence of dedicated FP personnel was independently associated with the ability to offer oocyte or embryo cryopreservation (odds ratio [OR], 4.7; 95% CI, 1.7 to 13.5), ovarian tissue cryopreservation (OR, 2.7; 95% CI, 1.2 to 6.0), and testicular tissue cryopreservation (OR, 3.3; 95% CI, 1.4 to 97.8). Only 26 (18.1%) participating institutions offered all current nonexperimental FP interventions. Barriers included cost (70.9%), inadequate knowledge or training (60.7%), difficulty characterizing fertility risk (50.4%), inadequate staffing (45.5%), and logistics with reproductive specialties (38%-39%). CONCLUSION This study provides the most comprehensive view of the current landscape of FP infrastructure for children and adolescents with cancer and demonstrates that existing infrastructure is inadequate to offer comprehensive services to patients. We discuss modifiable factors to improve patient access to FP.

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Fertility Preservation

10.2310/obg.19100 ◽

2018 ◽

Author(s):

Chantae S Sullivan-Pyke ◽

Clarisa Gracia

Keyword(s):

Fertility Preservation ◽

Ovarian Tissue ◽

Testicular Tissue ◽

Mature Oocyte ◽

Gonadotropin Releasing Hormone ◽

Oocyte Cryopreservation ◽

Ovarian Tissue Cryopreservation ◽

Embryo Cryopreservation ◽

Gonadotropin Releasing Hormone Agonist ◽

Tissue Cryopreservation

Fertility preservation has becoming increasingly important for patients at risk for gonadal failure, including those needing treatment for cancer or autoimmune conditions, genetic conditions that predispose to gonadal insufficiency, and age-related fertility decline. Embryo cryopreservation and mature oocyte cryopreservation are the standards for fertility preservation in postpubertal women. Ovarian tissue cryopreservation and gonadotropin-releasing hormone agonist use for ovarian suppression are experimental methods that may be offered to patients for whom embryo and/or mature oocyte cryopreservation are not applicable. The cryopreservation of spermatozoa is the standard for fertility preservation in postpubertal males, but testicular tissue cryopreservation may be offered to prepubertal males. This review contains 10 figures, 6 tables and 53 references Key words: controlled ovarian stimulation, embryo cryopreservation, gonadotropin-releasing hormone agonist, in vitro maturation, oocyte cryopreservation, ovarian tissue cryopreservation, sperm extraction, testicular tissue cryopreservation

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Should you be putting all your eggs into one basket? A look into the current state and future of ovarian tissue cryopreservation.

Journal of Cancer Biology and Therapeutics ◽

10.18314/gjct.v1i2.51 ◽

2015 ◽

Vol 1 (2) ◽

Author(s):

Shakina Rauff ◽

Zaraq Khan ◽

Claus Yding Andersen

Keyword(s):

Fertility Preservation ◽

Ovarian Tissue ◽

Mature Oocyte ◽

Reproductive Capacity ◽

Ovarian Tissue Cryopreservation ◽

Embryo Cryopreservation ◽

Social Motives ◽

Current State ◽

Medical Indications ◽

Tissue Cryopreservation

Ã‚Â Ovarian tissue cryopreservation has its primary goal in fertility preservation for women diagnosed with a malignancy and who may be rendered infertile because of the potential gonadotoxic chemotherapy and/or radiotherapy involved in treating their disease. Unlike the standard and endorsed methods of fertility preservation like mature oocyte and embryo cryopreservation, ovarian tissue freezing not only conserves the reproductive capacity of the woman but additionally, maintains the steroidogenic competence of the ovary due to the fact that the frozen cortex contains numerous ovarian follicles Ã¢â‚¬â€œ the functional unit of the ovary. Not every follicle is fated to aid procreation. In fact more than 99% are destined to end up in atresia, which may be viewed as an enormous waste of inherent resources. In light of this, there have been propositions to expand the scope of ovarian tissue cryopreservation and transplantation beyond its traditional purpose of fertility preservation for medical indications. Some of these ideas include utilizing cryopreserved ovarian tissue for induction of puberty, delaying the menopause and fertility preservation for social motives. Needless to say, these novel ideas will evoke questions, controversy and a plethora of criticism about the safety, superiority, cost-effectiveness, implications and necessity of these different utilities. In this article, we aim to explore some of the issues that shroud these new indications and discuss the advantages for and diatribe against these evolving suggestions.

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New insights for fertility preservation by ovarian tissue cryopreservation and transplantation in pediatric cancer patients

Fertility and Sterility ◽

10.1016/j.fertnstert.2020.07.057 ◽

2020 ◽

Vol 114 (6) ◽

pp. 1191

Author(s):

Sonia Herraiz ◽

Irene Cervelló

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Pediatric Cancer ◽

Ovarian Tissue ◽

Ovarian Tissue Cryopreservation ◽

Pediatric Cancer Patients ◽

Tissue Cryopreservation

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Deliveries following fertility preservation by ovarian tissue cryopreservation without autotransplantation—what should be expected?

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-018-1341-z ◽

2018 ◽

Vol 36 (2) ◽

pp. 335-340 ◽

Cited By ~ 3

Author(s):

Daniel Lantsberg ◽

Adel Farhi ◽

Inna Zaslavsky-Paltiel ◽

Barbara G. Silverman ◽

Liat Lerner-Geva ◽

...

Keyword(s):

Fertility Preservation ◽

Ovarian Tissue ◽

Ovarian Tissue Cryopreservation ◽

Tissue Cryopreservation

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P–466 Fertility preservation for medical reasons: International and intra-national variation in provision and the gap between guideline and practice

Human Reproduction ◽

10.1093/humrep/deab130.465 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

E Yasmin ◽

S Latif ◽

C Dia. Garcia ◽

S. Martin. D Silva

Keyword(s):

Northern Ireland ◽

Fertility Preservation ◽

Ovarian Tissue ◽

National Policy ◽

Cytotoxic Agents ◽

Ovarian Tissue Cryopreservation ◽

The Uk ◽

And Storage ◽

Tissue Cryopreservation ◽

Health Boards

Abstract Study question What is the gap between guidance and practice of fertility preservation between countries and within countries with common clinical guidelines? Summary answer Substantial variation in provision of FP exists between countries and within individual countries with gaps between national and international guidelines and policies governing provision. What is known already A robust guideline on female FP was published by ESHRE in 2020, advising the application of FP in cancer and other conditions where treatment with cytotoxic agents or surgery will compromise reproductive function. Across Europe, in 13 countries (43.3%) FP is funded for all available FP procedures, in 13 countries (43.3%) no FP funding is available, and in 4 countries (13.3%) at least one FP option is funded. Variation in state provision of fertility care in different countries in Europe was highlighted in the ESHRE guidance. It did not specifically examine individual national policies or whether a national policy exists. Study design, size, duration Five clinicians performing FP in Europe were contacted to collect current FP provision data. Policies retrieved from the internet were not included as they could not be verified. Finally, FP funding policies for 135 Clinical Commissioning Groups (CCGs) in England, 14 Health Boards in Scotland, 7 Health Boards in Wales and 5 Trusts in Northern Ireland and 17 policies for regional heath services in Spain were included were included. Participants/materials, setting, methods Policies on FP for the UK and Spain were reviewed (n = 178), including policies from the 161 regions from the four nations of the UK and policies of 17 autonomous bodies in Spain. Information on funded procedures, type of conditions included for funding and duration of storage were extracted. The provision of FP was compared to the current European Society of Human Reproduction and Embryology (ESHRE) and National Institute for Health and Care Excellence (NICE) guidelines. Main results and the role of chance In England, 127/128 (99%) CCGs fund cryopreservation of oocytes, sperm and embryos. Cancer is the exclusive indication in 11%. Provision of FP for transgender individuals is specified in 28%, ovarian tissue cryopreservation is funded in 8% and storage funding varies from five to ten years. In Scotland, a national policy is applied. All 14 health boards equitably fund cryopreservation of oocytes, sperm, embryos and ovarian and testicular tissue. Funding is provided for cancer, medical conditions which may impair fertility and transgender individuals. Storage funding is based on a five yearly review until age 43 in women and 60 in men. In Wales and Northern Ireland, cryopreservation of oocytes, sperm and embryos is funded for people undergoing medical or surgical treatment that is likely to make them infertile, provision for transgender individuals is not specified and ovarian tissue cryopreservation is not funded. In Spain, all 17 Health Services fund cryopreservation of oocytes, sperm and embryos for patients whose fertility is at risk due to gonadotoxic treatments or other pathological processes. Ovarian tissue cryopreservation is funded in 94%, provision for transgender individuals is specified in 12%, and storage funding is available until the age of 50 in women and 55 in men. Limitations, reasons for caution Inability to retrieve fertility preservation policies for every country in Europe is a limitation, for which ongoing collaboration is sought. The variable nature of FP provision is likely to be multi-factorial; a lag in publication of guidelines and updated policies, ethical considerations and resource distribution may govern health policies. Wider implications of the findings: The study highlights that provision of FP not only varies between countries but is also inconsistent within the same country. It is clear that there is a gap between ideal, evidence-based practice and actual provision. Variation in policies limits uniform access to care for patients. Trial registration number Not applicable.

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