New advances in fertility preservation for pediatric cancer patients.

PURPOSE OF REVIEW: The number of pediatric cancer survivors is growing rapidly as treatments become more effective. However, many current regimens cause gonadotoxicity and permanent infertility, significantly impacting quality of life. The purpose of this review is to update pediatric oncologists on risk factors for cancer treatment-associated gonadotoxicity, current methods for fertility preservation, and new scientific advances in this area.

RECENT FINDINGS: Infertility is an enormous quality-of-life issue for pediatric cancer survivors and their families. Numerous treatment options are already available to prevent infertility in patients at risk. It is important to counsel patients at risk and initiate management for fertility preservation prior to beginning therapy. Preclinical research indicates that it may be possible to bank gonadal tissues from patients for subsequent re-implantation after therapy or expansion of germ cells in vitro. Further translational studies are required to advance these technologies into clinical use.

SUMMARY: Pediatric cancer survivors are at risk for long-term treatment-related gonadal failure and infertility. Counseling and treatment should begin prior to initiating chemo or radiation therapy. Recent scientific advances in understanding germ cell biology should eventually generate new clinical strategies to maintain fertility in pediatric cancer patients.