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Reproductive concerns of children and adolescents with cancer: challenges and potential solutions
Catharyn Stern,1 Rachel Conyers,2 Lisa Orme,2 Shlomi Barak,1,3 Franca Agresta,1 John Seymour2
1Melbourne IVF and Royal Women's Hospital, 2Peter MacCallum Cancer Centre, Melbourne, and University of Melbourne, 3Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
Abstract: The diagnosis of a potentially life-threatening cancer is one of the most traumatic events that can befall a young person and his or her family. However, fortunately, most young people will survive their cancer and its treatment and go on to lead a long and healthy life, with an appropriate expectation of being able to have their own genetic family. However, cancer treatment, including surgery, chemotherapy, and radiotherapy, can have temporary and permanent effects on fertility, including damage to the uterus and pituitary gland, and reduction, or obliteration, of gonadal function, with consequential loss of oocytes or spermatozoa, which may result in ovarian or testicular failure. As the gamete pool is nonrenewable, permanent gonadal failure precludes subsequent fertility with a patient's own genetic material. Awareness and acknowledgement of the likely future fertility implications of cancer treatment is an essential part of any discussion about proposed therapies. Options for girls and young women include freezing mature oocytes and ovarian tissue, as well as attempting to protect the ovaries from the gonadotoxic effects of treatment. Options for boys and young men include semen collection and storage as well as testicular biopsy with freezing of testicular tissue or spermatozoa retrieved from the tissue. Fertility options can now be offered with increasing optimism about success and the provision of a genuine opportunity for having a family. While the initiation of cancer treatment is sometimes truly urgent, the opportunity for a detailed discussion about implications for fertility is of paramount importance for patients and their families and provides both reassurance and optimism about the future.
Keywords: fertility preservation, chemotherapy, radiotherapy, ovarian failure, testicular failure, gonadal function
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