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Fertility After Pediatric Cancer Treatment

February 16th, 2016  |  The Blog

An estimated 75% of children diagnosed with cancer survive into adulthood. The statistics are climbing higher but there is concern about children having children after cancer treatment. Their fertility is a real concern.

What Happens When Children Undergo Cancer Treatment?

Here are some facts about children undergoing cancer treatment:

Girls

Ovarian function is impaired. Specifically, the number of eggs within the ovaries is reduced, according to chief medical officer at Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Dr. Lisa Diller. Basically, cancer treatment causes ovaries to age significantly. Those who have had cancer treatment and are now 20-years old, have the ovarian function of a 35 to 40-year old woman.

Boys

According to Dr. Richard Yu, MD, PhD, a urologist in Boston Children’s Hospital Department of Urology, chemotherapy and radiation used to treat childhood cancer can obliterate the sperm stem cells in the testes, much like the treatments affect a girl’s ovaries and eggs.

The Problem

The best case scenario would be for a child who is about to undergo treatment to bank their eggs or sperm. Patients diagnosed with cancer before puberty do not have mature eggs or sperm to bank before they begin cancer treatment.

Alternative Solutions Regarding Infertility?

Experimental procedures are in place as alternatives to banking eggs and sperm. For girls, ovarian tissue preservation and for boys, testicular tissue preservation is on the horizon. The effectiveness of both alternatives remains to be determined for the long-term.

Boys

The procedure to collect sperm stem cells, which can be re-implanted at a later time or stimulated to develop into mature sperm, is currently developed but still experimental.

Girls

Ovarian tissue preservation is more complicated than sperm stem cell preservation. The current downsides to this alternative solution are:

  • It is very experimental
  • It is invasive for the female child
  • The cost is prohibitive, in the thousands of dollars
  • Not all retrieved tissue survives the freezing process
  • It is an unknown time frame for how long the tissue can remain frozen
  • If any cancer cells are present in the tissue, it cannot be re-implanted because cancer could be reintroduced into the patient

There is an ovarian marker, anti-Mullerian hormone (AMH), which can indicate girls who are at high risk for infertility after cancer treatment. These girls would potentially reap the benefit of egg or ovarian tissue banking.

How AHM Works

AMH levels are lower if a child has longer or more aggressive cancer treatment. AMH is a good indicator of ovarian reserve in adult females and also helps to look at the fertility potential for pediatric patients.

Boys

Biopsies are used to identify new sperm stem cell markers. The hope of researchers is that cancerous cells and healthy cell can be separated and better procedures to coax stem cells to mature will be identified.

The Long-Term Outcome

By the time these pediatric patients are adults, the hope is that the technology linked to these experimental procedures to preserve future fertility will have evolved. There needs to be successful technology to:

  • Re-implant tissue
  • Stimulate tissue
  • Mature eggs in a lab without re-implanting
  • Mature sperm in a lab without re-implanting

For this alternative procedure to actually be effective and successful, the technology to reuse the frozen tissue needs to catch-up with the procedures used to retrieve them. If the technology evolves over the next 10 to 20 years, those patients who banked eggs or sperm will benefit greatly with regard to infertility. Without banking eggs or sperm, there will be little to no chance of fertility in the future. It is a gamble but one that some feel is worth risking.

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