We are in an exciting and interesting time, when pediatricians and reproductive endocrinologists across the globe rise to the challenge of providing fertility services for people with a history of gonadotoxic diseases. Indeed, developments in numerous medical fields have improved long-term survival rates for many diseases that strike children and young adults. However, to survive is no longer enough. The emphasis is shifting, to enable people to live a life as normal as possible after cancer; this includes giving them the best possible opportunity to have their own biological children. However, recognition of the damaging effects of chemotherapy and pelvic irradiation, and sometimes of the disease process itself, in children and patients of reproductive age, is now common knowledge. As a consequence, innovative technologies and surgical procedures have been developed in order to give hope of preserving the potential for biological parenthood after healing. Though sperm cryopreservation before treatment is a well-established procedure, routinely performed for more than 20 years, the science and clinical practice of female fertility preservation remains at a pioneering level. This situation may be explained by the relative complexity of folliculogenesis and the large number of possible fertility-sparing treatments. Approaches to fertility preservation vary greatly, depending on the age of the patient, the type of disease and the reproductive medicine services available locally. Ovarian tissue cryopreservation (OTC), despite its experimental nature, may represent the main option in pre-pubertal girls. In addition, questions related to the potential of pre-pubertal ovarian tissue have been recently swept away with the first live birth reported in a patient having undergone OTC at 14 years old. However, the OTC procedure is relatively invasive and implies the reduction of the follicular ovarian stockpile, which is, in some situations, as genetic premature ovarian failure, conceptually difficult to accept. In addition, the ovarian tissue may carry malignant cells that could contraindicate its future use. Therefore, oocyte vitrification, following controlled ovarian hyperstimulation or after in vitro maturation, should be discussed. Whatever the technique used, fertility preservation in prepubertal girl and adolescents remains a challenge. Ethical aspects and projections into the future use should be systematically considered.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology