ESPE Abstracts (2016) 86 RFC7.6

The Hopeful Beginnings of Fertility Preservation in Children

Cindy Hoa,b, Harold Bournec,d, Debra Gookc,d, Gary Clarkec, Matthew Kemertzisc, Kate Sternc,d, Franca Agrestad, Margaret Zacharina, Yves Helourya, Hannah Clarke, Lisa Ormea, Shlomi Barakd & Yasmin Jayasinghea,c

aRoyal Children’s Hospital, Victoria, Australia; bKhoo Teck Puat-National University Children’s Medical Institute, Singapore,
Singapore; cRoyal Women’s Hospital, Victoria, Australia; dMelbourne IVF, Victoria, Australia; eMonash University, Victoria, Australia

Background: Fertility Preservation (FP) in children and adolescents poses unique challenges as efficacy is unproven.

Objective and hypotheses: To describe characteristics and evidence for potential fertility in ovarian and testicular tissue cryopreservation specimens (OTCP and TTCP respectively) taken from paediatric and adolescent patients, stratified by age, and prior chemotherapy.

Method: Retrospective review of gonadal biopsies and clinical records of patients consented into the Royal Children’s Hospital FP program between 1987–2015. Tissue was sectioned, with one section sent for histopathology prior to cryopreservation. In boys ≥ 12 years where spermatogenesis could be expected, a portion of tissue was dissected to look for mature sperm and if found, additional tissue was dissected and the suspension frozen. In girls, follicle density was assessed on histology. Cumulus oocyte complexes recovered, were cultured for 48 hours and mature oocytes frozen.

Results: TTCP specimens in 44 males (0.3–16.2 years) provided an average of 8, 2–5 mm slices each. Eleven subjects had tissue dissected, mature sperm were found in 8 (all were pubertal; with testicular size 10–12 ml; all with histology had evidence of spermatogenesis; one had prior low-risk gonadotoxic therapy). OTCP in 50 females (1.0–19.6 years) provided 12–222 slices (1×1×3 mm). Follicle density was 0.3–134/mm3. Mature oocytes were collected in 4 patients (12.6–17.7 years, all postmenarcheal and had no prior chemotherapy). Histology was free of malignancy.

Conclusion: Both TTCP and OTCP can be offered to young patients without delay in cancer treatment. Retrieval of mature sperm and oocytes from some pubertal patients may offer realistic hope for future fertility.