Pediatric cancer treatment can affect fertility. For many patients receiving cancer treatment, decrease or loss of reproductive function is temporary. But some patients do not regain this function. Before the start of patient therapy, thought must be given to whether a child’s fertility is likely to be impacted by treatment.
As treatments for childhood cancers have improved, more survivors are entering their reproductive years, and are thinking about starting families of their own. The Fertility Preservation Team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center recognizes that fertility is an extremely important issue related to long-term quality of life. We offer a wide variety of options to patients and families.
We work closely with the cancer care team to ensure that fertility consultation and discussion of preservation options are integrated into the patient and family education of all newly diagnosed patients.
Depending on the treatment received, some boys will have a high chance of recovery of testicular function. A good option for these boys may simply be to allow enough time for sperm production to restart. When these boys become men, if they have issues with fertility due to inadequate sperm production, specialists in male infertility and reproductive endocrinology will be available to assist them.
Sperm banking is offered to all eligible male patients who have demonstrated pubertal changes (typically 13 years old or more). Adolescents who are capable of producing a semen sample by self-stimulation can have the sample preserved for future use.
This is recommended for boys that are going to receive therapy that has a chance of causing permanent damage to sperm production.
All eligible male patients who have undergone puberty but are unable to produce a semen sample may also preserve sperm. A surgical biopsy of the testicle can be performed to obtain a sample of tissue from which sperm are produced. The sperm can then be extracted for preservation.
Boys that have not entered puberty do not produce sperm. But, their testicles contain cells that are essential for sperm production later on. These testicular stem cells can be affected by some therapies. Testicular tissue freezing is a preservation option that can be performed before puberty, but it is experimental. In this procedure, small pieces of testicular tissue are surgically removed before cancer treatment and frozen for future use.
While not an option for all females, some young women may have the opportunity to pursue this option when circumstances will allow. Hormonal medication is used to stimulate the formation of multiple follicles in the ovary which contain eggs. These eggs are then removed in a minor surgical procedure and are frozen for the patient’s potential future use to achieve a pregnancy. This method is becoming more and more widely accepted, and there have been hundreds of live births from frozen eggs. In a circumstance where the patient has a partner or wishes to use donated sperm, there is also the option of using the eggs to create an embryo, which can also be frozen for future use. Embryo freezing is considered an established method of fertility preservation.
Ovarian tissue freezing is available for all ages including young girls that have not yet had puberty. The advantage of ovarian tissue freezing is that the procedure can be done quickly and does not require time to stimulate eggs in the ovary with medication. Ovarian tissue freezing also requires a minor surgical procedure. In this process, doctors surgically remove either an entire ovary or a part of an ovary. The tissue is then processed, frozen, and stored for future use. When the patient wishes to become pregnant, the tissue can be thawed and re-implanted.
In successful transplants, the tissue starts producing hormones and eggs. There is also active research in extracting immature eggs from ovarian tissue in the laboratory and maturing them for use in in-vitro fertilization, without re-implanting the tissue. So far, successful pregnancies have only occurred after re-implanting the tissue. However, in the future it may be possible to have a pregnancy without having to have the tissue re-implanted. While ovarian tissue freezing holds a lot of promise, it is still considered experimental.
Our team includes members from the Dana-Farber/Boston Children's Cancer and Blood Disorders Center Department of Urology at Boston Children's Hospital and the Department of Obstetrics and Gynecology at Brigham and Women's Hospital.
Lisa Diller, MD
Chief Medical Officer
Dana-Farber/Boston Children's Cancer and Blood Disorders Center
Elizabeth Ginsburg, MD
Medical Director, Assisted Reproductive Technologies
Brigham and Women's Hospital
Marc Laufer, MD
Chief, Division of Gynecology
Co-Director, Center for Young Women's Health
Boston Children's Hospital
Kathleen Stiffler, CPNP
Richard Yu, MD, PhD
Assistant in Urology
To schedule an appointment or for questions regarding fertility preservation:
For girls 15 years old and older, call the new patient coordinator at the Center for Infertility and Reproductive Surgery at Brigham and Women's Hospital at 617-732-4222. Say "Fertility Preservation Consult for Cancer Patient" when booking.
For girls younger than 15 years old, call the patient coordinator at the Division of Gynecology at Boston Children's Hospital at 617-355-5768. Say "Fertility Preservation Consult" when booking.
Call 1-888-Pedi-Onc (1-888-733-4662) or email firstname.lastname@example.org for more information regarding male fertility preservation, to arrange for sperm banking, or to set up an appointment to see a specialist who focuses in male fertility preservation.
“Most women think that if they had cancer as a child, then they’ll never have children. It turns out that many of them can get pregnant. It just might be a little harder,” said Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children’s and senior author of the study.
A genetic test can explain why a child or young adult developed cancer and can help to predict whether he/she is at risk for other cancers