Pediatric fertility preservation

What is pediatric fertility preservation?

Fertility preservation is the process of saving or protecting eggs, sperm or reproductive tissue. It’s done before receiving chemotherapy, stem cell transplant, radiation therapy or other treatments that may affect a child's ability to have children later in life. The goal is to preserve your child’s fertility so they can have biological children in the future if they choose.

Children’s Health offers every fertility preservation option currently available, including some that are still in clinical trials. Your doctors will consider your child’s diagnosis, treatment plan, gender, age and stage of puberty as well as your family’s preferences to determine the best options.

Fertility preservation options for boys

• Sperm banking - Boys who have gone through puberty can provide sperm samples, which are then frozen and stored for the future. Sperm can remain frozen for decades.

• Testicular tissue freezing - A surgeon removes a testicular tissue sample, which is then frozen and stored for the future. This option may be available for boys who haven’t yet gone through puberty or who are unable to provide a specimen for sperm banking. This fertility preservation option is currently only available through clinical trial at Children’s Health.

Fertility preservation options for girls

• Oocyte (egg) or embryo freezing - Girls who have gone through puberty can undergo a procedure to retrieve oocytes (eggs), which are then frozen and stored for the future. Embryo freezing is also available, which means the eggs are fertilized before storage. Oocytes and embryos can remain frozen for decades.

• Ovarian tissue freezing - A surgeon removes one ovary, which is then frozen and stored for the future. Ovarian tissue can remain frozen for decades. This option is available for girls who haven’t gone through puberty or can’t undergo oocyte freezing.

• Ovarian shielding - Before radiation therapy, a doctor places lead devices over the ovaries to try to protect them from radiation damage.

• Ovarian transposition - A surgeon moves the ovaries to another spot in the belly area to help protect them from radiation damage.

• Gonadotropin releasing hormone (GnRH) therapy - These medications work by temporarily stopping the ovaries from producing hormones. This is an experimental approach to preserving fertility. Your child receives these medications while undergoing chemotherapy with the goal of reducing their infertility risk. This option is available for girls who have gone through puberty.

What are the benefits of pediatric fertility preservation?

The main benefit of fertility preservation is that it can help give your child the opportunity to have biological children in the future if they choose. Our team is by your side to help you make an informed decision and weigh the risks and benefits.

What are the risks with pediatric fertility preservation?

The risks vary based on the method of fertility preservation. If your child undergoes a procedure, there is a small risk of bleeding, infection and pain/discomfort after the procedure.

Medications have their own risks. Your provider team will review the risks and benefits of every medication before giving it to your child. Our team is highly trained in keeping any risks to an absolute minimum.

What to expect with pediatric fertility preservation

The process for fertility preservation varies depending on the method you choose. Here’s what you can expect before, during and after fertility preservation.

What to expect before pediatric fertility preservation

Your child’s oncologist will help you understand the potential risk of infertility from their proposed treatment. We’ll explain if fertility preservation is appropriate for your child, which options are available to them and the risks and benefits.

We’ll also explain testing your child may need before fertility preservation, such as blood tests. If your child is eligible for a fertility preservation method that is currently in clinical trials, our team will explain the study to you and help you enroll.

If you choose a fertility option that involves surgery, you’ll meet with the surgeon who will help you understand the procedure and answer any questions you have.

Our team of specially trained nurses, psychologists, child life specialists and social workers can help you and your child feel as comfortable as possible about your fertility preservation decision and the next steps in the process.

What to expect during pediatric fertility preservation

What boys can expect

• Sperm banking - This is a non-invasive way to preserve fertility for boys who have gone through puberty. Your child will provide 1-2 semen samples before starting treatment for their condition.

• Testicular tissue freezing - This fertility preservation method requires surgery while your child is in a sleep-like state with general anesthesia. Your child will not feel any pain or discomfort during the procedure. A surgeon makes a small cut (incision) to the scrotum and removes a sample of the tissue.

After the procedure is complete, your child is moved to a recovery room to wake up from anesthesia. You can meet them there. This surgery is minimally invasive, which means children recover quickly and typically can go home the same day. Most boys start therapy for their condition 1-2 days after this procedure.

What girls can expect

• Oocyte (egg) or embryo freezing - This is an option for girls who have gone through puberty. Your child will be given medications that stimulate the ovaries to produce multiple eggs. They’ll receive these medications for about 10 to 14 days. During this time, they’ll have very close monitoring with blood tests and ultrasounds.

  • They’ll then undergo a procedure to retrieve mature eggs. They will be asleep with general anesthesia during the procedure so they won’t feel any pain. Your provider removes the eggs by guiding a needle through the vagina using ultrasound guidance.

  • After the procedure is complete, your child will be moved to a recovery room where they’ll wake up from anesthesia. You can meet your child there. Most children go home the same day and can start their main therapy for their condition shortly after.

• Ovarian tissue freezing - This is an option for girls who haven’t gone through puberty yet or don’t have time to undergo oocyte freezing. This treatment includes minimally invasive surgery to remove one ovary. Minimally invasive means that most children recover very quickly because the surgeon only makes small cuts (incisions) to the pelvis to remove the ovary. During the procedure, your child will be in a sleep-like state with general anesthesia and will not feel any pain or discomfort.

  • After the procedure is complete, your child is moved to a recovery room to wake up from anesthesia. You can meet them there. Most children can go home the same day and start therapy for their condition 1-2 days after this procedure.

• Ovarian shielding - Ovarian shielding is used during your child’s radiation therapy. Your provider will place lead devices over the pelvis where the ovaries are located. The devices absorb radiation and help protect the ovaries from rays that could affect how these organs function. These devices won’t cause any pain or impact the effectiveness of the radiation therapy.

• Ovarian transposition - This is a minimally invasive surgery for girls who will be receiving radiation therapy near their ovaries. Your child will be in a sleep-like state with general anesthesia during the surgery. A surgeon will make a few small incisions in the skin near the ovaries and in the belly area. Then, the surgeon moves the ovaries to another spot in the belly area that won’t be as close to the radiation your child will receive. After the surgery is complete, your child will move to a recovery room and you can meet them there. Most children go home the same day and recover quickly.

• Gonadotropin-releasing hormone agonist - This medication aims to protect ovaries while your child is undergoing chemotherapy. Before your child starts chemotherapy, your provider will give your child an injection of this medicine. This medicine temporarily stops the ovaries from making hormones. Your child will need an injection every 1-3 months while undergoing chemotherapy. Your provider may recommend this option in combination with other fertility preservation options.

What to expect after pediatric fertility preservation

After undergoing fertility preservation, your child will begin treatment for cancer or the illness they have. When their treatment is complete, our providers monitor your child through puberty and assess their reproductive health. We’ll also have age-appropriate conversations about reproductive health as your child grows up.

For boys

After your child completes cancer treatment and goes through puberty, your provider can assess a sperm sample to check if their fertility was affected by their cancer treatment. This helps your provider have conversations with older teenage boys about their fertility and contraception choices. If your child did sperm banking or testicular tissue freezing, this assessment will also help your provider recommend whether you should continue storing their sample for future use.

For girls

Your provider will track your child’s puberty milestones and whether they have regular menstruation. If your child isn’t progressing through puberty or not having regular menstruation, we have specialists on our team who can help assess your child’s ovarian function and provide appropriate treatment if needed. We’ll have age-appropriate conversations with your child about how cancer treatment may have affected their fertility.

How do I prepare my child for pediatric fertility preservation?

The preparation before fertility preservation depends on the child’s individual treatment, the method of fertility preservation and your family values/preferences. Your providers will explain any instructions you may need to do at home before your child undergoes fertility preservation. This could include instructions to take or stop any medications.

Child life specialists are available to help your child feel as comfortable as possible about their fertility preservation method. Psychologists can also help you and your child prepare by coping with the emotional challenges of the diagnosis and treatment.

What questions should I ask my provider about pediatric fertility preservation?

• What is my child’s risk of infertility from the treatments they will receive?

• Is fertility preservation advised in my child’s particular case?

• When does my child need to undergo fertility preservation?

• What fertility preservation options are available for my child?

• How soon after fertility preservation can my child start their main treatment?

• Should my child stop taking any medications before fertility preservation?

• How soon will I be able to see my child after their fertility preservation?