APHON Pediatric Chemotherapy-Biotherapy Renewal

Fertility Preservation AnnMarie Martinez, MSN RN CPN CPHON ®

Learner Outcomes Upon completion of this Pediatric Chemotherapy and Biotherapy Provider Program learning activity 1. the learner will be able to distinguish methods of fertility preservation according to pubertal status 2. the learner will be able to list six high-risk gonadotoxic chemotherapies. ***** Advances in the treatment of childhood cancers have been on the rise, resulting in a remarkable 5-year overall survival rate of 85.1% for children diagnosed with cancer from 0 to 19 years of age, based on Surveillance, Epidemiology, and End Results (SEER) data from November 2020 (Howlader et al., 2021). Although this statistic is very promising, cancer treatments can result in subfertility, infertility, or sterility. Fertility preservation for pediatric patients should be discussed as soon as possible after the cancer diagnosis, regardless of the patient’s reproductive age. This section will cover normal reproductive physiology; the indications for fertility preservation; methods of fertility preservation, which are determined by the patient’s pubertal status; and counseling needs, barriers, and ethical and cultural considerations related to fertility preservation. Normal Reproductive Physiology The differences in male and female reproductive physiology determine the methods of fertility preservation available, and the options available for prepubertal boys and girls are minimal. In boys, spermatogenesis, though it occurs before puberty, does not lead to the production of mature sperm, or spermatozoa. Spermarche , or release of the spermatozoa, occurs in early to mid-puberty (ages 13 to 18 years). In girls, oogenesis occurs during fetal development. Mature oocyte development begins with menarche and occurs with each ovulation cycle (Klipstein et al., 2020). Indications for Fertility Preservation It is estimated that one in three people will get cancer at some point. Because survival rates are improving, the number of survivors whose reproductive future is in question is significant. For most cancers, the treatment involves a combination of two or more modalities, including chemotherapy, radiotherapy, surgical intervention, and immunotherapy. With the exception of immunotherapy, for which effects on fertility are now yet known, all these modalities can cause permanent infertility. The effects of chemotherapy and radiotherapy on the gonads are dose