APHON Pediatric Chemotherapy-Biotherapy Renewal

Table 2. Risk of Infertility Related to Chemotherapy Agents

High Risk

Intermediate Risk Low Risk

Unknown Risk

Busulfan Chlorambucil Cyclophosphamide Ifosfamide Melphalan Nitrogen mustard Procarbazine

Carboplatin with low cumulative dose Cisplatin with low cumulative dose Doxorubicin

Treatment protocols for Hodgkin lymphoma without alkylating agents Actinomycin D Bleomycin 5-Fluorouracil Methotrexate Radioiodine treatment for thyroid cancer Vincristine

Bevacizumab Erlotinib Imatinib Irinotecan

Paclitaxel and docetaxel for treatment of breast cancer Trastuzumab

Adapted from “Fertility Preservation Young Adults, Adolescents, and Children with Cancer: Medical and Ethical Considerations,” by K. A. Rodriguez-Wallberg, A. Anastacio, E. Vonheim, S. Deen, J. Malmros, and B. Borgström, 2020, Upsala Journal of Medical Sciences, 125 (2), 112–120; table 2, p. 115. https://doi.org/10.1080/03009734.2020.1737601. Copyright 2020 by the authors. Licensed under CC-BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/legalcode.

Methods for Preservation of Male Fertility Prepubertal

Gonadal and gamete preservation in prepubertal males is challenging because many proposed treatment modalities (with the exceptions of shielding the testes or moving them out of the radiation field) are currently experimental. Most experimental methods include hormone manipulation or preserving a sample of testicular tissue. Studies in animals suggest that cryopreservation of testicular tissue, autotransplantation, xenotransplantation, and in vitro maturation have the potential to be successful; however, these methods still need to be tested in humans. Effective pharmacological interventions have yet to be identified (Klipstein et al., 2020). Postpubertal Once postpubertal males start producing mature sperm, the options for fertility preservation change. The current options are sperm cryopreservation and testicular tissue cryopreservation, with sperm cryopreservation from masturbation being the most effective (Klipstein et al., 2020). The procedure for sperm collection should be performed before the initiation of treatment. Ideally, the collection would consist of at least 3 semen samples with a period of abstinence for 48 hours between each sample. In some cases, collection of the samples must occur within the