APHON Pediatric Chemotherapy-Biotherapy Renewal

same day because of the nature of the diagnosis and in order to prevent a delay in treatment (Del-Pozo-Lérida et al., 2019). Alternative methods of semen collection besides masturbation include testicular aspiration, electroejaculation under sedation, or retrieval from a urine sample post masturbation (Klipstein et al., 2020). Gonadal shielding is an option for those receiving radiotherapy and in which sperm collection is not possible. At the current time, testicular tissue cryopreservation should only be performed as part of a clinical trial or approved experimental protocols (Oktay et al., 2018).

Methods for Preservation of Female Fertility Prepubertal

As with fertility preservation for prepubertal males, fertility preservation for prepubertal females (with the exception of gonadal shielding and oophoropexy) is primarily experimental. For patients who will receive radiation therapy to the pelvis, the ovaries can be transposed (surgically relocated out of the field of radiation therapy). However, oocytes are very sensitive to radiation, and only 15% of patients who choose to undergo transposition of their ovaries will achieve the goal of becoming pregnant. Gonadal shielding is another option for ovarian protection during radiation therapy; however, it is less effective if the patient receives gonadotoxic chemotherapy in addition to radiotherapy (Klipstein et al., 2020). In the United States, an open trial is being held to assess the safety and efficacy of cryopreservation of ovarian tissue in prepubertal females. Thus far we have no evidence that use of the autotransplanted tissue can lead to pregnancy and delivery. In addition, tissue harvested from a patient at diagnosis could potentially be contaminated with leukemia cells, and this tissue could reintroduce leukemia cells into the patient’s body during a future autotransplant. Postpubertal Fertility preservation options for postpubertal females include oocyte or embryo cryopreservation. Although embryo preservation had previously been the only available option, oocyte cryopreservation has shifted from being considered an experimental method to being recommended in 2012 by the American Society of Reproductive Medicine (Klipstein et al., 2020). In embryo cryopreservation, the oocytes are fertilized with the sperm of a partner or an anonymous donor. This practice involves a larger number of social, emotional, and ethical considerations, which require a certain level of maturity. Now that oocyte cryopreservation has been recommended and proven successful, embryo cryopreservation is recommended for use only in rare circumstances. The oocyte cryopreservation is an invasive and lengthy process. It requires 10 days of transvaginal ultrasonography and blood tests, followed by a surgically performed transvaginal oocyte retrieval. Depending on the diagnosis and clinical status of the patient, the delay of a treatment regimen for 10 days or more may not be possible (Klipstein et al., 2020). Of note, even though contradictory evidence exists for the use of gonadotropin- releasing hormone (GnRH) or ovarian suppression, the 2018 American Society of Clinical Oncology (ASCO) guidelines suggest that in situations in which established fertility preservation methods (i.e. cryopreservation of oocytes, embryos, or ovarian tissue) are not possible, “GnRH