OPTIONS FOR SAVING FERTILITY IN PATIENTS BEFORE PUBERTY Nonexperimental Options • Shielding of the ovaries during radiation therapy: a special material (lead) vest is placed over the child’s uterus and ovaries. This can be done during radiation therapy that does not need to include the uterus or ovaries. • Moving the ovaries (oophoroprexy): one or both ovaries are surgically moved outside the radiation treatment field to another area of the body, usually up in the abdominal cavity. This must be done prior to radiation therapy. If the ovaries or uterus must receive radiation, this is not an option. It is important to know that these techniques do not protect against the effects of chemotherapy. Your oncologist and radiation oncologist can tell you if these options are appropriate for your daughter. Experimental Options Cryopreserving, or freezing, ovarian tissue: This requires a surgical procedure in which an ovary or part of an ovary is removed. The tissue containing immature eggs is fro- zen for your child to use later in life. The tissue may be reimplanted inside the body, depending on the type of cancer and treatments received, or potentially, the eggs could be matured outside of the body and used later through in vitro fertilization. Although current research is promising, maturing the eggs outside of the body has not yet been done successfully in humans. Cryopreserving requires surgery that should be performed before treatment starts. Insurance may or may not pay for this treatment or the yearly storage fees needed to keep the tissue frozen. Additionally, there will be laboratory tests that need to be completed. Insurance may not pay for these tests. The billing specialists working with the fertility preservation team will be able to provide you information regarding costs as well as check your individual insurance coverage. It is best to ask about coverage and payment rather than assuming that insurance or cost might prevent fertility preservation. OPTIONS FOR SAVING FERTILITY IN PATIENT AFTER PUBERTY BEGINS Nonexperimental Options Oocyte freezing is an established method of fertility preservation. Normally, the ovaries only mature one egg for ovulation in a menstrual cycle. This option requires a female to take hormone medications that will tell her ovaries to mature multiple eggs at once. The eggs are removed surgically and then frozen. When a woman is ready to become pregnant, the eggs are thawed and fertilized with sperm. The embryo can then be put into the uterus. This process might take 2-4 weeks to complete. If cancer treatment needs to start immediately, this is not an option. Insurance may or may not pay for oocyte freezing. There are yearly storage fees to keep eggs, embryos, and tissue frozen. Additionally, there will be laboratory tests that
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