Preserving fertility in children and adolescents

When a child or adolescent is diagnosed with cancer, there are many issues to consider. Often the focus is on survival, so children, teens and parents may not immediately think about fertility. However, the majority of young people survive cancer, and fertility may become important as they reach puberty (sexual maturity) and adulthood.

Learn more about:

• Overview
• Preserving fertility in young females
• Preserving fertility in young males
• Resources for young people

Overview

Some cancer treatments do not affect a child’s reproductive system. Others can damage the ovaries, which contain eggs, or the testicles, which make sperm. Sometimes this damage is temporary, but sometimes it’s permanent.

For a general overview of how cancer treatments affect fertility, see Female fertility and cancer treatments or Male fertility and cancer treatments. You can also talk to the health care team about how cancer treatment will affect fertility.

For an overview of ways to prevent or lower the risk of infertility, see below. Some of these procedures are experimental and available only in specialised centres. In many cases, decisions about fertility preservation are made before treatment begins.

This is a difficult time, and often the decision involves specialists, the young person and their parents or carers. Parents of young children under 18 will usually need to consent to any fertility preservation procedures.

Preserving fertility in young females

The options will depend on whether the young person has been through puberty. Most young females go through puberty between the ages of 8 and 13.

Before puberty

• Removing and freezing ovarian tissue. This is called ovarian cryopreservation. When needed, the tissue is put back into the body. The ovarian tissue contains underdeveloped immature eggs. Experiments are being done to mature the eggs in a laboratory before freezing, but this technique is under development and not widely available. There have been several births worldwide from ovarian tissue removed before puberty.

After puberty

• Collecting and freezing mature eggs or ovarian tissue (cryopreservation).
• Taking a long-acting hormone called GnRH may reduce activity in the ovaries or ovarian tissue and protect eggs from damage.
• Checking hormone levels to assess fertility. Young females may be fertile, but go through early menopause.

Before or after puberty

• Shielding the abdominal area during radiation therapy to the pelvis to provide some level of protection to the ovaries.
• Surgically moving the ovaries away from the field of radiation (ovarian transposition). If the ovaries aren’t protected, the risk of ovarian failure is higher (premature ovarian insufficiency).

Preserving fertility in young males

The options will depend on whether the young person has been through puberty. Most young males go through puberty between the ages of 9 and 14. After puberty, semen contains mature sperm.

Before puberty

• There are no proven fertility preservation methods for young males who have not gone through puberty.
• Freezing testicular tissue (testicular tissue cryopreservation) is being tested with young boys at high risk of infertility. Tissue that contains cells that make sperm is removed from the testicles through a small cut. This technique is not widely available and is still considered experimental.

After puberty

• Sperm banking (cryopreservation) can be used to collect, freeze and store mature sperm for later use with IVF.
• Testicular sperm extraction can remove sperm cells from the testicles, which are frozen and stored for later use with IVF. This technique is not widely available.
• Having tests to assess fertility. Young males may have erections and ejaculate, but not be fertile.

Before or after puberty

• Shielding the testicles with protective lead coverings during radiation therapy to the pelvis provides some level of protection. If this area  is not protected, sperm production may be affected, which could cause infertility.

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