Offering Fertility Preservation in Children Facing Gonadotoxic Therapy - A Multi-Disciplinary Approach
Vidhu B. Joshi, BSc, Adriana M. Delgado, BSc, Patricio C. Gargollo, MD, Asma Chattha, MBBS, Zaraq Khan, MBBS, Landon W. Trost, MD, Yulian Zhao, MD, PhD, David L. Walker, MSc, Dean D. Potter, Jr., MD, Siobhan T. Pittock, MBBCh, Carola A S Arndt, MD, Anthony G. Krenik, BSc, Candace F. Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
Due to dramatic improvement in long-term survival rates of childhood cancers, fertility preservation (FP) has been identified as a key measure for quality of life. In post-pubertal males, FP efforts are well-established via sperm cryopreservation; however, options are limited for pre-pubertal males. Testicular tissue cryopreservation (TTC) programs have provided a promising, although still experimental, opportunity for these children. We describe early results from an innovative FP program launched with the goal of delivering high quality, safe, and affordable care to childhood cancer patients facing gonadotoxic therapy.
The FP program at our institution has been approved by the Institutional Review Board. It is a collaborative effort between multiple specialties including pediatric oncology, pediatric gynecology, reproductive endocrinology, pediatric urology, pediatric surgery and laboratory medicine. For patients diagnosed with fertility threatening diseases or planned treatments, FP program members counsel the family regarding potential benefits, risks, and costs of TTC. To maximize safety by reducing the risk of multiple anesthetics, while also avoiding increased costs to the patient, fertility preservation procedures are combined with scheduled interventions such as central line/port placement. Approximately 80% of the tissue is designated for clinical use, while 20% is reserved for research purposes to facilitate development of techniques to advance fertility preservation science. Adverse events are assessed through a one-week follow-up phone call. Yearly phone surveys to assess the patient/family's perspective on the FP program and their experience are also conducted.
The program has enrolled 24 males in the TTC program. The average age (range) of participants is 8.53 years (1.77-15.36 years) (Table 1). To date, no serious adverse events have been reported. The most frequent minor adverse event reported was mild, self-resolving pain at the incision site (28.57%). According to 14 one-year follow-ups that were completed, 100% of families participating in the FP program felt that it was a good decision and 37% shared that fear of complications was the most difficult aspect of the decision (Figure 1). Greater than 90% of families would recommend the FP program to a friend.
The FP program is uniquely poised in the Midwest to offer high-quality, cost-effective, and innovative fertility preservation procedures to pre-pubertal children both locally and from neighboring states. These children would not otherwise have options to protect future reproductive potential. Patients often travel from several neighboring states to enroll in the program. In addition to maximizing patient safety by offering this procedure in combination with another procedure, the costs are reduced by combining the procedure with a clinically indicated intervention. Thus far, the procedure appears to be safe, and is associated with unanimously high patient satisfaction.
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