Incidence of Fertility preservation procedures in prepubertal and pubertal individuals with Cancer
Jesse Ory, MD1, Daniel E. Nassau, MD2, Carlos Delgado-Rodriguez, MD3, Aditya Sathe, MD4, Sirpi Nackeeran, MD2, Pranay Manda, MD4, Akshay Reddy, MD5, Rodrigo LP Romao, MD1, Ranjith Ramasamy, MD2.
1Dalhousie University, Halifax, NS, Canada, 2University of Miami, Miami, FL, USA, 3Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico, 4University of Tennessee Health Science Center, Memphis, TN, USA, 5University of Michigan, Ann Arbor, MI, USA.
BACKGROUND: Fertility Preservation (FP) for children and adolescents with cancer is underutilized. Although survival rates in these patients have increased over the last few decades, almost all oncologic treatments carry a risk of infertility. In postpubertal boys and girls, FP is achieved by cryopreservation of sperm or oocytes. In prepubertal individuals, immature ovarian and testicular tissue can be frozen; however, this is considered largely experimental. Our objective was to quantify who is receiving FP procedures in young adults with cancer, and help identify areas that could be targeted to increase the uptake of FP procedures.
METHODS: We performed a retrospective study of children under 18 years old who had surgery in 52 US pediatric hospitals registered in the Pediatric Health Information System (PHIS) from 2011 to 2019. Male and female cancer patients who underwent a testicular or ovarian biopsy were included. Any patients with testicular or ovarian malignancy, torsion or other diagnoses which may have required a gonadal biopsy were excluded. Data extracted included hospital, age at time of FP procedure, cancer diagnosis, receipt of chemotherapy, concurrent procedures, race, median income, and urban/rural status. RESULTS: A total of 600 boys and 550 girls who underwent a gonadal biopsy were identified. After applying the exclusion criteria, 418 boys (table 1) and 333 girls (table 2), with a mean age at gonadal biopsy of 8.3 (boys) and 8.8 (girls) years were included in the analysis. 363 boys were 12 and under and 55 boys were above 12. 224 girls were 11 and under, and 109 were above 11. The most common cancer diagnosis was hematologic in both boys (50.96%) and girls (36.64%). A concurrent procedure at time of testis biopsy was performed in 84% of boys, with chemotherapy device insertion being the most common (54.87%). In girls, a concurrent procedure took place 62% of the time, with chemotherapy device insertion being the most common at 40%. When separating patients into pre and post pubertal, no differences in characteristics were seen in boys or girls. Overall, the total number of testis and ovarian biopsies have been increasing since 2015 (Figure 1)
CONCLUSIONS: Since 2015, gonadal biopsy rates have increased in adolescents and children with cancer, presumably for FP. While FP is recommended in post-pubertal children, no protocol exists for prepubertal boys or girls, and these instances are likely the results of individual discussions between physicians and patient families. Our findings highlight the need to establish protocols and tracking for FP procedures in the US.
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