Fertility Preservation: Planning For Life Beyond Treatment
Apr 12, 2017
Fertility can be a sensitive topic for some families, especially when children and adolescents are faced with life-altering medical conditions that could affect future parenthood. Unfortunately, fertility conversations may happen too late in the process, or patients aren’t always educated on their options.
These discussions should occur prior to treatment, be part of the care path, and continue routinely for patients who have conditions and/or are undergoing treatments that may affect future fertility.
What is Fertility Preservation?
Fertility preservation is the process of saving or protecting sperm, eggs, or reproductive tissue so that a person can use them to have a biological child in the future.
Which children could benefit from fertility preservation?
Several different types of medical conditions or treatments can cause long-term fertility and reproductive health issues. Some examples of these conditions or treatments are:
Non-malignant disorders leading to bone marrow transplant
Rheumatic and renal diseases requiring therapy that can impact reproduction
Gender affirming therapy for gender dysphoria
Differences of sex development
What are the different types of fertility preservation?
Currently, established fertility preservation options exist for males who have started puberty (such as sperm banking or shielding the testes from the field of radiation) and females who have started menstruating (such as oocyte or embryo freezing, or shielding/moving the ovaries from the field of radiation). Experimental options also exist, such as medications (GnRH analogues), and some centers offer testicular and ovarian tissue freezing which are options for younger, prepubescent children.
What specialties are involved in fertility preservation for patients?
When possible, it’s ideal to have a team of providers who can work together to offer comprehensive counseling and fertility preservation options to youth and families. This team may include individuals from any or all of the following disciplines: endocrinology, ethics, genetics, gynecology, oncology, psychology, reproductive endocrinology, social work, and urology.
What’s next for fertility preservation?
This field has evolved dramatically over the past decade. Egg freezing has changed from experimental to established, and experts are discussing whether and when the same should occur for ovarian tissue cryopreservation - already considered established in some parts of the world, as more than 60 babies have been born using frozen ovarian tissue. Fertility preservation programs are being developed at pediatric centers, and aim to serve a larger and more diverse patient population.
Perhaps most importantly, researchers and clinicians are working together to better understand how to counsel each of these groups of youth and their families most effectively about this topic, to increase awareness and support among those at-risk, expand their options for parenthood, and optimize their quality of life.
For more information about Nationwide Children’s Hospital’s Fertility and Reproductive Health Program, click here.
Leena Nahata, MD, is a pediatric physician in the Section of Endocrinology and has immense experience as a past clinical assistant professor and attending physician at Nationwide Children’s Hospital.
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