Fertility preservation is possible for adolescents and young adults before cancer treatment

When an adolescent or young adult patient and their family are in the midst of making many decisions after a diagnosis such as cancer, they might not be considering is how medical treatments could impact the patient’s ability to have their own children in the future. Some treatments like radiation, chemotherapy and certain medications can affect fertility, so it’s important to have conversations about family planning before the treatments begin. Preserving fertility can be very important for a young person’s long-term quality of life.

The Children’s Minnesota Adolescent and Young Adult (AYA) Cancer program and Gynecology program place a special emphasis on informing patients and their families about options for preserving fertility as a part of treatment conversations. The team explains possible effects of certain treatments on fertility and guide patients and their families through fertility preservation options available at Children’s Minnesota.

Understanding the options

Educating patients and their families early on about possible fertility risks can help them decide if fertility preservation is possible and wanted. An oncology nurse practitioner will meet one-on-one with the patient and their family to discuss the risks, benefits and limitations for each option. And when advanced care is required, Children’s Minnesota offers leading-edge surgical services.

Female fertility preservation

Cancer surgery, chemotherapy and radiation may impair fertility or hormone production. Taking steps to preserve or protect tissue from the ovaries can provide a chance for future fertility and hormone production. It is important to note that most pediatric cancer survivors will be able to have children.

Some options for female fertility preservation at Children’s Minnesota include:

Ovarian transposition – ovaries are surgically moved away from the radiation site(s) and then later repositioned.
Ovarian shielding-protecting the ovaries with a vest during radiation.
Ovarian tissue cryopreservation (OTC) – surgeons remove an ovary or ovarian tissue. It is then frozen, stored and re-implanted at a later date when pregnancy is desired. This method is for patients at high risk for infertility and based on chemotherapy and radiation doses.

Referral to fertility clinics in the Twin Cities is an option for several other established fertility preservation methods.

Oocyte freezing is an established method of fertility preservation. This option requires hormone stimulation which will signal the ovaries to mature multiple eggs at once. The eggs are removed and frozen. When a woman is ready to conceive, eggs are thawed and fertilized with sperm. This method is for fertility preservation once a girl has begun puberty. The process may take at least two weeks.
Embryo freezing is a method for women who have an established partner or are willing to use donor sperm and is not common in a pediatric setting.

Conditions associated with ovarian insufficiency or that may require removal of the ovary(s) include cancer, galactosemia, Turner Syndrome, differences in sex development, gender-affirming care, bone marrow transplant and side-effects of medications used to treat conditions like Lupus.

Insurance coverage is variable and may not cover some of these options. There are yearly storage fees for frozen eggs, tissue and embryos but discounts are available. A billing specialist can provide patients with more information about costs and coverage.

About ovarian tissue cryopreservation (OTC)

Ovarian tissue cryopreservation (OTC) involves surgical removal of an ovary or ovarian tissue. The ovary is then frozen and stored. It can later be transplanted to make pregnancy possible. The procedure is a surgery requiring 1-3 small incisions in the abdomen. A laparoscope is inserted in the incision, allowing the surgeon to remove the ovary. The tissue is flash frozen and stored in specially equipped storage facilities. This procedure is often coupled with another procedure such as tumor surgery, port placement or bone marrow biopsy.

Once treatment is complete and the person who had an ovary removed is ready to have their hormone function restored, doctors thaw the tissue and return it to the body using a procedure similar to the removal. After the thawed tissue is replaced, ovarian activity may begin or resume after a few months. If the transplantation is successful and the patient is producing eggs, pregnancy can occur naturally or through in vitro fertilization (IVF). There have been more than 200 live births since 2020 according to an article published in Fertility and Sterility.

Male fertility preservation

Some options for male fertility preservation include:

Sperm banking is an established method for fertility preservation encouraged for males who have gone through puberty. There have been thousands of successful pregnancies worldwide. Collection is through masturbation and then frozen for later use. There are other surgical options for obtaining sperm if the young man is unable to produce a sample.
Testicular tissue cryopreservation – if a boy has not gone through puberty, fertility preservation options are considered experimental. Boys may be referred to fertility centers who have open studies for testicular tissue preservation. Tissue that contains sperm-making cells is removed from the testes through a small incision. It is frozen, stored and later thawed to retrieve the sperm. This is the only option for pre-pubertal boys. It is experimental and must be performed at centers that have a research study approved. There are no live human births reported using this method.
Sperm extraction or aspiration – sperm cells and tissue are removed from the testicle through a small needle attached to a syringe. It is then frozen and stored for future use.
Shielding of the testes during radiation.
Surgically moving the testes out of the radiation field.

Comprehensive fertility preservation support

Children’s Minnesota has a long history of providing extensive support services that help children and families cope with the diagnosis and treatment. Experts in child life, social work, financial advocacy, spiritual care, psychology and others are ready to work with families and partner health care providers for as long we are needed.

Fertility preservation support services we offer include:

24/7 consultation services about fertility preservation options
Options for suppressing menstruation and preserving fertility
Dedicated pediatric and adolescent gynecologists – the only fellowship trained in Minnesota
Oncology nurse practitioners who are experts in assessing treatment-related risks to fertility
Referral to fertility specialists
Sperm banking