In this report, a panel of transplant experts discuss state-of-the-art fertility preservation options available to adolescents and young adults who are considering hematopoietic cell transplantation (HCT). In addition, the report has recommendations for timing, delivery, and topics that hematologists/oncologists should consider discussing with patients.
Researchers recommend pre-transplant fertility preservation discussions, including:
- Infertility risk assessment considering the patient’s underlying disease, age, and treatment plan
- Overview of established and experimental fertility preservation techniques tailored to the patient’s sex, age, and underlying disease
- Assessment of the risk of side effects associated with fertility preservation procedures
The authors report on the advances in reproductive medicine that have increased the chances of post-transplant fertility preservation pre-transplant. They are available to pre- and post-pubertal males and females, and include gonadal shielding, oocyte and semen cryopreservation, and hormonal stimulation and suppression. Early studies indicate that spontaneous puberty is possible in children receiving reduced-intensity conditioning, although long-term follow-up data are not available.
Finally, because gonadal tissue injury begins with the first course of chemotherapy, oncologists should begin time-sensitive discussions on fertility preservation with their patients and family early in the treatment planning process.