Detailed inform­a­tion and a list of ref­er­ences can be found in Chapter 2.6 of the Fer­ti­PRO­TEKT book, “Indic­a­tions and fertility pre­ser­va­tion methods for onco­lo­gic­al and non-onco­lo­gic­al disorders”, which can be down­loaded free of charge.

Prognosis

The survival rates for girls and boys with malignant disease have improved steadily since the 1970s. The 15-year prob­ab­il­ity of survival is currently 81% of patients with cancer diagnosed before the age of 15.

+ survival rates for various diagnoses

Survival rates
Diagnosis 5 years 15 years
Total pae­di­at­ric oncology 83% 81%
Leuk­aemi­as and myel­o­pro­lif­er­at­ive diseases 88% 85%
Lymphomas 94% 92%
Central nervous system tumours 78% 71%
Neur­o­blastomas and glioblastomas 79% 76%
Bone tumours 72% 67%
Soft tissue tumours 73% 69%
Germ cell tumours 95% 94%

Damage to the ovaries and testes caused by chemo­ther­apy and/or radiotherapy

Fertility is affected in up to a third of girls and boys after chemo­ther­apy and / or radio­ther­apy and in over two thirds after a bone marrow trans­plant. Irra­di­ation of the brain can result in oocyte mat­ur­a­tion and sperm pro­duc­tion no longer being stim­u­lated. After radiation of the pelvis with more than 14 Gy, damage the uterus occurs which leads to an increased like­li­hood of pregnancy com­plic­a­tions. Detailed inform­a­tion is provided in Section 2.6 of the above-mentioned book.

Special features of fertility pro­tec­tion in children and adoles­cents with cancer

The fertility pro­tec­tion measures available for girls and boys differ in whether the treatment is started before or after the onset of puberty.

+ GnRH-agonists

GnRH agonists are not useful in girls and their effect­ive­ness is ques­tion­able in female adolescents.

+ Surgical repos­i­tion­ing of the ovaries

If the ovaries lay in the radiation field, repos­i­tion­ing them out of the field can be con­sidered, depending on the dose. It should be noted that in-vitro fer­til­iz­a­tion is often necessary at a later date if the fallopian tubes have to be cut during the operation.

+ ovarian stim­u­la­tion and freezing of egg cells

The ca. 14 days of hormonal stim­u­la­tion required before cryo­p­reser­va­tion of oocytes is not always possible because of the urgency of cancer treatment. Such a measure is only possible in adoles­cents, who already develop follicles and in whom a trans­va­gin­al ultra­sound scan can be performed.

+ Cryo­con­ser­va­tion of ovarian tissue

Cryo­p­reser­va­tion requires a lap­aro­scopy. Since ovarian tissue contains many eggs in children, the chance of a sub­sequent pregnancy after reim­plant­ing the tissue is high. This measure is therefore often a good option.

+ Cryo­con­ser­va­tion of sperm

Cryo­p­reser­va­tion of sperm after puberty is possible from approx­im­ately 13 years of age with the cor­res­pond­ing signs of puberty (Tanner 3).

+ Cryo­con­ser­va­tion of immature testic­u­lar tissue

The cryo­p­reser­va­tion of immature testic­u­lar tissue which is removed before puberty is still only an exper­i­ment­al option.

Practical approach

A detailed explan­a­tion which is tailored to the indi­vidu­al risk should include the risk of fertility problems as well as the prospects and risks of fertility pre­ser­va­tion measures. Young adoles­cents should make a decision together with their parents. The pos­sib­il­ity of sub­sequent adoption if fertility is lost should also be mentioned during the con­sulta­tion. Likewise, the families should be informed that chemo­ther­apy and radio­ther­apy do not lead to higher risk of later having children born with a malformation.