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.
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
|Diagnosis||5 years||15 years|
|Total paediatric oncology||83%||81%|
|Leukaemias and myeloproliferative diseases||88%||85%|
|Central nervous system tumours||78%||71%|
|Neuroblastomas and glioblastomas||79%||76%|
|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 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.
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.