Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review

Infographic · Sep 2024 · 2 min read

In brief

Systematic review examining ovarian tissue cryopreservation outcomes in 612 female childhood cancer patients across 7 countries. Among patients who underwent tissue transplantation and desired pregnancy, 33% achieved pregnancy with 67% resulting in live births, though long-term pediatric data remains limited.

Ovarian tissue cryopreservation (OTC) is increasingly used to preserve fertility in female pediatric cancer patients at risk for gonadotoxicity.
Among 501 pediatric patients who underwent OTC, only 5.9% proceeded to ovarian tissue transplantation (OTT) in adulthood.
Of patients desiring pregnancy after OTT, 33% achieved pregnancy and 67% of those had live births, showing promising but limited outcomes.
Long-term outcome data for pediatric OTC is lacking, with most studies focused on adult patients in high-income countries.
Standardized fertility preservation guidelines for childhood cancer patients require more longitudinal pediatric-specific research.

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A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with surgical technique variations. Bar charts or percentage indicators display outcome metrics below each procedure illustration.

Srinithya R Gillipelli, Luca Pio, Paul D Losty, Abdelhafeez H Abdelhafeez

Background and aims: As survival rates in childhood cancer progress significantly, health outcomes in adulthood are pivotal to quality of life (QoL). Female patients undergoing chemotherapy and radiation for childhood cancer may experience adverse effects such as gonadotoxicity-related ovarian insufficiency. Ovarian tissue cryopreservation (OTC) is well studied in adults, but has only recently started to be explored in an effort to preserve fertility in young patients with childhood cancer. This systematic review aims to critically highlight contemporary outcomes of cryopreservation in female pediatric cancer patients.

Methods: A systematic search was conducted in PubMed, Embase, and Web of Science databases to identify English-language full text articles and abstracts published between 2004 and 2022 describing cryopreservation among female children (0-21 years old) with cancer. Abstracts and full-text articles were screened for inclusion. Subsequently, data from eligible studies was extracted and analyzed. Descriptive statistics were utilized to estimate overall outcomes of cryopreservation.

Results: Of 104 abstracts and 34 full-text articles, 12 studies were included. Data was collected from 7 world countries and involved some 612 pediatric and adolescent patients with malignant disease. Most common cancers included hematological malignant disease (81%), CNS nervous system malignant tumors (56%), and sarcomas (39%). Of the 6 studies with full reporting, OTC was undertaken in 501 patients, and 5.9% (30/501) of these patients underwent ovarian tissue transplantation (OTT). After OTT, 27 patients desired pregnancy and 33% (9/27) became pregnant. Six of these 9 patients (67%) had live births.

Conclusions: Preliminary analysis showed that OTC has been successfully performed but not yet studied thoroughly in pediatric cancer patients in a longitudinal manner. This study has further shown that cryopreservation outcomes are mainly reported among adult patients living in high income countries, demonstrating a crucial need for long-term outcome studies focused on pediatric and prepuberal OTC, subsequent OTT, and potential pregnancy. This work is considered critical to aid standardize recommendations of fertility preservation in childhood cancer patients and to better inform the efficacy of these procedures to benefit patients in world nations of all fiscal income levels.

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