Options for Female Fertility Preservation: Pediatric Oncofertility 2017

Oocyte cryopreservation was taken out of experimental realm and made standard of care by the Society for Reproductive Medicine in 2012

Live birth rates for embryos and oocytes are on average around 33 to 52%

Recent protocols for ovarian stimulation can now go from consultation to cryopreservation of oocytes in less than 2 weeks using luteal phase stimulation

Connecticut is now the first state with mandated fertility preservation coverage, achieved by changing the definition of infertility from 'otherwise healthy females' trying for 6-12 months to 'medical necessity'

Ovarian transposition can achieve 50 to 90% reductions in radiation to the ovary and 30 to 50% maintenance of ovarian function

In 2013, ASCO put out guidelines recommending that patients be informed there is insufficient evidence to recommend GnRH analogs as a form of fertility protection

The POEMS study (prevention of early menopause study) in breast cancer patients using goserelin with chemotherapy showed statistically significant reduction in ovarian failure and decreased odds ratio for pregnancies compared to chemotherapy alone

Ovarian tissue cryopreservation is the only method of fertility preservation available for prepubertal patients

Current cryopreservation standard for ovarian tissue is slow freeze technique, though vitrification studies show it is likely a better technique but lacks outcome data

There have been 86 live births in the literature from orthotopic transplantation of cryopreserved ovarian tissue

Two of the 86 live births from ovarian tissue transplantation were from patients in the pediatric population who were not yet menarcheal, with only one reported in literature

The Judul study of 545 ovarian tissue cryopreservation procedures showed only 5 minor complications and 1 major complication requiring repeat surgery for bleeding

There has been only one death from a procedure for removal of an ovary for ovarian tissue cryopreservation in all reported literature

In the Judul study, 30% of patients were under age 18 and 15% were pre-pubertal

The Judul study showed a deceased rate of about 10% overall and 13.5% in patients less than 18 years old

Only 4% of patients in the Judul study utilized their cryopreserved ovarian tissue, compared to less than 10% utilization rate for oncology patients who cryopreserve semen

96% of patients in the Judul study were satisfied with having the ovarian tissue cryopreservation procedure, including those who did not utilize their tissue

Cincinnati Children's protocol allows ovarian tissue cryopreservation for females ages 1 month to 41 years undergoing treatment that puts them at risk for loss of ovarian function, with FSH less than 20

Cincinnati Children's has performed over 70 ovarian tissue cryopreservations with patients ranging from 0.6 to 33 years old, with average age 10-11 years

In Cincinnati Children's series of 52 patients, there were 4 complications: 3 minor and 1 small bowel obstruction 1 year post-procedure in a patient with bowel graft-versus-host disease

Cincinnati Children's had 5 patients deceased after ovarian tissue cryopreservation (9.6%), none related to the procedure, all related to primary disease

In very younger patients it is technically difficult to remove cortical strips on an ovary that is already very small, which is why whole ovary removal is preferred