By Alanna Kennedy
Preserving Your Child’s Fertility
By Alanna Kennedy
Addressing infertility—even just talking about it—becomes more complicated when the cancer patient is a child.
Many of the fertility preservation options available to adults are also open to children who have reached puberty. Even so, doctors don’t always broach the subject with these patients or their parents. “Fertility issues are seen as later effects and aren’t first and foremost in doctors’ minds,” says Marla Clayman, a health communication researcher at the Feinberg School of Medicine in Chicago. But these are important conversations for doctors and patients to have, she says, because unlike other late effects of treatment, infertility is sometimes preventable with early intervention.
For girls, just as for women, fertility preservation can be complicated. Girls who have begun menstruating can potentially use the same egg maturation processes available to adult women prior to the start of cancer treatment (see “Options Before Treatment,” in the main article). For girls who haven’t yet reached puberty, doctors may be able to freeze ovarian tissue, using the same technique that has been used with some success on adult women.
However, ovarian tissue freezing is still experimental, cautions Melissa Sileo of LiveStrong’s SurvivorCare program. In a study reported in the July 2007 issue of Pediatric Blood and Cancer, researchers removed and froze ovarian tissue from 47 girls who had not yet reached puberty. Researchers will have to wait years before learning whether this effort results in healthy babies. And new evidence reported in July suggests that cancer survivors’ frozen ovarian tissue can potentially harbor cancer cells (see “Options Before Treatment,” in the main article).
Boys who have reached puberty can bank their sperm prior to cancer treatment. But the process can pose special challenges for young adolescent males, who may be embarrassed by the idea of collecting seminal fluid, says Kathleen Galvin, a family communication researcher at Northwestern University in Evanston, Ill. She suggests that parents seek out a hospital social worker or nurse to help mediate a conversation to put the boy at ease.
Pre-pubertal boys can’t produce sperm, but their testicular tissue can be frozen. Just like ovarian tissue freezing for girls, however, the technique is still experimental. In a study published in the January 2010 issue of the journal Human Reproduction, researchers reported that they had collected and frozen testicular tissue from 14 boys at the Children’s Hospital of Philadelphia. Time will tell if the method will be successful.
Despite all of the medical advances aimed at helping pediatric cancer patients preserve their ability to have children of their own, experts say parents shouldn’t feel obligated to take advantage of fertility preservation. “I wouldn’t want parents to beat themselves up over it if they weren’t offered it,” says Clayman. “Or if they took a good look at the evidence and decided against it. Parenting a sick child is hard enough.”