When a child receives a cancer diagnosis, the first concern is always to find a successful treatment. Unfortunately, some treatments may also cause infertility. A promising new technique may be able to restore fertility to those who lose it through treatment.
The Huffington Post reports that Lurie Children’s Hospital in Chicago and the Children’s Hospital of Philadelphia are among the hospitals offering a new experimental treatment that may restore fertility in cancer patients. The procedure involves removing and preserving tissue from the ovaries and testes in the hope that implanting the tissue in the patient as an adult will result in normal reproductive function.
Because doctors have only recently begun to use the technique, it will take years for the pediatric patients to grow up and find out whether it’s effective, but there have been some previous attempts that give reason for optimism. It has been successful when performed on adults, but it is unclear whether it is also effective when the tissue used is from a child with an immature reproductive system. However, a woman in Belgium successfully conceived after undergoing this procedure at age 13.
At Children’s Hospital of Philadelphia, the procedure for girls involves the removal of part of one ovary. Most of the tissue is frozen, as are any mature eggs. If the patient wishes to get pregnant, a doctor can implant the ovarian tissue to restore function of the ovaries. The hospital performs this procedure on girls as young as 1 year old. Researchers retain a small portion of the tissue for studies of future treatment possibilities. The parallel procedure for prepubescent boys is more experimental. Before puberty, boys do not produce sperm cells, but do have stem cells in the testes that can later become sperm. Animal research indicates that removing these stem cells from boys and implanting them in adulthood may result in sperm production. The youngest patient to undergo this procedure was just 3 months old.
Although cancer treatments for children don’t always cause infertility, treatments like chemotherapy, radiation and surgery may all present this risk, depending on the type and location of the cancer. Among the chemotherapy drugs that present the highest risk are Busulfan, Cytoxan, Procarbazine and Ifosfamide. Radiation can affect fertility if it targets areas near the pelvis. Radiation to the brain can also affect fertility. Surgery can affect fertility when the cancer involves the reproductive organs.
Children who have already gone through puberty have additional options for preserving or restoring fertility after cancer treatment. Prior to treatment, boys can have their sperm frozen and stored for future use beginning as early as age 12. This is an established approach with a high rate of success. In some cases, girls can have hormone treatments to stimulate egg production, then have the eggs frozen for later use. If the patient has a partner, doctors can also fertilize the eggs and store the embryos. Egg and embryo freezing also have a history of effective use.
Doctors normally perform these procedures while the child is already under sedation or anesthesia. Dr. Erin Rowell of Lurie Children’s Hospital notes that an additional benefit of these procedures is that they encourage parents to think about a hopeful future in which their children recover. Although a childhood cancer diagnosis is always scary, it is usually not fatal; approximately 80 percent of children with cancer survive.
While its effectiveness remains to be seen, this treatment could minimize one of pediatric cancer’s heartbreaking effects and bring peace of mind to both children and parents.
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