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Review
. 2023 May 3:14:1147898.
doi: 10.3389/fendo.2023.1147898. eCollection 2023.

Fertility preservation in pediatric healthcare: a review

Lin Chen  1 , Zirui Dong  2   3 , Xiaoyan Chen  4   5
Affiliations
Review

Fertility preservation in pediatric healthcare: a review

Lin Chen et al. Front Endocrinol (Lausanne). .

Abstract

Survival rates for children and adolescents diagnosed with malignancy have been steadily increasing due to advances in oncology treatments. These treatments can have a toxic effect on the gonads. Currently, oocyte and sperm cryopreservation are recognized as well-established and successful strategies for fertility preservation for pubertal patients, while the use of gonadotropin-releasing hormone agonists for ovarian protection is controversial. For prepubertal girls, ovarian tissue cryopreservation is the sole option. However, the endocrinological and reproductive outcomes after ovarian tissue transplantation are highly heterogeneous. On the other hand, immature testicular tissue cryopreservation remains the only alternative for prepubertal boys, yet it is still experimental. Although there are several published guidelines for navigating fertility preservation for pediatric and adolescent patients as well as transgender populations, it is still restricted in clinical practice. This review aims to discuss the indications and clinical outcomes of fertility preservation. We also discuss the probably effective and efficient workflow to facilitate fertility preservation.

Keywords: fertility preservation; oocyte cryopreservation; ovarian tissue cryopreservation; pediatric; testicular tissue cryopreservation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Options for female fertility preservation. For pubertal patients, mature oocyte cryopreservation is the optimal strategy. Controlled ovarian hyperstimulation and oocyte retrieval can be completed within two weeks if the treatments can be delayed. Another method requiring less time for ovarian stimulation is cryopreservation of in vitro matured immature cumulus-oocyte-complex (COCs). Additionally, immature COCs can be obtained while harvesting ovarian tissue for cryopreservation. Thawed oocytes are utilized for in vitro fertilization with intracellular sperm injection (A), resulting in live birth rates per transfer varying between 39% and 52%. If the patient is prepubertal or requires immediate treatments, ovarian tissue cryopreservation remains the only option. The ovarian cortex is surgically removed, dissected, and cryopreserved. While vitrification is ideal for the cryopreservation of oocytes, slow-freezing is currently preferred for the preservation of ovarian tissue. Thawed ovarian slices may be transplanted either orthotopically or heterotopically (B). Transplantation to orthotopic sites (broad ligament and ovarian medulla) provides the chance for spontaneous conception, whereas transplanting to heterotopic sites necessitates assisted reproductive techniques. The overall live birth rates after OTT range from 18.2% to 43.3%.
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