A child’s right to fertility preservation when undergoing sterilizing chemotherapy

ScienceDaily. Published online: 10th June 2016.

Image shows light microscopy of primary follicle of the ovary.

Ovarian tissue cryopreservation (OTC), harvesting and freezing ovarian tissue, is the most promising complication-free strategy to preserve potential fertility in pre-pubescent girls undergoing sterilising chemotherapy, according to a 13 year study by Fanny Chambon et al. in the journal, Human Fertility.

Almost 80% of children and adolescents currently treated for cancer or leukemia will be long term survivors. Paediatric oncologists are concerned that side effects such as low fertility, infertility and early menopause can reduce the quality of life for survivors. Indeed, in females, cancer treatments can result in premature ovarian insufficiency (POI). Therefore, preserving fertility in young girls is becoming a key issue for improving quality of life. However, only a few teams performing OTC in children have reported on their practice.

The paper reports on 13 years’ experience of ovarian tissue cryopreservation before sterilising treatment. The aim of the study on OTC in 36 girls at risk of early menopause, aged between 2 and 19 years old, at the Clermont-Ferrand City Paediatric Oncology Department is to assess how effective, feasible and risky this treatment is.

Laparoscopy was used to collect a third of each ovary that was frozen by a slow cooling protocol. Histological analysis of one random sample of each harvested ovarian tissue fragment was routinely performed before freezing.

The study uncovers unresolved issues in the practice of OTC. The minimum age to offer OTC remains undetermined, there is no current consensus on the quantity of ovarian cortex to be harvested for cryopreservation or whether best practice is to remove an entire ovary or to remove part of each ovary. Detecting ovarian damage is difficult too as it is not standardised, and re-introducing cancer cells via an ovarian graft because of malignant cells in frozen thawed ovarian tissue remains a concern.

Read the original research abstract here

Read the full commentary here

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