Incidence of fertility preservation procedures in prepubertal individuals with cancer

Published:September 15, 2022DOI:



      Fertility Preservation (FP) for children and adolescents with cancer is underutilized. In prepubertal individuals, ovarian and testicular tissue can be frozen; however, this is still considered largely experimental. Our objective was to identify trends of FP in prepubertal individuals.


      We performed a retrospective study of prepubertal children with cancer identified through the Pediatric Health Information System from 2011 to 2020. Children who underwent a testicular or ovarian biopsy were included. Any patients with testicular or ovarian malignancy, or other diagnoses which may have required a gonadal biopsy were excluded.


      A total of 418 boys under 13 and 333 girls under 12 who underwent a gonadal biopsy were identified. There was a total of 66,929 new cancer diagnoses in girls and 86,001 new cancer diagnoses in boys during this time. The most common cancer diagnosis was hematologic in both boys (50.96%) and girls (36.64%). A concurrent procedure at time of gonadal biopsy was performed in 84% of boys and 62% of girls, with line insertion being the most common. The only predictive variable of receiving a gonadal biopsy was increasing year. Overall, only 0.04% of children had a gonadal biopsy for FP during this time period.


      Summary Fig. 1
      Graphical AbstractIncidence of gonadal biopsies per year amongst prepubertal individuals.



      FP (fertility preservation), PHIS (pediatric health information systems), US (United States)
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        • Phillips S.M.
        • Padgett L.S.
        • Leisenring W.M.
        • Stratton K.K.
        • Bishop K
        • Krull K.R.
        • et al.
        Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiol.
        Biomarkers Prev. 2015; 24: 653-663
        • Patel P.
        • Kohn T.P.
        • Cohen J.
        • Shiff B.
        • Kohn J.
        • Ramasamy R.
        • et al.
        Evaluation of reported fertility preservation counseling before chemotherapy using the quality Oncology practice initiative survey.
        JAMA Netw Open. 2020; 3: 1-11
        • Kim S.Y.
        • Kim S.K.
        • Lee J.R.
        • Woodruff T.K.
        Toward precision medicine for preserving fertility in cancer patients: existing and emerging fertility preservation options for women.
        J. Gynecol. Oncol. 2016; 27: 1-18
        • Oktay K.
        • Harvey B.E.
        • Partridge A.H.
        • Quinn G.P.
        • Reinecke J.
        • Taylor H.S.
        • et al.
        Fertility preservation in patients with cancer: ASCO clinical practice guideline update.
        J Clin Oncol. 2018; 36: 1994-2001
        • Letourneau J.M.
        • Ebbel E.E.
        • Katz P.P.
        • Katz A.
        • Ai W.Z.
        • Chien A.J.
        • et al.
        Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer.
        Cancer. 2012; 118: 1710-1717
        • Li N.
        • Jayasinghe Y.
        • Kemertzis M.A.
        • Moore P.
        • Peate M.
        Fertility preservation in pediatric and adolescent Oncology patients: the decision-making process of parents.
        J Adolesc Young Adult Oncol. 2017; 6: 213-222
        • Loren A.W.
        • Mangu P.B.
        • Beck L.N.
        • Brennan L.
        • Magdalinski A.J.
        • Partridge A.H.
        • et al.
        Fertility preservation for patients with cancer.
        American society of clinical Oncology clinical practice guideline update. 2014; 31
        • Hermann B.P.
        • Sukhwani M.
        • Winkler F.
        • Pascarella J.N.
        • Peters K.A.
        • Sheng Y.
        • et al.
        Spermatogonial stem cell transplantation into rhesus testes regenerates spermatogenesis producing functional sperm.
        Cell Stem Cell. 2012; 11: 715-726
        • Sato T.
        • Katagiri K.
        • Gohbara A.
        • Inoue K.
        • Ogonuki N.
        • Ogura A.
        • et al.
        In vitro production of functional sperm in cultured neonatal mouse testes.
        Nature. 2011; 471: 504-508
        • Muñoz M.
        • Santaballa A.
        • Seguí M.A.
        • Beato C.
        • De La Cruz S.
        • Espinosa J.
        • et al.
        SEOM Clinical Guideline of fertility preservation and reproduction in cancer patients (2016).
        Clin Transl Oncol. 2016; 18: 1229-1236
        • van den Berg H.
        • Repping S.
        • van der Veen F.
        Parental desire and acceptability of spermatogonial stem cell cryopreservation in boys with cancer.
        Hum Reprod. 2007; 22: 594-597
        • Jadoul P.
        • Dolmans M.M.
        • Donnez J.
        Fertility preservation in girls during childhood: is it feasible, efficient and safe and to whom should it be proposed?.
        Hum Reprod Update. 2010; 16: 617-630
        • Demeestere I.
        • Simon P.
        • Dedeken L.
        • Moffa F.
        • Tsepeledis S.
        • Brachet C.
        • et al.
        Live birth after autograft of ovarian tissue cryopreserved during childhood.
        Hum Reprod. 2015; 30: 2107-2109
        • Matthews S.J.
        • Picton H.
        • Ernst E.
        • Anderson C.Y.
        Successful pregnancy in a woman previously suffering from β-thalassemia following transplantation of ovarian tissue cryopreserved before puberty.
        Minerva Ginecol. 2018; 70: 432-435
        • Euling S.Y.
        • Herman-Giddens M.E.
        • Lee P.A.
        • Selevan S.G.
        • Juul A.
        • Sorensen T.I.A.
        • et al.
        Examination of US puberty-timing data from 1940 to 1994 for secular trends: panel findings.
        Pediatrics. 2008; : 121
        • Klosky J.L.
        • Wang F.
        • Russell K.M.
        • Zhang H.
        • Flynn J.S.
        • Huang L.
        • et al.
        Prevalence and predictors of sperm banking in adolescents newly diagnosed with cancer: examination of adolescent, parent, and provider factors influencing fertility preservation outcomes.
        J Clin Oncol. 2017; 35: 3830-3836
        • Covelli A.
        • Facey M.
        • Kennedy E.
        • Brezden-Masley C.
        • Gupta A.A.
        • Greenblatt E.
        • et al.
        Clinicians’ perspectives on barriers to discussing infertility and fertility preservation with young women with cancer.
        JAMA Netw Open. 2019; 2: 1-13
        • Rashedi A.S.
        • De Roo S.F.
        • Ataman L.M.
        • Edmonds M.E.
        • Silva A.A.
        • Scarella A.
        • et al.
        Survey of fertility preservation options available to patients with cancer around the globe.
        J. Glob. Oncol. 2018; 2018: 331-344
        • McDougall R.J.
        • Gillam L.
        • Delany C.
        • Jayasinghe Y.
        Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?.
        J Med Ethics. 2018; 44: 27-31
        • Mulder R.L.
        • Font-Gonzalez A.
        • Hudson M.M.
        • Van Santen H.M.
        • Loeffen E.A.H.
        • Burns K.C.
        • et al.
        Fertility preservation for female patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE consortium and the international late effects of childhood cancer guideline harmonization group.
        Lancet Oncol. 2021; 22: e45-e56
        • Mulder R.L.
        • Font-Gonzalez A.
        • Green D.M.
        • Loeffen E.A.
        • Hudson M.M.
        • Loonen J.
        • et al.
        Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group.
        Lancet Oncol. 2021; 22: e57-e67
        • Takae S.
        • Lee J.R.
        • Mahajan N.
        • Wiweko B.
        • Sukcharoen N.
        • Novero V.
        • et al.
        Fertility preservation for child and adolescent cancer patients in Asian countries.
        Front Endocrinol. 2019; 10
        • Raźnikiewicz A.
        • Korlacki W.
        • Grabowski A.
        The role of laparoscopy in paediatric and adolescent gynaecology.
        Wideochirurgia Inne Tech Malo Inwazyjne. 2020; 15: 424-436
        • Romao R.L.P.
        • Lorenzo A.J.
        Fertility preservation options for children and adolescents with cancer.
        Can. Urol. Assoc. J. 2017; 11: S97-S102
        • Donnez J.
        • Kim S.S.
        Fertility preservation: principles and practice. 2nd ed. Cambridge University Press, Cambridge2021 (Available at:)
        • Anon
        Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion.
        Fertil Steril. 2019; 112: 1022-1033