From
Dr. Nelson G. Rosen
Pediatric oncofertility: preserving reproductive futures for childhood cancer survivors
With Dr. Monica Laronda
Chapter 1 of 6
Program rationale
Introduction and rationale for pediatric fertility preservation
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Loss of control over reproductive future is one of the top quality of life parameters of importance for childhood cancer survivors
Most cancer survivors prefer to have a biological offspring over a gamete donation or a gestational carrier
Parents want fertility preservation options presented for their children regardless of their infertility risk or prognosis, based on Lurie Children's own research
Patient risk for premature gonadal insufficiency is determined by calculating cumulative cyclophosphamide equivalent dose, imminent surgery, chemotherapy with alkylating agents, or radiation therapy
A 12-year-old receiving 10 gray of radiation can undergo menopause at approximately 19.5 years old
Life expectancy can be reduced by 2 years from additional comorbidities resulting from lack of gonadal hormones after premature menopause
Lurie Children's fertility program first started collaborating with Northwestern University Oncofertility Consortium in 2011
Lurie Children's has performed over 200 ovarian tissue cryopreservation procedures and approximately 170 testicular tissue cryopreservation procedures
Approximately 25% of ovarian tissue cryopreservation patients are referrals from outside Lurie Children's Hospital
Ovarian tissue cryopreservation is performed with a unilateral oophorectomy, and the other ovary compensates and maintains the same level of hormones
The remaining ovary can release more eggs when stimulated for assisted reproductive technologies, and there is little difference in age at menopause
The first successful ovarian tissue cryopreservation and transplantation in a large animal model was done in sheep in 1994
The first orthotopic human transplant was performed in the pelvic wall in 2000
The first live births following ovarian autotransplant from frozen-thawed tissue happened between 2004 and 2006 in Israel
Hormone production after ovarian tissue transplantation lasts an average of 2 to 5 years and has been reported to exceed 12 years
For many cancer patients, there is a possibility of reintroducing cancer cells from their tissue during autotransplantation
Green fluorescent protein expressing follicles transplanted in a 3D printed scaffold into a mouse without this protein spontaneously produced pups expressing the green fluorescent protein, proving the eggs came from the bioprosthetic ovary
Infants with very young ovaries are significantly different in their makeup of different cell types compared to prepubertal and postpubertal ovaries from slightly older individuals
The Laronda lab found 82 different matrosome proteins in the ovary, with 42 significantly differentially expressed across different compartments
The lab discovered 11 matrosome proteins that had not yet been previously identified within the ovary
The density of extracellular matrix protein matched the rigidity curve of atomic force microscopy analysis, suggesting the rigidity of the ovary might be in part due to the amount of extracellular matrix proteins in a region
Cancer treatments can cause gonadal failure, limiting or destroying the patient's ability to produce offspring in the future
ASCO guidelines underscore the importance of discussing with newly diagnosed cancer patients that their future fertility may be affected by cancer treatments
Fertility preservation is important for any child at risk for premature gonadal insufficiency, including Turner syndrome and mixed gonadal dysgenesis, not just cancer patients
Children with ovaries can undergo ovarian stimulation and oocyte retrieval if they've gone through puberty, or ovarian tissue cryopreservation for pediatric, adolescent, and young adult patients
Children with testes can bank sperm if they've gone through puberty or opt for testicular tissue cryopreservation
A normal ovary has about 300,000 follicles at the time of birth, declining steadily until menopause around age 50
The first patient was enrolled in March 2011 and underwent ovarian tissue cryopreservation
The program opened for testicular tissue cryopreservation in 2015
When able, laparoscopic oophorectomy is done at the time of another required procedure such as port placement to decrease the number of times the patient is under general anesthesia
There are approximately 140 reported live births from ovarian tissue autotransplantation
The rate of autotransplantation for recipients who have restored fertility is between 20% and 40%
The Laronda lab developed a 3D printed scaffold composed of 10% gelatin and were able to grow healthy oocytes from mice
Lurie Children's has received a HubMap consortium grant and is now a contributing site generating a normal human ovary atlas describing the ovary microenvironment across development
EMILIN1 protein was identified as potentially influencing follicular genesis