Special considerations in pediatric female fertility preservation

With the decreasing mortality of pediatric cancer, issues of survivorship should be addressed at the beginning of therapy. It is known that some treatment protocols cause loss of fertility and hormone production and thus counseling should occur before treatment begins. Currently this is a top unmet need despite its recommendation from several pediatric oncologic and reproductive societies. All patients should be counseled on their risk of infertility related to gonadotoxic therapy and understand whether they are a candidate for a fertility preservation procedure. Both prepubertal and postpubertal girls can undergo ovarian tissue cryopreservation via unilateral oophorectomy, however only postpubertal patients can have ovarian hormone stimulation with egg retrieval. Autotransplantation of cryopreserved ovarian tissue is utilized when fertility or hormone function needs to be restored, while eggs can be thawed for future in-vitro fertilization. This review focuses on female fertility and hormone preservation counseling, options and surgical pearls, current state of research and fertility preservation outcomes, through a case-based format.