Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview



Fertility-related services in pediatric oncology are increasing, but barriers to care remain and few structured programs are described in the literature. Therefore, the study objectives were (1) to characterize fertility-related services in a large pediatric oncology center and (2) to discuss recommendations for fertility-related services across the pediatric cancer continuum.


Medical records of all cases referred to our Fertility Preservation Clinic within a 3-year period were reviewed, which included 292 patients/survivors with malignant disease. Approximately half (n = 152/292, 52.1%) were cancer patients referred prior to treatment (n = 92/152) or while on active therapy (n = 60/152). The other half (n = 140/292; 47.9%) were survivors who had completed treatment.


Referrals more than doubled over 3 years. Most patients referred before treatment were offered and opted for FP (72.8% attempted; 58.9% completed). More male than female patients opted for FP (77.6% vs. 22.4%), but completion rates were higher among females (93.3% vs. 76.9%). Rates of FP before treatment did not increase over time (p = .752). Many patients on-treatment were referred for infertility risk counseling, demonstrating information/support needs in this group. Referred survivors questioned their fertility post-treatment and completed fertility assessments, indicating intact fertility among few (~ 15%).


This review demonstrated the acceptance and increasing need for fertility-related services in pediatric oncology across the cancer continuum, including FP before treatment, counseling during treatment, and fertility assessment in survivorship. Based on our experiences, current recommendations are discussed and include standardized procedures, streamlined referrals, adequate communication/education (of providers and families), and meeting specific needs of young cancer patients/survivors.

This is a preview of subscription content, log in to check access.


  1. 1.

    ASRM, American Society for Reproductive Medicine Practice Committee, Society for Assisted Reproductive Technology (2013) Mature oocyte cryopreservation: a guideline. Fertil Steril 99:37–43

    Article  Google Scholar 

  2. 2.

    Chemaitilly W, Cohen LE (2017) Diagnosis of endocrine disease: endocrine late-effects of childhood cancer and its treatments. Eur J Endocrinol 176:183–203

    Article  Google Scholar 

  3. 3.

    Li N, Jayasinghe Y, Kemertzis MA et al (2017) Fertility preservation in pediatric and adolescent oncology patients: the decision-making process of parents. J AYA Oncol 6:213–222

    Google Scholar 

  4. 4.

    Fallat ME, Hutter J, American Academy of Pediatrics Committee on Bioethics, et al. (2008) Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics 121:e1461–e1469

    Article  Google Scholar 

  5. 5.

    Klosky JL, Wang F, Russell KM et al (2017) 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 in press

  6. 6.

    Köhler TS, Kondapalli LA, Shah A, Chan S, Woodruff TK, Brannigan RE (2011) Results from the survey for preservation of adolescent reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer. J Assist Reprod Genet 28:269–277

    Article  Google Scholar 

  7. 7.

    Vindrola-Padros C, Dyer KE, Cyrus J, Lubker IM (2017) Healthcare professionals’ views on discussing fertility preservation with young cancer patients: a mixed method systematic review of the literature. Psycho-Oncology 26:4–14

    Article  Google Scholar 

  8. 8.

    Nieman CL, Kinahan KE, Yount SE et al (2007) Fertility preservation and adolescent cancer patients: lessons from adult survivors of childhood cancer and their parents. In: Woodruff TK, Snyder KA (eds) Oncofertility: fertility preservation for cancer survivors. Springer, New York, pp 201–217

    Google Scholar 

  9. 9.

    Ginsberg JP, Li Y, Carlson CA et al (2014) Testicular tissue cryopreservation in prepubertal male children: an analysis of parental decision-making. Peds Blood Cancer 61:1673–1678

    Article  Google Scholar 

  10. 10.

    Oktay K, Harvey BE, Partridge AH et al (2018) Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 14(6):381–385. https://doi.org/10.1200/JOP.18.00160

  11. 11.

    Ethics Committee of the American Society for Reproductive Medicine (2018) Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion. Fertil Steril 110:380–386

    Article  Google Scholar 

  12. 12.

    Anazodo A, Ataman-Millhouse L, Jayasinghe Y et al (2018) Oncofertility—an emerging discipline rather than a special consideration. Pediatr Blood Cancer 65:e27297

    Article  Google Scholar 

  13. 13.

    Martinez F (2017) Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Hum Reprod 108:1802–1811.e2

    Article  Google Scholar 

  14. 14.

    Fernbach A, Lockart B, Armus CL, Bashore LM, Levine J, Kroon L, Sylvain G, Rodgers C (2014) Evidence-based recommendations for fertility preservation options for inclusion in treatment protocols for pediatric and adolescent patients diagnosed with cancer. J Pediatr Oncol Nurs 31:211–222

    Article  Google Scholar 

  15. 15.

    Smith BM, Duncan FE, Ataman L, Smith K, Quinn GP, Chang RJ, Finlayson C, Orwig K, Valli-Pulaski H, Moravek MB, Zelinski MB, Irene Su H, Vitek W, Smith JF, Jeruss JS, Gracia C, Coutifaris C, Shah D, Nahata L, Gomez-Lobo V, Appiah LC, Brannigan RE, Gillis V, Gradishar W, Javed A, Rhoton-Vlasak AS, Kondapalli LA, Neuber E, Ginsberg JP, Muller CH, Hirshfeld-Cytron J, Kutteh WH, Lindheim SR, Cherven B, Meacham LR, Rao P, Torno L, Sender LS, Vadaparampil ST, Skiles JL, Schafer-Kalkhoff T, Frias OJ, Byrne J, Westphal LM, Schust DJ, Klosky JL, McCracken K, Ting A, Khan Z, Granberg C, Lockart B, Scoccia B, Laronda MM, Mersereau JE, Marsh C, Pavone ME, Woodruff TK (2018) The National Physicians Cooperative: transforming fertility management in the cancer setting and beyond. Future Oncol 14:3059–3072

    CAS  Article  Google Scholar 

  16. 16.

    Moravek MB, Appiah LC, Anazodo A et al (2019) Development of a pediatric fertility preservation program: a report from the pediatric initiative network of the oncofertility consortium. J Adolesc Health 64(5):563–573. https://doi.org/10.1016/j.jadohealth.2018.10.297

  17. 17.

    Ben-Aharon I, Abir R, Perl G et al (2016) Optimizing the process of fertility preservation in pediatric female cancer patients–a multidisciplinary program. BMC Cancer 16:620

    Article  Google Scholar 

  18. 18.

    Carlson CA, Kolon TF, Mattei P, Hobbie W, Gracia CR, Ogle S, Ginsberg JP (2017) Developing a hospital-wide fertility preservation service for pediatric and young adult patients. J Adolesc Health 61:571–576

    Article  Google Scholar 

  19. 19.

    Bradford NK, Walker R, Henney R et al (2018) Improvements in clinical practice for fertility preservation among young cancer patients: results from bundled interventions. J AYA Oncol 7:37–45

    Article  Google Scholar 

  20. 20.

    Shnorhavorian M, Kroon L, Jeffries H et al (2012) Creating a standardized process to offer the standard of care: continuous process improvement methodology is associated with increased rates of sperm cryopreservation among adolescent and young adult males with cancer. J Pediatr Hematol Oncol 34:e315–e319

    Article  Google Scholar 

  21. 21.

    Lehmann V, Nahata L, Ferrante FC et al (2018) Fertility-related perceptions and impact on romantic relationships among adult survivors of childhood cancer. J Adolesc Young Adult Oncol 7(4):409–414

  22. 22.

    Hohmann C, Borgmann-Staudt A, Rendtorff R, Reinmuth S, Holzhausen S, Willich SN, Henze G, Goldbeck L, Keil T (2011) Patient counselling on the risk of infertility and its impact on childhood cancer survivors: results from a national survey. J Psychosoc Oncol 29:274–285

    Article  Google Scholar 

  23. 23.

    Kim J, Mersereau JE (2015) A pilot study about female adolescent/young childhood cancer survivors’ knowledge about reproductive health and their views about consultation with a fertility specialist. Palliat Support Care 13:1251–1260

    CAS  Article  Google Scholar 

  24. 24.

    Lehmann V, Chemaitilly W, Lu L et al (2019) Gonadal functioning and perceptions of infertility risk among adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study. J Clin Oncol 37(11):893–902

  25. 25.

    Aubin S, Perez S (2015) The clinician’s toolbox: assessing the sexual impacts of cancer on adolescents and young adults with cancer (AYAC). Sex Med 3:198–212

    Article  Google Scholar 

  26. 26.

    Rubinsak LA, Christianson MS, Akers A et al (2018) Reproductive health care across the lifecourse of the female cancer patient. Support Care Cancer 27(1):23–32. https://doi.org/10.1007/s00520-018-4360-5

  27. 27.

    Cooper TG, Noonan E, Von Eckardstein S et al (2010) World Health Organization reference values for human semen characteristics. Hum Reprod Update 16:231–245

    Article  Google Scholar 

  28. 28.

    Björndahl L, Barratt CL, Mortimer D et al (2015) ‘How to count sperm properly’: checklist for acceptability of studies based on human semen analysis. Hum Reprod 31:227–232

    PubMed  Google Scholar 

  29. 29.

    Kirkman T. Statistics to use [Online]. Available at: http://www.physics.csbsju.edu/stats/. Accessed October, 1, 2018

  30. 30.

    van der Kaaij MA, Heutte N, van Echten-Arends J, Raemaekers JM, Carde P, Noordijk EM, Fermé C, Thomas J, Eghbali H, Brice P, Bonmati C, Henry-Amar M, Kluin-Nelemans HC (2009) Sperm quality before treatment in patients with early stage Hodgkin’s lymphoma enrolled in EORTC-GELA Lymphoma Group trials. Haematologica 94:1691–1697

    Article  Google Scholar 

  31. 31.

    Kutteh WH, Klosky JL, Green DM et al (2018) Ovulation induction and oocyte retrieval for fertility preservation in young adolescents newly diagnosed with medulloblastoma: a case series. J Obstet Gynaecol 38:878–879

    Article  Google Scholar 

  32. 32.

    Nilsson J, Jervaeus A, Lampic C, Eriksson LE, Widmark C, Armuand GM, Malmros J, Marshall Heyman M, Wettergren L (2014) ‘Will I be able to have a baby?’ Results from online focus group discussions with childhood cancer survivors in Sweden. Hum Reprod 29:2704–2711

    CAS  Article  Google Scholar 

  33. 33.

    Zebrack BJ, Casillas J, Nohr L, Adams H, Zeltzer LK (2004) Fertility issues for young adult survivors of childhood cancer. Psycho-Oncology 13:689–699

    Article  Google Scholar 

  34. 34.

    Crawshaw M, Sloper P (2010) ‘Swimming against the tide’–the influence of fertility matters on the transition to adulthood or survivorship following adolescent cancer. Eur J Cancer Care 19:610–620

    CAS  Article  Google Scholar 

  35. 35.

    Murphy D, Klosky JL, Termuhlen A et al (2013) The need for reproductive and sexual health discussions with adolescent and young adult cancer patients. Contraception 88:215–220

    Article  Google Scholar 

  36. 36.

    Frederick NN, Campbell K, Kenney LB et al (2018) Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: the clinician perspective. Peds Blood & Cancer 65:e27087

    Article  Google Scholar 

  37. 37.

    Lunsford AJ, Whelan K, McCormick K, McLaren J (2014) Antimüllerian hormone as a measure of reproductive function in female childhood cancer survivors. Fertil Steril 101:227–231

    CAS  Article  Google Scholar 

  38. 38.

    Green DM, Liu W, Kutteh WH et al (2014) Cumulative alkylating agent exposure and semen parameters in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study. Lancet Oncol 15:1215–1223

    CAS  Article  Google Scholar 

  39. 39.

    Green DM, Kawashima T, Stovall M, Leisenring W, Sklar CA, Mertens AC, Donaldson SS, Byrne J, Robison LL (2009) Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 27:2677–2685

    CAS  Article  Google Scholar 

  40. 40.

    Ginsberg JP, Ogle SK, Tuchman LK et al (2008) Sperm banking for adolescent and young adult cancer patients: sperm quality, patient, and parent perspectives. Peds Blood Cancer 50:594–598

    Article  Google Scholar 

  41. 41.

    Klosky JL, Flynn JS, Lehmann V et al (2017) Parental influences on sperm banking attempts among adolescent males newly diagnosed with cancer. Fertil Steril 108:1043–1049

    Article  Google Scholar 

  42. 42.

    Stein DM, Victorson DE, Choy JT et al (2014) Fertility preservation preferences and perspectives among adult male survivors of pediatric cancer and their parents. J AYA Oncol 3:75–82

    Google Scholar 

  43. 43.

    Bahadur G, Whelan J, Ralph D et al (2001) Gaining consent to freeze spermatozoa from adolescents with cancer: legal, ethical and practical aspects. Hum Reprod 16:188–193

    CAS  Article  Google Scholar 

  44. 44.

    Barlevy D, Elger BS, Wangmo T, Ravitsky V (2017) Adolescent oncofertility discussions: recommendations from a systematic literature review. AJOB Empirical Bioethics 8:106–115

    Article  Google Scholar 

  45. 45.

    Melissa’s Law for Fertility Preservation [Online]. Available at: https://oncofertility.northwestern.edu/sites/oncofertility/files/Greenwich Magazine.pdf, 2018. Accessed Nov 2018

Download references


No specific external funding was used to support this medical record review and manuscript preparation, but support to St Jude Children’s Research Hospital is provided by the Cancer Center Support (CORE) grant (CA21765, PI: Roberts) and the American Lebanese Syrian Associated Charities.

Author information



Corresponding author

Correspondence to Vicky Lehmann.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board (IRB) of St. Jude Children’s Research Hospital (#FWA00004775) and with the 1964 Helsinki Declaration and its later amendments and comparable ethical standards.

Informed consent

Due to the nature of this retrospective medical chart reviews and no direct patient involvement with the study, and in accordance with our IRB, no additional informed consent was obtained from participants.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lehmann, V., Kutteh, W.H., Sparrow, C.K. et al. Fertility-related services in pediatric oncology across the cancer continuum: a clinic overview. Support Care Cancer 28, 3955–3964 (2020). https://doi.org/10.1007/s00520-019-05248-4

Download citation


  • Fertility preservation
  • Fertility assessments
  • Pediatric neoplasms
  • Cancer survivor
  • Cryopreservation
  • Infertility