Fertility preservation for children with brain tumors

Oct. 01, 2022

Mayo Clinic Children's Center is one of the few centers that offers fertility preservation services to children who are treated for brain cancer. Multidisciplinary specialists in the Mayo Clinic Pediatric Fertility Preservation Program work closely with pediatric neuro-oncologists to discuss options with patients and their families.

Few centers offer fertility preservation to pediatric patients. Fertility preservation for children with brain tumors is even rarer. "Our commitment to this care is very strong," says Asma J. Chattha, M.B.B.S., a consultant in Pediatric and Adolescent Reproductive Health at the Mayo Clinic Children's Center in Rochester, Minnesota.

Patients with primary brain tumors are at risk of infertility because of the potential damaging effects on the hypothalamic-pituitary axis by tumor infiltration, cranial surgery and radiotherapy. In addition, chemotherapy can impair sperm production in males and deplete the pool of ovarian oocytes in females. Fertility preservation is ideally completed before chemotherapy or radiation therapy begins.

"Pediatric brain tumors are unique because the prognosis and treatment vary widely. Our neuro-oncologists determine whether the conversation on pediatric fertility preservation should occur," Dr. Chattha says.

The American Society of Clinical Oncology recommends that health care providers discuss treatment-related fertility risks and fertility preservation options with all patients of reproductive age as early as possible in the treatment course. Yet fertility preservation is an infrequently addressed clinical issue for pediatric patients facing cancer therapy, especially if they have brain tumors.

Until recently, fertility preservation was possible only after puberty. "We now have options for even our youngest patients and see children ages 0 to 17 years in the Pediatric Fertility Preservation Program," Dr. Chattha says.

The procedures for prepubescent children involve cryopreservation of testicular or ovarian tissue. Preserved testicular tissue can later be used to generate spermatogonial stem cells, which can then be matured to produce functional sperm. The preserved ovarian tissue contains immature oocytes, which may be later reimplanted in the patient or matured outside of the patient's body when the patient wants to have a child.

Postpubertal males can bank sperm. Post-menarchal females can proceed with oocyte cryopreservation, although the procedure can delay cancer care by 2 to 3 weeks.

Mayo Clinic Children's Center patients and their families have 24/7 access to the pediatric fertility preservation team. "We have had instances where patients were starting chemotherapy within the next 24 to 48 hours, and we were able to perform fertility preservation procedures before that," Dr. Chattha says. "We're all quite prepared to get our laboratory and research personnel as well as staff mobilized quickly."

Reaction to the program is highly positive among patients' families. In a study published in the October 2021 issue of the Journal of Pediatric and Adolescent Gynecology, Mayo Clinic researchers reported that 100% of parents and guardians surveyed were glad to receive counseling about pediatric fertility preservation.

"These conversations about fertility preservation take place at such a sensitive time in the child's development, when a family is already struggling in terms of decision-making," Dr. Chattha says. "But just having the option to discuss fertility preservation brings a lot of hope to families and patients."