This document discusses fertility preservation options for adolescents and young adults undergoing cancer treatment. It provides an overview of the risks cancer treatments pose to fertility for both males and females. For males, sperm banking and testicular tissue freezing are discussed as options. For females, embryo banking, oocyte cryopreservation, and ovarian tissue freezing are covered, though many methods are still considered experimental. The challenges of discussing fertility with young patients and barriers to accessing fertility preservation are also summarized.

1. Jennifer Levine, MD, MSW Division of Pediatric Oncology Columbia University Medical Center San Antonio, Texas October 2, 2010 Fertility Preservation in Adolescents and Young Adults with Cancer

2. Fertility Preservation for Adolescents and Young Adults IMPROVED REPRODUCTIVE TECHNOLOGY PATIENT AWARENESS/ ADVOCACY: QUALITY OF LIFE IMPROVED SURVIVAL

3. ASCO Guideline Summary 2006 “ As part of informed consent prior to therapy, oncologists should address the possibility of infertility with patients as early in treatment planning as possible.”

9. Gonadotoxicity of Treatment Regimens

17. Levine et al, JCO, May 2010

20. Normal Ovarian Reserve AGE FOLLICLE COUNT 25,000 37 1,000 51 Menopause birth 1,000,000 12 Menarche

21. Acute Ovarian Failure Follicle Count 25,000 (37) 1,000 (51) Cancer Treatment (16) Traditionally measured by amenorrhea, FSH, estradiol

22. Premature Menopause Follicle Count 25,000 (37) 1,000 (51) Cancer Treatment (25) (30)

25. Gonadotoxicity of Treatment Regimens

36. Parenthood Post Treatment: Diminished Ovarian Reserve Follicle Count 25,000 (37) 1,000 (51) Cancer Treatment (25) (30) Serum Levels: AMH, Inhibin B Vaginal Ultrasound: Antral follicle count, Ovarian Volume