title: Fertility preservation in patients receiving cyclophosphamide therapy for renal disease.
abstract: Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.
authors.affiliation: Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, gajjara@email.chop.edu.
authors.forename: Radha
authors.initials: R
authors.lastname: Gajjar
authors.forename: Steven D
authors.initials: SD
authors.lastname: Miller
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Meyers
authors.forename: Jill P
authors.initials: JP
authors.lastname: Ginsberg
mesh_terms: D000328:Adult; D002648:Child; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy*; D008297:Male
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide