title: Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program.
abstract: Current evidence indicates sub-optimal incidence of fertility preservation (FP) in eligible patients. We present herein our designated multidisciplinary program for FP in pediatric and adolescent population and present our data on FP in female patients.
  
  
  
  Pediatric patients (age 0-18) who were candidate for highly gonadotoxic treatments were referred to FP program for a multidisciplinary discussion and gonadal risk-assessment followed by either oocyte cryopreservation or ovarian cryopreservation (OCP) for female patients, and sperm banking for male patients. The OCP protocol consists of aspiration of oocytes from small antral follicles and in-vitro maturation followed by cryopreservation, as well as ovarian tissue cryopreservation.
  
  
  
  The establishment of a designated FP program resulted in a significant increase in referral and subsequent FP procedures of all eligible patients. Sixty-two female patients were referred for FP discussion during a period of 36 months; 41 underwent OCP; 11 underwent oocyte cryopreservation and six were declined due to parental decision. The median age was 13.2y (range 18 months-18y). Thirty-two (51.6 %) were chemotherapy-naïve. Seventeen patients (27 %) had sarcoma, 16 patients (26 %) had acute leukemia. The mean number of mature oocytes that were eventually vitrified was significantly higher in chemotherapy-naïve patients compared with chemotherapy-exposed patients (mean 12 oocytes (1-42) versus 2 (0-7)).
  
  
  
  Multidisciplinary programs that encompass experts of all relevant fields, skilled laboratory resources and a facilitated path appear to maximize the yield. We observed a considerable higher referral rates following launching a designated program and earlier OCP in chemo-naïve patients that culminated in a better fertility preservation procedure.
authors: Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. iritbenahron@gmail.com.
authors: Irit
authors: I
authors: Ben-Aharon
authors: IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: R
authors: R
authors: Abir
authors: Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: G
authors: G
authors: Perl
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: J
authors: J
authors: Stein
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: G
authors: G
authors: Gilad
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: H
authors: H
authors: Toledano
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: S
authors: S
authors: Elitzur
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: G
authors: G
authors: Avrahami
authors: IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: A
authors: A
authors: Ben-Haroush
authors: IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: G
authors: G
authors: Oron
authors: Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: E
authors: E
authors: Freud
authors: Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: D
authors: D
authors: Kravarusic
authors: Division of Pediatric Hematology Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
authors: M
authors: M
authors: Ben-Arush
authors: Department of Pediatric Hematology Oncology, Ha'Emek Hospital, Afula, Israel.
authors: G
authors: G
authors: Herzel
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: I
authors: I
authors: Yaniv
authors: Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: S M
authors: SM
authors: Stemmer
authors: IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: B
authors: B
authors: Fisch
authors: Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: S
authors: S
authors: Ash
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007223:Infant; D009369:Neoplasms / Q000150:complications / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents
keywords: Fertility preservation; Ovarian cryopreservation; Pediatric cancer patients