Expert consensus
A fertility preservation consultation should be initiated prior to
therapy. Post-menarchal girls receiving any alkylating agent or pelvic
radiation should be offered the option of oocyte harvest if it can be
accomplished without inappropriate delay in therapy initiation.
Girls who will receive pelvic radiation may be offered ovarian
transposition.
Ovarian tissue cryopreservation (OTC) is an additional, experimental
fertility preservation option available to both pre- and post-menarchal
girls receiving alkylating agent therapy and/or pelvic radiation. The
risk for infertility and premature menopause is proportional to the dose
of alkylating agent, as quantified by the cyclophosphamide equivalent
dose (CED), but different cooperative study groups and local
institutions employ various thresholds for offering this intervention.
Oocyte harvest and cryopreservation in the late teenage years, after
therapy completion, is another option.