Significantly Increased Risk of Infertility Significantly Increased Risk of Infertility Significantly Increased Risk of Infertility
Male Female
Alkylators CED (gm/m2)
≥ 4
Prepubertal: > 12 Pubertal: > 8
Heavy Metals mg/m2 (Cisplatin/Carboplatin) Cisplatin > 500 is significantly increased risk Minimally increased risk
Hematopoietic Stem Cell Transplant
Alkylator +/-Total body irradiation Myeloablative and Reduced intensity regimens Alkylator +/-Total body irradiation Myeloablative and Reduced intensity regimens
Radiation Exposure
Testicular ≥ 4.0 Gy Hypothalamus > 40 Gy Ovarian: ≥ 15 Gy (Prepubertal) ≥ 10 Gy (Pubertal) Hypothalamus > 40 Gy
Surgery
Orchiectomy (bilateral) Retroperitoneal lymph node dissection (RPLND)
Oophorectomy (bilateral)
Fertility Preservation Options Fertility Preservation Options Fertility Preservation Options
Male Female
Post-Pubertal Sperm banking: prior *any* chemotherapy Embryo cryopreservation
Testicular sperm extraction (TESE) Oocyte cryopreservation
Pre-Pubertal (or Post-Pubertal) Testicular tissue cryopreservation (TTC) – experimental Ovarian tissue cryopreservation (OTC) – no longer experimental
Ovarian transposition in patients receiving pelvic radiation
GnRH agonists Not effective and Not recommended Can be offered to women with breast cancer for protection from ovarian insufficiency but should Not replace oocyte or embryo cryopreservation