|
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 |