Introduction

Why offer fertility preservation to children?

The remarkable improvement in overall childhood cancer survival has helped to shift focus towards ensuring a better quality of life for survivors. Unfortunately, many pediatric malignancies and benign medical conditions require high intensity, multimodality treatments which are gonadotoxic and may cause premature gonadal insufficiency and infertility [1]. Children with a variety of medical diagnoses may find themselves candidates for fertility preservation as part of their comprehensive care.

The American Academy of Pediatrics, American Society of Clinical Oncology and American Society of Reproductive Medicine recommend clinicians discuss the consequences of planned medical treatments on future fertility, the possibility of premature gonadal insufficiency and the available fertility preservation options for that patient [2][3][4]. These recommendations stem from the desire of childhood cancer survivors and their families to be informed about their risk of infertility and fertility preservation options [5].

Why should pediatric surgeons be involved in fertility preservation initiatives?

Pediatric surgeons should be involved in fertility preservation initiatives because of their training and expertise in advanced minimally invasive surgery for children. This becomes vastly important for fertility preservation procedures in infants and young children where removal of the gonadal tissue must be carried out in a delicate manner for optimal gonadal tissue preservation and where operative safety must be ensured due to the experimental nature of these procedures. Fertility preservation programs are multidisciplinary and often involve pediatric oncologists, endocrinologists, adolescent gynecologists and urologists. Very few pediatric surgeons are currently involved in fertility preservation initiatives yet they have been trained to perform the adnexal and testicular surgery required for gonadal tissue harvesting. The American Academy of Pediatrics recommends referral to a pediatric surgeon for anyone under the age of five years [6]. This will become increasingly important as fertility preservation procedures are offered to younger patients.