Sperm and ova conservation: existing standards of practice in North America

Abstract

Background and procedure: Rapid advances have occurred in both reproductive medicine and survival from childhood cancer. To establish the current level of best clinical practice for sperm, ovarian, and prepubertal tissue collection and storage, a cross-sectional survey of a major pediatric oncology collaborative study group (Pediatric Oncology Group, POG) was performed.

Results: Of the 110 centers surveyed, 69 questionnaires (63%) were completed. No responding center had guidelines regarding which young people should be offered sperm, ovarian, or prepubertal testicular tissue conservation; 93% centers had offered sperm and 10% ova conservation; 15% had offered sperm conservation to males prior to completion of sexual development and 3% to girls prior to sexual maturation. All centers were more likely to offer sperm conservation than ova conservation for any given disease. The most common diseases for which conservation was offered were Hodgkin and non-Hodgkin lymphoma, and sarcomas. Fertility counseling was offered in a variety of settings by 71% of centers by health care professionals, including doctors, nurses, social workers, psychologists, and geneticists.

Conclusion: There was little agreement regarding appropriate indications for, and method of, gamete preservation in children's cancer centers. It is hard to establish best clinical practice from these data. Unresolved medical, legal, and ethical issues necessitate the development of a voluntary code of practice and guidelines in order to ensure good clinical practice.