Advances in the diagnosis and treatment of childhood, adolescent and adult cancer have increased the life expectancy of premenopausal women with the disease. Oncological indications for ovarian tissue cryopreservation are summarized. Patients undergoing oophorectomy for prophylaxis may potentially benefit from ovarian cryopreservation. There have been numerous reported cases of autotransplantation of cryopreserved ovarian tissue, either to an orthotopic or heterotopic site. Approximately one third of young women exposed to chemotherapy develop ovarian failure. It is our ethical responsibility to propose cryopreservation of ovarian tissue to all adolescents and young women under institutional review board (IRB) protocols having to undergo chemotherapy with alkylating agents. Research programs need to determine whether active angiogenesis can be induced to accelerate the process of neovascularization in grafted tissue, if isolated human follicles can be grafted or, indeed, if microvascular re-anatomosis of an entire cryopreserved ovary is a valuable option.

This chapter reviews pediatric cancer therapy and its consequences on fertility. Chemotherapy can cause infertility, premature ovarian failure, menstrual irregularity and delayed puberty. The effects of chemotherapy on ovarian function are both agent and dose-dependent, and this effect may be additive to that resulting from abdominopelvic radiotherapy. Testicular dysfunction is among the most common long-term side effect of chemotherapy in men. The germinal epithelium is very susceptible to injury by cytotoxic drugs secondary to its high mitotic rate. Reduction in the dose or use of alkylating agents and abdominopelvic radiotherapy is the most effective means of preserving ovarian function and promoting positive reproductive outcomes in pediatric cancer survivors. Sperm cryopreservation after masturbation is the most established and effective method of fertility preservation in males. Oncologists have a responsibility to inform parents and age-appropriate patients about the likelihood that their cancer treatment may permanently affect their fertility.