Surgical Fertility Preservation Can Be Safely Performed Without Delaying Treatment for Children With Severe Aplastic Anemia

Pediatric patients with severe aplastic anemia (SAA) who undergo hematopoietic cell transplantation are at significantly increased risk of infertility. Pretransplant fertility preservation (FP) options for prepubertal children are surgical procedures: ovarian or testicular tissue cryopreservation (OTC and TTC). Bleeding and infection risk must be considered given profound cytopenias in these patients. We prospectively enrolled patients in a surgical FP clinical protocol at our institution from 2015 to 2023. We evaluated the approach and outcomes of all 14 patients with SAA who underwent surgical FP (TTC: n = 7; OTC: n = 7). No patients experienced a surgical complication related to FP. With our patient cohort, surgical FP was safely achieved utilizing a comprehensive standard of care pathway.