Beyond Survival: Addressing Pediatric Oncofertility Risk, Preservation Methods, and Care Disparities

Advances in cancer treatment and supportive care have resulted in more than 80% of pediatric cancer patients surviving into adulthood. This progress has prompted consideration of factors influencing long-term quality of life for patients, including fertility. The ability to have biological children is important to many survivors. Yet, gonadotoxic therapies, such as alkylating agents and radiation, can damage gonadal tissues and cause infertility. Since these treatments remain essential for cure, efforts have expanded to better understand fertility risks and preservation strategies. Prominent organizations, including the American Society for Reproductive Medicine, American Society of Clinical Oncology, American Academy of Pediatrics, Association of Pediatric Hematology/Oncology Nurses, and Children's Oncology Group, recommend all cancer patients receive comprehensive counseling on fertility risks and options. This review outlines current knowledge on fertility risk, preservation strategies, care barriers, and future directions to improve fertility preservation access and outcomes for pediatric cancer patients and survivors.