Are Fertility Preservation Procedures Before Gonadotoxic Therapy and Hematopoietic Stem Cell Transplantation Feasible and Safe in Very Young Children? A Retrospective Cohort Study

BACKGROUND: Fertility preservation (FP) is increasingly integrated into the care of pediatric patients exposed to gonadotoxic therapy or conditioning for hematopoietic stem cell transplantation (HSCT), yet perioperative data in infants and toddlers remain scarce. PROCEDURE: We retrospectively analyzed all patients < 18 years undergoing surgical FP at Goethe-University Hospital between 2014 and 2025 (laparoscopic hemiovarectomy in females; open testicular tissue retrieval in males), comparing outcomes in children < 48 months versus older patients. Fifty-two females and 30 males were included, of whom 6 females (11.5%) and 6 males (20%) were < 48 months. RESULTS: Overall complication rates were 30.8% in females and 53.3% in males, but after excluding disease-related transfusions, these rates decreased to 5.8% and 10.0%, respectively. Importantly, no complications occurred in patients < 48 months, and rates did not differ significantly between age groups (0 vs. 6.5% in females, p = 1; 0 vs. 12.5% in males, p = 1). No major (Clavien-Dindo ≥ III) complications were observed. Procedure duration and postoperative hospital stay were comparable across age groups. CONCLUSIONS: These data demonstrate that surgical FP in infants and toddlers is technically feasible and safe, with perioperative outcomes comparable to those in older children, supporting early integration of FP into pediatric care pathways.