JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):118
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263752

P-106. Fertility Preservation Methods in Prepubertal Patients Undergoing Chemotherapy: A Narrative Review

Endjeli Vogler Reche¹, Julia Cipriano Oliveira¹, Mauricio Gabriel Staduto Cevallos¹, Maria Monica Pereira¹

¹ Centro Universitário São Camilo - São Paulo - SP - Brasil

Objective: To identify fertility preservation methods in prepubertal patients undergoing chemotherapy.
Methods: A narrative review was conducted based on studies indexed in the Medline (via PubMed) database, including studies published between 2015 and 2025, using terms related to fertility preservation and child, resulting in 181 articles. Experimental studies and case reports on any fertility preservation approach in prepubertal patients who had undergone or were to undergo chemotherapy for any diagnosis were included. A double-blind peer selection was performed by two independent reviewers on the Rayyan platform, with conflicts resolved by a third reviewer. Data extraction was carried out using a Microsoft Excel spreadsheet. Extracted data included: study type, sample size, mean age, diagnosis, and fertility preservation technique used.
Results: Twelve studies were included: one cross-sectional study and eleven case reports. The mean age of the pediatric patients in the case reports was 5.1 years. Most presented with gynecologic or oncologic tumors with potential gonadotoxic risk, with the most frequent cancer types being germ cell tumors (such as yolk sac tumor) and sarcomas (mainly rhabdomyosarcoma). The most frequently used fertility preservation technique was ovarian tissue cryopreservation (OTC) (six cases), performed through unilateral laparoscopic oophorectomy followed by tissue freezing via vitrification or slow freezing. This approach was employed in girls with both solid cancers and hematologic diseases, such as leukemia, particularly in cases with high risk of ovarian failure. Radical laparoscopic trachelectomy was the second most common technique (three cases), primarily indicated for localized cervical tumors, such as rhabdomyosarcoma and uterine yolk sac tumor, with the aim of preserving the uterus and enabling future pregnancy. Other less frequent strategies included: uterine and ovarian transposition prior to radiotherapy to prevent gonadal damage from pelvic irradiation; conservative preservation of ovarian parenchyma during surgery for benign tumor; and ovarian tissue transplantation (OTT), performed with successful reproduction 15 years after OTC. Regarding the evaluation of these techniques' effectiveness, few cases directly reported reproductive outcomes. Only one case report described a successful pregnancy following OTT performed 15 years after OTC, resulting in the birth of a healthy baby. In the remaining cases, ovarian function or reproductive anatomy was preserved, but the effectiveness of these techniques in ensuring future fertility has not yet been fully assessed, as the patients are young and have not yet attempted pregnancy. Therefore, assessment of the efficacy of these interventions will depend on long-term patient follow-up, monitoring puberty, ovarian function, reproductive attempts and, when applicable, the success of spontaneous or assisted pregnancy. Additionally, a cross-sectional study indicated that the use of educational videos on pediatric fertility preservation methods may improve knowledge in both sexes and reduce anxiety, with a higher rate of seeking these methods upon cancer diagnosis. Children, particularly those over 12 years old, also showed better understanding of the subject and were able to participate actively in decision-making.
Conclusion: Available studies demonstrate that ovarian tissue cryopreservation appears to be the most promising technique for fertility preservation in prepubertal girls undergoing oncologic treatments, given its technical feasibility, angiogenic potential and structural preservation of follicles. However, most available data are still based on case reports with short follow-up. Therefore, clinical trials and prospective studies of higher methodological quality and longer follow-up are needed to validate the efficacy and safety of these interventions, as well as to expand knowledge about their applicability in different pediatric contexts.