Purpose of Review Children and adolescents with cancer have an increased risk of infertility due to the gonadotoxic effect of their treatments. With a growing number of adult survivors, the risk of infertility has increasingly become a primary concern for patients and their families. The purpose of the current review is to discuss the evaluation, risk stratification, and options for male fertility preservation (FP) in children and adolescents with cancer as well as the strategies to develop a program for FP. Recent Findings A growing body of evidence supports the risk of gonadotoxicity with an increasing dose of alkylating agents, heavy metals, and hypothalamic and testicular radiation as well as any conditioning regimen for a hematopoietic stem cell transplantation. The current guidelines recommend that all patients be counseled on the risk of infertility and options FP at diagnosis and throughout survivorship. High-quality evidence supports the use of sperm cryopreservation as the most well-established option for FP. It should therefore be offered to all pubertal and postpubertal patients with a recent diagnosis of cancer and ideally completed prior to the initiation of treatment. Although the evidence is more limited, a semen specimen may also be obtained with the use of penile vibratory sitmulation, electroejaculation, or testicular sperm extraction if patients are unable to provide a specimen via masturbation and have a strong interest in FP. Testicular tissue cryopreservation is the only available option with the greatest potential for FP in prepubertal patients, based on the success with transplantation of immature testicular tissue and spermatogonial stem cells in animal models. However, it is still considered investigational with no retrieval of mature sperm or pregnancies reported to date. It should therefore be performed under an institutional review board-approved protocol. The current infrastructure is variable but largely inadequate for FP, and many patients are not being routinely counseled on the risk of infertility or offered the appropriate options based on the existing guidelines. A multi-disciplinary team with a navigator or coordinator is critical to a successful program for FP, but the development of evidence-based and scalable interventions is needed. Summary The risk of infertility should be addressed in all children and adolescents with cancer. The role of male FP has continued to expand and evolve with a better understanding of its importance and emergence of assisted reproductive technologies. Ongoing research is essential to improve the access to and options for FP in the future.

Male Fertility Preservation in Children and Adolescents with Cancer

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发表日期：

2026年1月3日

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Andrew C. Strine

摘要

Purpose of Review

Children and adolescents with cancer have an increased risk of infertility due to the gonadotoxic effect of their treatments. With a growing number of adult survivors, the risk of infertility has increasingly become a primary concern for patients and their families. The purpose of the current review is to discuss the evaluation, risk stratification, and options for male fertility preservation (FP) in children and adolescents with cancer as well as the strategies to develop a program for FP.

Recent Findings

A growing body of evidence supports the risk of gonadotoxicity with an increasing dose of alkylating agents, heavy metals, and hypothalamic and testicular radiation as well as any conditioning regimen for a hematopoietic stem cell transplantation. The current guidelines recommend that all patients be counseled on the risk of infertility and options FP at diagnosis and throughout survivorship. High-quality evidence supports the use of sperm cryopreservation as the most well-established option for FP. It should therefore be offered to all pubertal and postpubertal patients with a recent diagnosis of cancer and ideally completed prior to the initiation of treatment. Although the evidence is more limited, a semen specimen may also be obtained with the use of penile vibratory sitmulation, electroejaculation, or testicular sperm extraction if patients are unable to provide a specimen via masturbation and have a strong interest in FP. Testicular tissue cryopreservation is the only available option with the greatest potential for FP in prepubertal patients, based on the success with transplantation of immature testicular tissue and spermatogonial stem cells in animal models. However, it is still considered investigational with no retrieval of mature sperm or pregnancies reported to date. It should therefore be performed under an institutional review board-approved protocol. The current infrastructure is variable but largely inadequate for FP, and many patients are not being routinely counseled on the risk of infertility or offered the appropriate options based on the existing guidelines. A multi-disciplinary team with a navigator or coordinator is critical to a successful program for FP, but the development of evidence-based and scalable interventions is needed.

Summary

The risk of infertility should be addressed in all children and adolescents with cancer. The role of male FP has continued to expand and evolve with a better understanding of its importance and emergence of assisted reproductive technologies. Ongoing research is essential to improve the access to and options for FP in the future.