By Guest commentary Sunday, February 16th, 2025

By Frank & Calli Kalman

Among the most devastating consequences of childhood cancer is the loss of future fertility. 

If they survive, the high levels of chemotherapy needed to save young lives often make it impossible for survivors to have children of their own.

As parents of a child who has been fighting cancer for over two decades, we’ve witnessed firsthand the devastating impact of lost fertility our daughter and her husband have faced.

About 15 years ago, we asked our daughter’s attending oncologist if we should collect and freeze her eggs. 

Her response: “That’s interesting.” And basically, ignoring our question. 

After asking her new doctor, she referred us to a fertility specialist at USC. Our daughter’s eggs were collected and frozen, but unfortunately, timing proved critical. 

Before collecting her eggs, she had already seen a lot of chemotherapy. 

By the time she was ready to use them, her oncologist team reached a consensus: the risk of complications was too high due to her extensive exposure to chemotherapy. 

This made it unsafe to thaw and use the preserved eggs.

The problem is that most infants and young children who develop cancer before puberty have no eggs or sperm cells to collect. 

This issue is compounded for children exposed to chemotherapy before puberty when reproductive cells are not yet available. 

However, recent breakthroughs have changed the landscape.

Kyle E. Orwig, PhD, from the University of Pittsburgh School of Medicine’s Department of Obstetrics, Gynecology, and Reproductive Sciences, delivered a pivotal presentation on this topic at The Children’s Neuroblastoma Cancer Foundation conference in Chicago a few months ago, which we attended.

Dr. Orwig’s team provides a comprehensive menu of options to preserve future fertility for people and kids with ovaries or testes who are at risk of infertility due to their disease or medical treatment. 

The standard options to preserve fertility in young patients who have already gone through puberty are egg freezing and sperm freezing. 

These options are not available to kids who are prepubertal at the time of their diagnosis and treatment because they are not yet making mature eggs or sperm. 

For prepubertal patients, Dr. Orwig’s team can freeze immature ovarian or testicular tissues with the hope that those tissues can be matured to produce eggs or sperm. 

Ovarian tissue and testicular tissue freezing are early-stage technologies usually performed under research protocols. 

However, with over 180 live births from frozen, transplanted ovarian tissues, some centers are offering ovarian tissue freezing as the standard of care. 

Frozen testicular tissue in reproduction lags behind ovarian tissues by ten years. 

There are no live births reported after the transplantation of testicular tissues. 

Therefore, testicular tissue freezing is universally considered experimental. 

Dr. Orwig emphasizes that it is essential to harvest tissue early, ideally before the initiation of treatment, to maximize the future reproductive potential of the tissue. 

He and his colleagues worldwide are working hard to responsibly develop technologies that will enable patients to use their reproductive tissues or cells to have children when they are ready. 

Europe is far ahead of the United States in this field.

THE BOTTOM LINE

While testicular tissue preservation currently lags behind ovarian tissue preservation in reproductive capabilities, Dr. Orwig and colleagues are optimistic. 

The consensus is by the time today’s young patients reach reproductive age, advancing technology — mainly based on European developments — will make sperm production from preserved testicular tissue possible.

For ovarian tissue and testicular tissue freezing, we recommend contacting Dr. Orwig’s team to learn about fertility preservation options, pricing, and facilities for freezing and long-term storage.

There have been about 25 live births from transplanted ovarian tissue in the United States, all from Dr. Kutluk Oktay in New York at Innovation Fertility Preservation and IVF and Dr. Sherman Silber in St. Louis Fertility Center of St. Louis, Missouri.

Dr. Orwig emphasized that his team is equipped to expedite tissue preservation procedures immediately following a cancer diagnosis. 

They have established partnerships with centers across the country that can quickly collect and preserve these tissues.

IMPORTANT CONSIDERATIONS

Parents need to be advocates for their children by requesting information about fertility risks and fertility preservation options as soon as possible, even if their children have already received chemotherapy. 

Doctor Orwig’s talk was posted on YouTube, and his presentation starts at 41 minutes and 15 seconds point on a 7-hour recording: youtube.com/watch?v=nD-zYV_ili0

PRIORITIZING THE FUTURE DURING A CRISIS

My wife and I know firsthand that when your child’s life is at stake, it’s challenging to consider anything else — even long-term benefits. 

It’s easy to overlook taking extra steps that could have a massive meaning down the road. 

But there’s one crucial step worth mustering energy for once you learn your child has cancer and chemotherapy is recommended, reach out to Dr. Orwig or his team or others offering such treatments.

Frank Kalman is the executive director of End Kids Cancer, a nonprofit aimed at funding cancer treatments for children to help increase survival rates. His wife, Calli, contributed to the piece.