C. J. Harris1,2, K. S. Corkum1,2, E. E. Rowell1,2 1Feinberg School Of Medicine – Northwestern University,Surgery,Chicago, IL, USA 2Ann and Robert H. Lurie Children’s Hospital of Chicago,Pediatric Surgery,Chicago, IL, USA
Introduction:
Significant reduction in overall childhood cancer mortality over several decades has allowed for greater emphasis on efforts to improve quality of life issues affecting survivors, including fertility preservation (FP). Unfortunately, many benign and malignant conditions require gonadotoxic treatments that may threaten a child’s future fertility. Currently the only FP options for prepubertal children are testicular tissue cryopreservation (TTC) and ovarian tissue cryopreservation (OTC), which involve surgical removal of gonadal tissue. The American Academy of Pediatrics (AAP) recommends that a board-certified pediatric surgeon should be responsible for the surgical care of pediatric patients 0-12 years old who require minimally invasive procedures. Many FP programs utilize pediatric and adolescent gynecologists and urologists to carry out FP procedures. This study sought to evaluate the participation of pediatric surgery departments in FP and the exposure of pediatric surgery fellows to adnexal and testicular cases.
Methods:
An electronic survey was distributed to pediatric surgery fellowship program directors in the United States and Canada via email. Questions were related to participation in FP initiatives and procedures, limitations to participation, and involvement of fellows in adnexal and testicular surgery.
Results:
Survey participation was 49% (28/57). Of respondents, 43% (12/28) of programs report participation in FP initiatives. Of departments with FP programs, the most common procedure for males was TTC (58%, 7/12) and testicular sperm extraction (42%, 5/12), however only 50% (6/12) of programs reported performing at least one FP procedure for males in the last year. For female infertility, the most common procedures were surgical transposition of the ovaries (83%, 10/12) and laparoscopic OTC (67%, 8/12). Over the last year, 75% (9/12) of programs performed at least one procedure for female FP. Of departments without a FP program, the most commonly cited limitations were that FP was another department’s responsibility (50%, 8/16) and lack of multidisciplinary team (31%, 5/16). Additionally, one program cited lack of funding. Notably, lack of tissue handling (6%, 1/16) and lack of experience with benign ovarian and testicular procedures (0%, 0/16) were not common limitations. All programs, regardless of participation in FP, noted 100% exposure of their fellows to benign and malignant adnexal cases. During fellowship, most trainees logged greater than ten adnexal cases (39% performed 11-20 cases and 25% performed 21-30 cases).
Conclusion:
The only options for FP in prepubertal patients are OTC and TTC, which require surgical removal of gonadal tissue for cryopreservation. The AAP currently recommends that pediatric surgeons operate on this age group of children. Even with these recommendations pediatric surgery departments have a low participation in FP, despite adequate training of fellows to perform these procedures.