Clinical Consensus Statement No. 459: Oncofertility - Bridging the Geographical Gap in Pediatric and Adolescent Gynaecology in Canada.

OBJECTIVE

To review the options for fertility preservation in Canada for paediatric and adolescent gynaecology patients who are receiving fertotoxic therapy.

TARGET POPULATION

Adolescent and pediatric individuals with ovaries and a treatment plan that affects future reproductive options.

OPTIONS

Depending on the individual's pubertal status and in accordance with ethical guidelines, appropriate fertility preservation methods such as oocyte preservation, ovarian tissue preservation, and ovarian transposition should be considered alongside their treatment. Modification of treatment protocols may also be necessary.

OUTCOMES

Canada currently lacks provincial and national initiatives to offer fertility preservation for pediatric and adolescent individuals. Many barriers contribute to this, including knowledge gaps among providers, lack of assent processes, and limited access to urgent consultation and specialized procedures. In addition to this, patients and providers may experience barriers in accessing funding.

BENEFITS, HARMS, AND COSTS: The recommendations outlined in this committee opinion will benefit both providers and families by providing them with knowledge of treatment options. While consultations with specialist providers and in hospital procedures are covered, patients are responsible to pay for medications, procedures performed in private surgical centres, and tissue storage, which can put a large financial burden on families. There may be inter-province and inter-hospital differences in coverage for treatment. Additionally, there is considerable gender inequity in the higher cost of cryopreservation of eggs compared with sperm.

EVIDENCE

A literature review of systematic reviews and original research (cohort studies, case series/studies were included; there were no randomized Controlled trials published) was conducted in PubMed from January 1990 to January 2025 using the MeSH search terms fertility preservation, paediatric/pediatric, adolescent, and female. Articles were included if they focused on individuals assigned female at birth, were related to the field of oncofertility, were available through the University of Calgary's library system, and were written in English.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

INTENDED AUDIENCE

Family physicians and nurse practitioners providing primary care, obstetricians and Gynaecologists, Reproductive Endocrinologist and Infertility Specialists, and Paediatric Oncologists TWEETABLE ABSTRACT: Oncofertility - It takes a village. Building a network to improve access to oncofertility in Canada.

SUMMARY STATEMENTS

RECOMMENDATIONS.