2021 Volume 58 Issue 2 Pages 118-123
Nowadays, in internationally well-known institutes for fertility preservation (FP), pediatric cancer patients account for 12–18% of all FP patients undergoing ovarian tissue cryopreservation (OTC). OTC, which requires only 1–4 days, is useful for FP in pediatric patients with rapid progression of their cancer and for whom transvaginal egg retrieval is impossible. In Japan, there are 15 pediatric cancer hospitals, most of which do not have OTC facilities. As a solution to this, a centralized system similar to FertiPROTEKT and the Danish model, which have a long history of conducting top-level OTC, should be established. A centralized system requires open and frequent communications among the patient, family, pediatric surgeons, pediatricians, anesthesiologists, and assisted reproductive physicians. Building strong relationships is vital to smoothly perform shared decision making, general anesthesia, laparoscopic ovariectomy, cryopreservation, and postoperative management. For hospitals without OTC facilities, our Human Ovarian-tissue Preservation Enterprise (HOPE) can provide a transportation system to move the tissues from hospitals to HOPE and an OTC facility with experts who can handle the slow freezing method to cryopreserve tissues, the safety of which has been proven. Nowadays, about 2,500 pediatric cancer patients are reported annually with a five-year survival rate of 70–80%. Given the declining birth rate and aging population in Japan, FP for pediatric cancer patients is essential. By introducing the cases of transplantation of frozen-thawed ovarian tissues for induction of puberty and pregnancy, we discuss the benefits of FP for pediatric cancer patients and the challenges we faced to establish a centralized network system.
