Table 1.

Summary of recommendations for oncofertility initiatives for children and adolescents diagnosed with cancer

Why offer fertility preservation to children, adolescents, and young adults with cancer?

- Many treatment modalities for cancer are gonadotoxic ○Chemotherapy - Alkylating agents ○ Radiation therapy ○ Surgery ○ Unknown effect of large number of new agents, including antibodies and targeted therapy - Patients and families want to be informed about impact of treatment on fertility and preservation options at the time of diagnosis

Which groups should be targeted by fertility preservation strategies?

- All-inclusive approach – every patient at the time of diagnosis OR - Patients at higher risk of infertility ○ Higher doses of alkylating agents (sarcomas, neuroblastoma) ○ Higher doses of radiation therapy ○ Gonadal surgery (germ cell tumours, paratesticular rhabdomyosarcoma)

What is the ideal timing for discussion and adoption of fertility preservation strategies?

- Ideally at the time of diagnosis and before any therapeutic measures have been initiated, when feasible. Previously treated patients who progress and require highly gonadotoxic salvage therapy may consider options despite potential lower likelihood of success