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Other relevant clinical care guidance
American Academy of Pediatrics (AAP)
• Providers should refer patients at risk for fertility loss (primarily focusing on childhood cancer) for fertility preservation before gonadotoxic therapy (2008)1
• Providers should counsel at-risk pediatric populations about fertility & sexual function & this should begin in infancy with parents or at earliest time point a patient may be affected (2018)2
Pediatric Endocrine Consensus Statement (2006)3
• Providers should disclose to youth with disorders of sex development about their
condition & counseled about fertility & sexual function, using “collaborative, ongoing” approach
1Fallat, Hutter, AAP. Preservation of fertility in pediatric & adolescent patients with cancer. Pediatrics. 2008. 2Nahata, et al, AAP. Counseling in pediatric populations at risk for infertility &/or sexual function concerns. Pediatrics. 2018. 3Lee et al. International Consensus Conference on Intersex organized by Lawson Wilkins Pediatric Endocrine Society & European Society for Paediatric Endocrinology. Consensus statement on management of intersex disorders. Pediatrics. 2006.
Interventions: Structural changes
1. Evaluation of hospital-wide fertility preservation service1
• Developed centralized team for standard referral & active scanning of inpatient
& clinic lists for newly diagnosed patients
• Referral patterns 20-months pre- vs. post-initiative
– Increased by 70%
– Doubled from Divisions outside oncology from 15% pre- vs. 34% post-initiative
2. Guidance to developing pediatric fertility preservation programs2 • Recommends overcoming barriers, including low referral rates, requires
– Institutional commitment
– Multidisciplinary meetings to train staff across institution
– Fertility referral as part of checklists / order sets or use of “opt out” approach – Easily accessible & educational website
– Social work/patient navigator (to assist families in financial need)
1Moravek et al. J Adolesc Health. 2019. 2Carlson et al. J Adolesc Health. 2017.
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