Fertility preservation in young patients before allogeneic haematopoietic SCT

As the long-term survival rate of patients receiving HSCT increases, quality of life issues, including the possibility to parent children, deservedly gain ever more attention. We therefore fully endorse the authors’ appeal for fertility preservation in this patient group, and appreciate their efforts to raise awareness of this issue in the medical community. We would like to take the opportunity to emphasise that the options for fertility preservation for this group are restricted. To illustrate this notion we would like to supplement their paper with a brief discussion of the available options. For male patients, fertility preservation is relatively easy, provided that their HSCT starts after puberty, that is the onset of semen production. Semen cryopreservation is a readily available option that can be offered in practically every fertility centre and can be performed with no or hardly any delay in the treatment. For pre-pubertal boys, unfortunately, there are to date no options. The cryopreservation of spermatogonial stem cells with the aim of retransplanting them after cure resulting in the initiation of spermatogenesis, is currently being investigated. 2 For female patients the situation is more complicated. Considering the young age of most patients, emergency in vitro fertilisation followed by cryopreservation of the generated embryos will in the majority of cases not be an option, as this requires a stable relationship with a male partner. The cryopreservation (by means of vitrification) of oocytes is the next logical alternative. This option is suitable for postpubertal girls and requires hormonal ovarian hyperstimulation to increase the number of mature oocytes that can be obtained. 3 Depending on the number of oocytes one wishes to obtain, one or more cycles of hyperstimulation may be required. As a consequence, treatment will have to be postponed for at least 14 days or up to several months. It should be determined for each patient individually what period of postponement of the treatment is acceptable. In prepubertal girls, or in those cases where delay of the treatment is not advisable, immature oocytes may be obtained and vitrified. These oocytes have to be matured in vitro ,b efore they can be used for fertilisation at a later stage of life. To the