Practical and ethical issues for fertility preservation for children and young people with cancer

The increasing number of paediatric cancer survivors in the last few decades has focused attention on minimizing long-term effects caused by oncological therapy without compromising survival rates. Loss of reproductive function is one of the most distressing potential adverse consequences of successful treatment. Several new reproductive techniques are now available for fertility preservation in these patients. Predicting the risk to fertility for an individual of a planned course of treatment is extremely difficult, particularly in the pediatric population. In this review we discuss the practical and ethical issues that must be addressed so that our patients can benefit from these new technologies. Multidisciplinary teams, specialized centers and decisions made in the “child and young person's best interests” form the basis of the optimal approach to fertility preservation.