O-177 The importance of an onco-fertility program for pediatric oncology patients
Authors: IJgosse I , Looijenga L , Klijn A , Oude Ophuis R , Heuvel-Eibrink van den M , Veening M , Bos A , Broer S , Leeuwen van J , Steeg van der L , Sriram S , Perk van der M , Wetering van de M 
Published: June 2023

Abstract

Study question
How to start an onco-fertility program in a pediatric oncology unit as standard of care

Summary answer
An active onco-fertility program helps to offer the best option for future fertility for pediatric oncology patients. Awareness of fertility risk is necessary.

What is known already
Infertility after treatment for pediatric oncology is an important late effect Of these patients, 25-35 % classify as high risk (HR) for infertility. With the increasing survival chance (&gt;80%) this late effect plays an important role.

Study design, size, duration
An onco-fertility program was started in 2018 with the start of a centralized hospital for pediatric oncology patients (yearly 600 patients) navigated by a nurse-practitioner. The program runs with intense collaboration between the different specialties. All new patients are identified. Fertility-risk is based on the international fertility guidelines.

Participants/materials, setting, methods
All patients are informed on fertility risk by their oncologist. All HR children are additionally counseled by the onco-fertility nurse-practitioner and referred for further counseling to gynecology for ovarian tissue cryopreservation(OTC) or urology for sperm cryopreservation or testicular biopsy (in research setting). Monthly the onco-fertility working-group members discuss difficult cases and research in the field. Survivors have the possibility for fertility consultations.

Main results and the role of chance
Awareness of treatment (chemotherapy, radiotherapy and surgery) on fertility in children has increased from 2018 till now 2023 among oncologists, nursing staff, carers of the child, and the patients themselves. We offer fertility preservation mainly in the high risk for infertility group but also for low risk groups we offer information and counseling . In the outpatient clinic for survivors, there is an increasing number of consults yearly on fertility questions From 2018 till 2022 we saw a fourfold of consults.
The number of high risk for infertility over the years is stable around 30%. Over the years we see an increasing number of patients who have fertility preservation done in time In the girls this increased from 32% in 2018 to nearly 40% in 2022. For the boys it increased from 37% in 2018 to 57% in 2022

Limitations, reasons for caution
This is an ongoing programme in a large pediatric oncology unit in a first world country where this programme is possible. insurance is well organized We realize that in other countries it is much more difficult to run this program

Wider implications of the findings
In 75% of survivors risk of infertility is the most important late effect. Therefore running an onco fertility program at the start of the patient journey offering the patient the best options for fertility preservation will help the patient in future to improve their quality of life concerning fertility issues.

Trial registration number
not applicable