Background: Childhood cancer patients and their families are increasingly offered oncofertility care including information regarding their risk of gonadal damage by paediatric oncologists, fertility counselling by fertility specialists and fertility preservation options. However, experiences regarding oncofertility care are underreported. We aimed to summarize the available evidence of experiences of female childhood cancer patients and survivors regarding oncofertility care. Methods: Manuscripts were systematically identified using the PubMed and Embase database. From, respectively, 1256 and 3857 manuscripts, 7 articles were included and assessed, including risk of bias assessment. Outcome measures included data describing experiences of female childhood cancer patients and survivors, regarding fertility information, counselling and/or preservation. Results: Female patients and survivors are variably satisfied with fertility information, report challenges in communication with healthcare professionals and prefer to receive general information at diagnosis and detailed fertility information later. Regrets after fertility counselling are underreported, but are associated with refusing fertility preservation. Lastly, regardless of counselling, female patients and survivors report fertility concerns about their future children’s health and effect on relationships. Conclusion: Currently, the satisfaction with oncofertility care varies and female patients or survivors report regrets and concerns regardless of receiving fertility information or counselling. These results may help to improve the content of fertility information, communication skills of healthcare professionals and timing of counselling.

STUDY QUESTION: What is the quality of our standard oncofertility care, with a focus on fertility counselling and preservation rates, in children and adolescents with cancer and a high risk of treatment-induced gonadal damage (HRgd) at our national centralised paediatric oncology centre? SUMMARY ANSWER: Standardised personalised oncofertility care was achieved in 66.1% of identified HRgd children and adolescents with cancer, of whom 60.1% of patients underwent fertility preservation methods. WHAT IS KNOWN ALREADY: Increasing survival rates among childhood cancer patients have heightened awareness of long-term treatment-related toxicities, including gonadal damage and subsequent risk of infertility. The American Society for Reproductive Medicine and the International Guideline Harmonization Group recommend that fertility preservation counselling should be offered to paediatric and adolescent cancer patients at high risk of gonadal damage, including consideration of gonadal tissue preservation when appropriate. However, evidence on the implementation of oncofertility care programmes in HRgd paediatric and adolescent cancer patients remains limited. STUDY DESIGN, SIZE, DURATION: This descriptive cohort study reports on standard oncofertility care in a national prospective cohort of HRgd childhood cancer patients, between January 2020 and December 2023, in our national paediatric oncology centre. PARTICIPANTS/MATERIALS, SETTING, METHODS: In all HRgd childhood cancer patients, who were diagnosed or relapsed between January 2020 and December 2023 in the Princess Máxima Center, our standard oncofertility care strategy was evaluated. Prospective collection of demographics, tumours, treatment, and oncofertility care details, as well as retrospective collection and analysis of reasons why HRgd patients and their families were not counselled or did not undergo fertility preservation, was performed. MAIN RESULTS AND THE ROLE OF CHANCE: Between January 2020 and December 2023, 599 patients (age range 0–23 years; 345 males, 254 females) were triaged as HRgd (459 children newly diagnosed and 140 relapsed patients), including 396 (66.1%) who were counselled with 238 of these (60.1%) undergoing fertility preservation. Reasons why HRgd patients did not receive fertility counselling (n = 203/599, 34%) included their clinical status at diagnosis, young age of the patient, and anticipated poor prognosis. Uncertainties regarding future reproductive outcomes after autotransplantation of preserved tissue and concerns about potential risks of preservation procedures, were reasons for HRgd patients (n = 158/396, 40%) to refrain from fertility preservation. LIMITATIONS, REASONS FOR CAUTION: Triage information of HRgd patients who were diagnosed and/or relapsed during the establishment of oncofertility care in our centre may still be lacking. WIDER IMPLICATIONS OF THE FINDINGS: Further improvement in oncofertility care is warranted by counselling all HRgd patients and offering all of them gonadal tissue preservation through standardised documentation, whenever applicable. Future knowledge on reproductive and safety outcomes after cryopreservation and autotransplantation of gonadal tissue will further enhance fertility counselling. FUNDING: This project is cofounded by funding from the Princess Máxima Center for Pediatric Oncology, the Twinning in Research and Education to improve survival in childhood solid tumours in Lithuania (TREL) project (H2020-EU.4.b grant number 952438), and SCAling up early and late effects Research in Lithuanian childhood cancer survivors through Education and Twinning (SCARLET) project (Horizon CSA grant number 10119949). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. DISCLOSURES: The authors have declared that no competing interests exist. TRIAL REGISTRATION NUMBERS: METC research file NL72115.041.19 (METC-protocol number 19/783, Netherlands trial register number NL8192); METC research file NL73818.000.21 (METC-protocol number 0000002974).

To report our experiences on the safety of laparoscopic oophorectomy (LO) for ovarian tissue cryopreservation in childhood cancer (CC) patients. Descriptive study of a prospectively registered cohort. All CC patients undergoing LO in the Netherlands from November 2020 until April 2024. Laparoscopic oophorectomy for means of fertility preservation before or during gonadotoxic treatment. Safety, including procedure-related complications, such as critical events (desaturation, bradycardia), need for mechanical ventilation in a pediatric intensive care unit (PICU), site infections, hemorrhage, and survival, scored according to Clavien Dindo (CD) classification. Eighty-eight patients, median age 6.5 years (range 1–18 years) underwent LO, of which 2/88 patients developed CD grade 4, 1/88 CD grade 3, and 8/88 CD grade 2 complications, with the most common being port site infection (6%) and bleeding (6%). No clear determinant could be identified as a risk factor for complications. All patients recovered from procedure-related complications and no patient died as a consequence of oophorectomy. Laparoscopic oophorectomy is a relatively safe procedure to preserve future fertility for girls with cancer with a high risk of gonadal failure and consequent infertility. However, LO can be accompanied by complications in children with cancer. Therefore, safety monitoring and identification of risk factors for complications based on larger cohorts in future studies are needed. Prevention of complications of LO is an important obligation to balance the future benefits against the risks of LO to enhance the future chance of pregnancy for girls with cancer.