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Fertility problems after treatment can often be prevented

Especially when your child is still young, you may hardly think about it. But a possible side-effect of cancer treatment can be infertility. Fortunately, there is much possible to prevent this, researcher Madeleine van der Perk and pediatric oncologist Margreet Veening say. ‘You know what you're doing it all for, when a seven-year-old girl says: ’I want to be a mom one day too!’’

Immediately after diagnosis, there is only one question for parents: will my child get better again? Parents usually do not think about possible infertility. But for children who survive cancer, it is one of the main long-term side effects of the treatment. Pediatric oncologist Margreet Veening: ‘You only notice problems with fertility years later. As more and more children survive cancer, more attention is being paid to these kinds of side effects. Informing everyone in time is important to prevent survivors from thinking that they are infertile or fertile, even though they may not.’

Unexpectedly pregnant anyway
A well-known story is that of a young woman who had kidney cancer as a child. She always thought she couldn't get pregnant. When her belly got fatter, she feared the disease was coming back. She turned out to be pregnant. Doctor-researcher Madeleine van der Perk: ‘It is therefore important to discuss any infertility with all children and parents in time. And that's more than just saying it is a possible side effect. ‘

Discussing risks in advance
The working group on co-fertility (cancer and fertility, ed.) wants to inform all families at the start of the treatment. Nursing specialist on co-fertility Irene IJgosse assesses the risks of infertility in new patients together with the main practitioner. In peace she discusses this with the child and parents. And she explains how to prevent later fertility problems. She refers girls with a high risk of infertility to the fertility gynecologist. Van der Perk: ‘It is often a great relief that something can be done. Moreover, when someone comes to talk about later, it gives confidence that there is a ‘later.’

Freezing tissue for later
UMC Utrecht gynecologist Annelies Bos already told about the possibilities in the parent newsletter last year. Boys in puberty can freeze sperm cells and girls can freeze eggs or ovarian tissue. Van der Perk: ‘You can replace that tissue later. But because you don't want to accidentally replace any metastatic cancer cells, we are also working hard on new techniques. For example, allow eggs to mature outside the body. And developing artificial ovaries. ‘

Developments in research
Fertility risk research is progressing rapidly. For example, researchers at the Máxima are studying the damage of treatment and the reprocessing of stem cells from frozen testicle tissue of young boys. Van der Perk: ‘In the past, children with cancer usually did not even reach fertile age. Now that is different. You know what you're doing it for when a 7-year-old girl tells you, ‘I want to be a mom later too!’

More  information
In Attent, the magazine of the VOKK, nr. 4 2018, an article about Fertility conservation and childhood cancer was published. Do you have questions about fertility and the treatment of your child? Ask the attending physician or the nurse specialist. Or send an email to Irene IJgosse: vs-fertiliteit@prinsesmaximacentrum.nl.

Pediatric oncologists from all departments are part of the working group on co-fertility: dr. M.A. Veening (hemato-oncology), prof. M.M. van den Heuvel-Eibrink (solid tumors), dr. M.D. van de Wetering (neuro-oncology), dr. A.B. Versluys (stem cell transplantation department). dr. A.W.F. van der Steeg (pediatric surgeon), dr. A.M.E. Bos (fertility gynecologist), dr. A.J. Klijn (pediatric urologist) and H.M. van Santen (pediatric endocrinologist) are involved. Researchers, nurses, pedagogical staff, psychologists and social workers also participate. This is how care and research work closely together.