Introduction: Fertility preservation (FP) for children and adolescents with cancer is underused.  In postpubertal boys and girls, FP is achieved by cryopreservation of sperm or oocytes. In prepubertal individuals, immature ovarian and testicular tissue can be frozen; however, this is considered largely experimental. Our objective was to quantify who is receiving FP procedures in young adults with cancer.

Methods: We performed a retrospective study of children under 18 years old who had surgery in 52 U.S. pediatric hospitals registered in the Pediatric Health Information System (PHIS) from 2011–2019. Male and female cancer patients who underwent a testicular or ovarian biopsy were included. Any patients with testicular or ovarian malignancy, torsion, or other diagnoses that may have required a gonadal biopsy were excluded.

Results: A total of 600 boys and 550 girls who underwent a gonadal biopsy were identified. After applying the exclusion criteria, 418 boys (Table 1) and 333 girls (Table 2), with a mean age at gonadal biopsy of 8.3 (boys) and 8.8 (girls) years, were included in the analysis; 363 boys were 12 and under and 55 boys were above 12, while 224 girls were 11 and under and 109 were above 11. The most common cancer diagnosis was hematological in both boys (50.96%) and girls (36.64%). A concurrent procedure at time of testis biopsy was performed in 84% of boys, with chemotherapy device insertion being the most common (54.87%). In girls, a concurrent procedure took place 62% of the time, with chemotherapy device insertion being the most common at 40%. When separating patients into pre- and post-pubertal, no differences in characteristics were seen in boys or girls. Overall, the total number of testis and ovarian biopsies has been increasing since 2011 (Figure 1).

Conclusions: Since 2011, gonadal biopsy rates have increased in adolescents and children with cancer, presumably for FP. Our findings highlight the need to establish protocols and tracking for FP procedures in the U.S.