Fertility Preservation in Pre-Pubertal Girls

During the last decade, there has been a considerable increase in the survival of childhood cancer as a result of improved anti-cancer Treatments Multi agent chemotherapy increased 5-year survival rate for childhood .One of the major concerns in girls suffer from childhood cancer is the adverse effect of cancer therapy on their fertility .Chemotherapy and radiation therapy, are established risk factors result in acute ovarian failure. The effect of cancer therapy on gonadal function varies, ranging from no effect to total loss of ovarian function. These effects related to several factors, including the type and dose of chemo-therapy, radiation, type of surgical intervention, and the field of radiotherapy. Due to the potentially detrimental effects of chemotherapy and radiotherapy on future fertility, international societies, recommend discussion on the risks of cancer therapy on fertility and options for preservation with all patients before the initiation of any therapy. Ethical issues in this population of cancer patients should be considered .because parents make decision for their children; therefore, adult factors maybe effect on the decision. Child hood fertility preservation methods are experimental procedures and have uncertain outcomes. For this reason, children should be involved in the discussion. Meth-ods to Preserve the Reproductive Potential in female children Undergoing Gonadotoxic Cancer therapy are cryopreservation of ovarian tissue, oophoropexy, gonadal shielding. For cryo-preservation of ovarian tissue in prepubertal girls, extraction of less than half an ovary (20-30%) may be enough. The risk of contamination of ovarian tissue with malignant cell fallowed by reintroducing malignant cells in blood borne cancer is high. Promising result has been reported with an artificial ovary in animal models. Gonadal shielding consists of physical protec-tion of gonadal tissue with suitable shields during radiation. Oophoropexy is used when pelvic or abdominal irradiation is scheduled: Ovary is transposed via laparoscopy or mini-lapa-rotomy toward the pelvic walls laterally or behind the uterus medially. It is also important to emphasize that the existence of uniform guidelines is essential for proper clinical practice and will make it possible to use a common and shared approach to this intricate subject.