Fertility Preservation in Male Children, Adolescents, and Young Adults With Cancer: A Systematic Review and Appraisal of Guidelines.
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PURPOSE: Advances in child, adolescent and young adult oncology have shifted the focus of cancer treatment towards quality of life. Gonadotoxicity remains a devastating late effect of treatment for some survivors. While numerous guidelines exist for fertility preservation, referral rates for fertility preservation are low. We sought to recognize and understand systemic barriers to standardized fertility care for male child, adolescent and young adults with cancer. MATERIALS AND METHODS: We performed a systematic review and database search of clinical practice guidelines. Eligible guidelines included male children, adolescents, and young adults between the ages of 0-39 years diagnosed with any cancer. Appraisal was performed using the AGREE II instrument. Concordance across 28 clinical and logistical areas was analyzed to identify areas of consensus and disagreement. RESULTS: We identified 33 guidelines globally that met inclusion criteria. Seventy-two percent of appraised guidelines were rated as "high quality". Concordance across guidelines was low overall (25%), with complete discordance in ethical and logistical domains. Key consensus items included sperm cryopreservation as a preservation method, initiation prior to gonadotoxic treatment, and inclusion of an oncologist and fertility specialist on the care team. Guidelines disagreed on the specific makeup of a multidisciplinary care team, pre-pubertal treatments, and specific ethical/logistical aspects. CONCLUSIONS: Although guidance for fertility preservation exists, it remains inconsistent and incompletely specified, particularly on ethical and logistical domains, thus limiting its clinical utility. Global efforts must prioritize standardization of logistical and ethical frameworks to enable implementation in real-world clinical practice and accelerate research in areas of controversy.