Fertility Preservation Taskforce

• Yasmin Jayasinghe

  A/Prof

  yasmin.jayasinghe@unimelb.edu.au
  +61 3 8345 3721

Research Overview

Over 80% of children, adolescents and young adults (AYA) diagnosed with cancer survive to adulthood. Fertility impairment is a major survivorship consideration. We know from follow-up studies of childhood cancer survivors that infertility may affect long-term well being, relationships and life decisions. We now understand that lack of information about the impact of cancer treatments on fertility can increase distress and anxiety in young people. International bodies now recommend discussion of fertility risks and options prior to cancer treatment.

Fertility Preservation poses unique clinical challenges in children, as some procedures are considered experimental. It also poses ethical challenges around consent and beneficence for the young person. Fertility preservation is time sensitive as it is best undertaken prior to the administration of chemotherapy or radiotherapy. Discussions often occur around one or two days after diagnosis of cancer, which is a stressful time.  Ovarian tissue collected from children prior to cancer treatment can be stored for many years, and tissue may survive for some years after transplantation back into the body years later. There have been isolated reports in children of return of ovarian function after transplantation. Over 200 pregnancies have been reported worldwide, but only two from tissue from a child. For boys testicular tissue collection may be undertaken, but at present mature sperm from this tissue has not been produced. Lack of governance over paediatric and adolescent Fertility Preservation, creates burdens for families and health providers. Unfortunately detailed national guidelines do not exist to guide clinicians in this complex area of practice.

Under the leadership of A/Prof Yasmin Jayasinghe, The Royal Children’s Hospital Melbourne developed a multidisciplinary collaborative Paediatric Adolescent and Young Adult Fertility Preservation Program in conjunction with the Royal Women’s Hospital Melbourne in 2012. At the same time the Fertility Preservation (FP) Taskforce was developed at The University of Melbourne. The aims of The FP Taskforce are to integrate the collective wisdom of families of children with cancer and experts from a range of disciplines (Paediatric Gynaecology, Oncology, Endocrinology, Reproductive Medicine, Ethics, Legal, Sociology, Paediatric Surgery), in order to develop clinical pathways and policies around paediatric and adolescent  fertility preservation;  to guide referrals to Clinical Ethics Committees around fertility preservation;  to improve patient-provider communication; to design academic programs which collect safety and efficacy data, and information on long-term acceptance by cancer survivors; and to educate health providers and the community.

^{Pictured L-R : Dr Apoorva Bhargava, A/Professor Yasmin Jayasinghe,  Dr Madhura Jayasingam, Dr Michael Assis, Dr Zobaida Edib & Aisyah Shamsuddin}

Staff

Dr Madhura Jayasingam - PhD Student, start date: April 2023
Mahnaz Sharifi - PhD Student, start date: June 2023
Aisyah Shamsuddin- PhD Student, start date: September 2024

Collaborators

• Paediatric Integrated Cancer Service
• Australian and New Zealand Consortium for Oncofertility
• Victorian Comprehensive Cancer Center (VCCC)
• Royal Children Hospital
• Murdoch Children’s Research Institute
• The Oncofertility Consortium (Michigan State University, USA)
• Victorian and Tasmanian Youth Cancer Action Board (YCAB)
  University of Edinburgh
• The Victorian Childhood Cancer Outcomes Registry (VCCOR)
• Australian & New Zealand Children’s Haematology/ Oncology Group (ANZCHOG)

Funding

Medical Research Future Fund (MRFF)

MRFAR000308 dated September 2022

Research Outcomes

MANUSCRIPTS

1. Accepted: Kaur H et al. Australian New Zealand Children Haematology Oncology Group (ANZCHOG) oncofertility clinical practice guidelines (CPGs) for children, adolescent and young adults (CAYA), using a Delphi consensus. Best Prac Obstet Gynecol Nov 2024
2. Accepted : Jayasinghe Y, Ginsburg E. Oncofertility in children and adolescents. Clinics in Obstetrics and Gynaecology accepted Jun 2024
3. Simms-Cendan JS, Jayasinghe Y, Aguilar A, Nunzio CD, Rome E, Orti M, Vatopoulou A, Drejza M, Tyson N, Sumida M, Romano M. FIGIJ and NASPAG Advocacy Statement Supporting Fertility Preservation for Pediatric and Adolescent Patients Receiving Gonadotoxic Therapy. J Pediatr Adolesc Gynecol. 2024 Jun 14:S1083-3188(24)00230-4.
4. Lau LS, Allingham C, Anazodo A, Sullivan M, Peate M, Hunter S, Stern C, Ryan AL, Super L, Orme LM, McCarthy M, Gook D, Lewin J, Marino J, Ryan J, Downie P, Manudhane R, Winstanley M, Pettit T, Lantsberg D, Irving H, Reid S, Heath JA, Kabalan-Baeza P, Wanaguru D, Moore L, Gillam L, Zacharin M, Assis M, Rozen G, Hunter T, Julania S, Sharwood E, Ameratunga D, Jayasinghe Y; ANZCO Clinical Trial Network. The Australian New Zealand Consortium in Children, Adolescents, and Young Adults Oncofertility action plan. Pediatr Blood Cancer. 2024 May 7:e31041.
5. Duffin K, Neuhaus N, Andersen CY, Barraud-Lange V, Braye A, Eguizabal C, Feraille A, Ginsberg JP, Gook D, Goossens E, Jahnukainen K, Jayasinghe Y, Keros V, Kliesch S, Lane S, Mulder CL, Orwig KE, van Pelt AMM, Poirot C, Rimmer MP, Rives N, Sadri-Ardekani H, Safrai M, Schlatt S, Stukenborg JB, van de Wetering MD, Wyns C, Mitchell RT. A 20-year overview of fertility preservation in boys: new insights gained through a comprehensive international survey. Hum Reprod Open. 2024 Feb 16;2024(2):hoae010.
6. Salama M, Jayasinghe Y. Editorial: Fertility preservation in the pediatric and adolescent populations, volume II. Front Endocrinol (Lausanne). 2024 Feb 1;15:1372225.
7. Slonim M, Peate M, Merigan K, Lantsberg D, Anderson RA, Stern K, Gook D, Jayasinghe Y. Ovarian stimulation and oocyte cryopreservation in females and transgender males aged 18 years or less: a systematic review. Front Endocrinol (Lausanne). 2023 Jun 19;14:1146476.
8. Hoefgen HR, Benoit J, Chan S, Jayasinghe Y, Lustberg M, Pohl V, Saraf A, Schmidt D, Appiah LC. Female reproductive health in pediatric, adolescent, and young adult cancer survivors. Pediatr Blood Cancer. 2023 Jun 28:e29170.
9. Ahler A, Gook D, Moussaoui D, Archer J, Zacharin M, D'Arcy C, Sullivan M, Jayasinghe Y. Metastatic neuroblastoma in fertility preservation biopsy of clinically normal testis: a case report Reproductive Biomedicine Online 2023 May 9 :S1472-6483(23)00285-7
10. Chattha A, Salama M, Jayasinghe Y. Fertility preservation in the pediatric population (editorial). Frontiers in Endocrinology 2023 Feb 16;14:1149532
11. Salama M, Nahata L, Jayasinghe Y, Gomez-Lobo V, Laronda MM, Moravek MB, Meacham LR, Christianson MS, Lambertini M, Anazodo A, Quinn GP, Woodruff TK.Pediatric oncofertility care in limited versus optimum resource settings: results from 39 surveyed centers in Repro-Can-OPEN Study Part I & II. J Assist Reprod Genet. 2023 Mar;40(3):443-454.
12. Harris CJ, Rowell EE, Jayasinghe Y, Cost C, Childress KJ, Frederick NN, McNally O, Appiah L, Anazodo A. Pediatric, adolescent, and young adult breast and reproductive tumors. Pediatr Blood Cancer. 2023 Sep;70 Suppl 5:e29422.
13. Kieu V, Stern C, Harris J, Jayasinghe Y, Bradford N, Cui W, Deans R, Hunter T, Allingham C, Kane SC, Lau LS, Logan S, McLachlan R, Neville K, Peate M, Phillips M, Saunders C, Tome M, Upreti R, White K, Anazodo A, Hart RJ. Australian fertility preservation guidelines for people with cancer 2022: review and recommendations. Med J Aust. 2022 Dec 12;217(11):564-569.

REPORTS

Jayasinghe Y, Ahmad G, Gillam L, Hanna D, Hughes D, Lin Khaw S,  Zacharin M, McCarthy M, Orme L, Sullivan M, Super L, Zacharin M, McFadden K, Elam L, Salveen P, Navarro-Perez D, Fleming J, Serrano-Real R, Lau LS, Gook D, Clarke G, Bourne H, Spain P, Allingham C, Ahler A, Super L. The RCH Fertility Preservation Guidance 5th Edition. Fertility Preservation Taskforce Melbourne 2023 pp1-83.

INVITED CONFERENCE PRESENTATIONS

1. Jayasinghe Y. Implementation of paediatric and adolescent oncofertility using a learning health system. Lublin PAG Conference How to deliver patient safety-centered multidisciplinary care in pediatric and adolescent gynecology” Lublin Poland September 2024
2. Jayasinghe Y. Pediatric oncofertility in the Australia-New Zealand Network –The clinical and ethics framework. 5th Swedish Symposium of Fertility Preservation  Stockholm, May 30-31 and June 1, 2024
3. Jayasinghe Y. Fertility preservation uptake in transgender youth: barriers and facilitators. Westlake International Pediatric Adolescent Gynaecology Scientific Conference. Hangzhou China Oct 2023
4. Jayasinghe Y. Fertility impact of novel therapies. Oncofertility Consortium conference Pittsburgh September 2023
5. Jayasinghe Y. Building the next generation of oncofertility clinicians in Australia and New Zealand AOSPAG Webinar Malaysia August 2023
6. Jayasinghe Y Oncofertility Registries. Oncofertility Consortium webinar Michigan Aug 2023
7. Astrid Ahler Yasmin Jayasinghe Just ASK? Fertility, Sexuality & Body Image. Oncofertility Consortium webinar Michigan Jan 2023
8. Jayasinghe Y. Sequelae  of  childhood  cancer.  World Congress  of  Paediatric  and Adolescent Gynaecology Belgrade Serbia 2023
9. Jayasinghe Y. Clinical  Oncological  Society  of   Australia,  Youth  Cancer  Service Community  of  Practice  Implementation  of  COSA  Fertility  Preservation  Guidelines Brisbane November 2022
10. Jayasinghe Y. Monday lunch live Fertility After Cancer: helping patients know their options October Melbourne 2022
11. Jayasinghe Y. Quality  Assurance  and  Credentialling  in  Paediatric  and  Adolescent Oncofertility Oncofertility Consortium Pittsburgh Oct 2022
12. Jayasinghe Y. Fertility  Preservation  in  young  people:  the  new  standard  of  care ANZCHOG Sydney July 2022

PEER REVIEWED CONFERENCE PROCEEDINGS

1. Mcdonald L, Shamsuddin A, Assis M, Messiha R,  Lantsberg D, Zacharin M, Peate M, Katz D And  Jayasinghe Y.   Electroejaculation (EEJ) and Penile Vibratory Stimulation (PVS) for fertility preservation (FP) in children, adolescents, and young adults (CAYA). A systematic review. USANZ, 1-4 March 2025, Perth Poster
2. Mcdonald L, Shamsuddin A, Assis M, Messiha R,  Lantsberg D, Zacharin M, Peate M, Katz D And  Jayasinghe Y.   Electroejaculation (EEJ) and Penile Vibratory Stimulation (PVS) for fertility preservation (FP) in children, adolescents, and young adults (CAYA). A systematic review. RACS Victorian Scientific Research Awards Nov 2024 Poster
3. Sharifi M, ….6th Global Adolescent and Young Adult Cancer Congress, Melbourne Dec 2024 e-poster
4. Assis, M Jayasingam M, Gook D, Kelsey T, Anderson R, Jayasinghe Y. Modelling biopsy sample ovarian follicle density in paediatric and young adult oncofertility patients. Annual Academic Conference Por Latinoamerica y Para Latinoamerica, Melbourne Oct 2024
5. Andrew E, Assis M, Elam L, McFadden K, Jayasinghe Y. Monitoring Key Performance Indicators in Oncofertility Care at the Royal Children's Hospital, Melbourne: An Australian Retrospective Cohort Study ISFP, Tokyo Nov 2024
6. McFadden K, Assis M, Gook D, Jayasinghe Y. Experience of fertility preservation nurse coordinator in a large paediatric hospital. ISFP, Tokyo Nov 2024
7. Zacharin M, Keshwani R, Sullivan M, Jayasinghe Y, Gook D. Predicting fertility in young boys after gonadotoxic treatments–recovery of spermatogenesis. ISFP, Tokyo Nov 2024
8. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R, Jayasinghe Y. Ovarian follicle density in the child adolescent and young adult (CAYA) cancer population. ISFP, Tokyo Nov 2024
9. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R, Jayasinghe Y. Ovarian follicle density in the child adolescent and young adult (CAYA) cancer population. RANZCOG ASM, Wellington, Oct 2024  poster
10. Jayasingam M, Assis M, Gook D, Lin J, Kelsey T, Anderson R, Gomez-lobo V, Yano-Maher J, Jayasinghe Y. Characterisation of abnormal follicles in ovarian biopsies from children, adolescents and young adults. FSANZ, Perth Sep 2024 oral
11. Mcdonald L, Shamsuddin A, Assis M, Messiha R,  Lantsberg D, Zacharin M, Peate M, Katz D And  Jayasinghe Y.   Electroejaculation (EEJ) and Penile Vibratory Stimulation (PVS) for fertility preservation (FP) in children, adolescents, and young adults (CAYA). A systematic review. RWH research symposium Melbourne Poster. Sep 2024
12. Mcdonald L, Shamsuddin A, Assis M, Messiha R, Lantsberg D, Zacharin M, Peate M, Katz D, Jayasinghe Y.  Electroejaculation (EEJ) and Penile Vibratory Stimulation (PVS) for fertility preservation (FP) in children, adolescents, and young adults (CAYA). FSANZ, Perth Sep 2024 poster
13. Liu J, Assis M, Jayasinghe Y. The use of goserelin in adolescent oncofertility. Oncofertility Consortium Conference; 2024 August ANZCHOG oral
14. McDonald L, Allingham C, Lau LS, Real RS, Lantsberg D, Zacharin M, McCarthy M, Orme L, Sullivan M, Gillam L, Peate M, Jayasinghe Y . Fertility preservation at the Royal Children’s Hospital: Decision Regret over time. ASPOG May 3 2024
15. McDonald L, Allingham C, Lau LS, Real RS, Lantsberg D, Zacharin M, McCarthy M, Orme L, Sullivan M, Gillam L, Peate M, Jayasinghe Y . Fertility preservation at the Royal Children’s Hospital: Impact of coordinated oncofertility care on clinicians time. ASPOG May 3 2024
16. Jayasingam M, Assis M, Gook D, Lin J, Stern K, Kelsey T, Anderson R.A, Jayasinghe Y. Frequent occurrence of Biovular follicles in paediatric human ovary. Poster presented at: Women’s Student Symposium;2023 Nov 14-15; Royal Women's Hospital, Melbourne, Victoria, Australia. Poster Number 16
17. Jayasingam M, Assis M, Gook D, Lin J, Stern K, Kelsey T, Anderson R.A, Jayasinghe Y. Frequent occurrence of Biovular follicles in paediatric human ovary. Poster presented at: Oncofertility Consortium Conference; 2023 Nov 6-8; Pittsburgh USA. Poster Number 48
18. Gook D, Assis M, Lin J, Stern K, Kelsey T, Anderson R,  Jayasinghe Y, P-417 Biovular follicles are commonly found in prepubertal but not adult ovaries, Human Reproduction, Volume 38, Issue Supplement_1, June 2023, dead093.767, https://doi.org/10.1093/humrep/dead093.767 Eshre Copenhagen 2023
19. Liu J, Assis M, Jayasinghe Y. The use of goserelin in adolescent oncofertility. Oncofertility Consortium Conference; 2023 Nov 6-8; Pittsburgh USA.
20. Paterson S, Assis M, O’Shea E, McFadden K, Elam L, Agresta F, Allingham C, Anazodo A, Anderson R, Clark H, Gook D, Jayasuriya S, Julania S, Kelsey T, Lantsberg D, Merigan K, Navarro-Perez D, Orme L, Stern K, Super L, Jayasinghe Y Evaluating fertility preservation procedures in paediatric patients undergoing gonadotoxic treatment at the Royal Children’s Hospital Melbourne; Oncofertility Consortium Conference; 2023 Nov 6-8; Pittsburgh USA.
21. Saggio I, Assis M, Peate M, McCarthy M, Peters S, Paynter C, Jayasinghe Y. Evaluating a Fertility Decision Aid with Eye-Tracking Technology: A Pilot Study. RWH Symposium Conference Sep 2023
22. Saggio I, Assis M, Peate M, McCarthy M, Peters S, Paynter C, Jayasinghe Y. Evaluating a Fertility Decision Aid with Eye-Tracking Technology: A Pilot Study. Oncofertility Consortium Conference; 2023 Nov 6-8; Pittsburgh USA.
23. Bult E, Allingham C, Orme L, Jayasinghe Y. Utility of multidisciplinary meetings in paediatric and adolescent oncofertility is accepted as POSTER World Congress of Pediatric and Adolescent Gynaecology Belgrade Serbia May 2023
24. Lee A, Assis M, King S, Lantsberg D, Drever N, Moeed S, Jayasinghe Y. Assessing providers’ views and needs in paediatric fertility preservation surgery is accepted as VIDEO and for JPAG World Congress of Pediatric and Adolescent Gynaecology Belgrade Serbia May 2023 (First prize)
25. *Assis M, Osborn J, Gook D, Jayasinghe Y. Statistical mechanics and folliculogenesis – a review of the current state of modelling AZAMP Hobart February 2023.
26. Lantsberg D, Gook D, Mizrachi Y, Zacharin M, Georgiou E, Assis M, Stern C, Jayasinghe Y. Prepubertal Testicular Tissue Cryopreservation: a single centre experience ISFP Brussels November 2022
27. Liu J, Assis M, Anderson R, Jayasinghe Y. The use of goserelin in adolescent oncofertility. RWH research symposium Melbourne October 2022.
28. Jayasingam M, Assis M, Gook D, Lin J, Stern K, Kelsey T, Anderson R.A, Jayasinghe Y. Frequent occurrence of Biovular follicles in paediatric human ovary. Poster presented at: Oncofertility Consortium Conference; 2023 Nov 6-8; Pittsburgh USA. Poster Number 48.
29. Jayasingam M, Assis M, Gook D, Lin J, Stern K, Kelsey T, Anderson R.A, Jayasinghe Y. Frequent occurrence of Biovular follicles in paediatric human ovary. Oral and Poster presentation at: Women’s Student Symposium;2023 Nov 14-15; Royal Women's Hospital, Melbourne, Victoria, Australia. Poster Number 16.
30. Jayasingam M, Assis M, Gook D, Lin J, Kelsey T, Anderson R.A, Yano J.C, Gomez-Lobo V, Jayasinghe Y. Characterisation of abnormal follicles in ovarian biopsies from children adolescent and young adults. Oral presentation at Fertility Society of Australia and New Zealand annual conference 2024; September 14-17; Crown Conference Centre, Perth, Western Australia.
31. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R.A, Jayasinghe Y. Ovarian follicle density in the child adolescent and young adult cancer population oral presentation at Melbourne Children's Campus 2024 Student Symposium, 2024; September 24-25; Royal Children’s Hospital, Melbourne, Australia.
32. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R.A, Jayasinghe Y. Ovarian follicle density in the child adolescent and young adult cancer population. oral presentation at: Oncofertility Consortium Conference; 2024 Nov 11-13; Detroit, USA.
33. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R.A, Jayasinghe Y. Characterization of nuclear and oocyte aberrations in follicles from ovarian biopsies of children, adolescents, and young Adults. Poster presented at ISFP2024, The 8th World Congress of the International Society for Fertility Preservation; November 15-17; JP Tower Hall & Conference, Tokyo, Japan.Poster Number 27.
34. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R.A, Jayasinghe Y. Ovarian follicle density in the child adolescent and young adult cancer population. Poster presented at ISFP2024, The 8th World Congress of the International Society for Fertility Preservation; November 15-17; JP Tower Hall & Conference, Tokyo, Japan. Poster Number 24.
35. Jayasingam M, Assis M, Gook D, Kelsey T, Anderson R.A, Jayasinghe Y. Ovarian follicle density in the child adolescent and young adult cancer population. Oral and Poster presentation at: Women’s Student Symposium;2024 Nov 20-21; Royal Women's Hospital, Melbourne, Victoria, Australia.