Each year, approximately 15,000 children between the ages of birth and 19 years are diagnosed with cancer [1]. Over the past five decades, there have been remarkable strides made in the modalities used to treat pediatric malignancies. As a result, nearly 80% of children diagnosed with cancer can expect to be cured. Recent estimates indicate that there are over 380,000 survivors of childhood cancer (diagnosed before the age of 20) in the United States. About 40% of these survivors are now between the ages of 20 and 40 and in their reproductive years [2].

Achieving cure is often associated with significant treatment-related sequelae, with approximately two-thirds of all pediatric cancer survivors experiencing at least one chronic medical condition [3]. Gonadal damage and infertility from chemotherapy, radiation, and surgery can be an unfortunate consequence of cancer therapy for both males and females. It is estimated that the cumulative prevalence at age 50 years in survivors of pediatric malignancies approaches 32% for primary ovarian failure and 31% for Leydig cell failure [4].

Over the last several decades, survival rates for childhood cancer have steadily increased. In fact, with the overall cure rate for pediatric malignancies now approaching 80%, current estimates indicate that one in every 640 young adults in the United States will be a survivor of childhood cancer [1]. Unfortunately, many survivors struggle with medical side effects of their treatment including disorders of the endocrine system, cardiac and pulmonary dysfunction, secondary neoplasms, and infertility. Gonadal damage is a relatively common consequence of the treatments used to cure pediatric cancer. The extent of cytotoxic germ cell damage depends on the specific chemotherapeutic agents used and the cumulative doses received. Alkylating agents (particularly cyclophosphamide, ifosfamide, nitrosureas, chlorambucil, melphalan, busulfan, and procarbazine) are the most common class of drugs known to effect gonadal function and their impact has been studied extensively [2]. Additionally, the testes have a very low threshold for radiation exposure, and even small doses are known to be gonadotoxic. As treatment regimens for pediatric oncologic malignancies have improved, more and more survivors are entering their reproductive years [3].