Helping paediatric cancer patients protect their future fertility

When 12-year-old Chloe first noticed a small lump in her cheek in 2025, she didn’t think much of it.  

“It wasn’t hurting or anything,” she says. “But slowly, it did get bigger.”  

Her parents took her to a health centre to get it checked out, just in case. After a month of appointments, tests, referrals and misdiagnoses — all while the family was on vacation far away from their home in the Northwest Territories — Chloe and her family found themselves at The Hospital for Sick Children (SickKids) facing a diagnosis of rhabdomyosarcoma, a rare cancer that forms in soft tissues.  

Treatment began quickly, including chemotherapy, surgery and radiation. Amid the urgency, Chloe’s care team introduced an unexpected conversation: her future fertility. 

“It was kind of a whirlwind,” says Paul, Chloe’s father. “You’re dealing with the diagnosis, the treatment plan…and then suddenly you’re talking about something that feels so far in the future.”  

Yet for many patients, that conversation cannot wait. Some cancer treatments, including certain chemotherapy drugs and radiation, can affect fertility later in life by impacting the health of the ovaries, testes, eggs and sperm. As a result, decisions about preserving fertility often need to be made within days of diagnosis, before treatment begins. 

To help patients like Chloe keep their future fertility options open, SickKids, in collaboration with Mount Sinai Fertility, part of Sinai Health, created the SickKids-MSF Fertility Preservation Program. 

Established in 2024, the program combines expertise and technology from both institutions to offer young cancer patients a range of fertility preservation options. This includes egg and sperm retrieval and preservation, as well as a cutting-edge method to preserve ovarian tissue, an advanced procedure available because of the specialized equipment and expertise at Sinai Health, which has Ontario’s only facility that can properly preserve and store ovarian tissue.  

Co-directed by Dr. Kriti Kumar, a Paediatric Oncologist at SickKids and Assistant Professor in the Department of Pediatrics at University of Toronto, and Dr. Jennia Michaeli, a Reproductive Endocrinology and Infertility Specialist at Sinai Health and Assistant Professor in the Department of Obstetrics and Gynecology at University of Toronto, the program is designed to integrate fertility preservation into a patient’s broader cancer care. The team works with multidisciplinary care teams, building their knowledge and capacity so fertility discussion can happen early and consistently.  

Patients and families have also helped shape the program, working closely with the team to create educational resources that support sensitive, age-appropriate conversations. 

“We designed the program to build capacity and awareness among frontline providers in a patient and family-centred way,” says Julie Chiba Branson, Program Manager and Adjunct Lecturer in the Department of Occupational Science and Occupational Therapy, University of Toronto. “This allows conversations about fertility to become an early and standard part of care, not an afterthought.”  

“With the timing being critical, many teams need to be involved and informed about what is available,” adds Michaeli. “Having engaged with many young adult survivorship groups, I know how important being able to offer this choice can be later in life.”    

For Chloe, since her treatment plan was mapped in quick succession after diagnosis, these conversations happened fast. 

“We had about a day to decide,” Paul recalls. “But ultimately, we knew it was important for Chloe to have options when she gets older. It’s a nice hedge against potential side effects.” 

Once a patient chooses a preservation approach, teams from Haematology/Oncology, Paediatric and Adolescent Gynecology, Endocrinology, Urology, Pathology and other areas work together across hospitals to coordinate care. 

In Chloe’s case, this meant removing one ovary at SickKids before cooling, safely transporting, processing and storing the tissue at Sinai Health, as well as immature eggs, which sometimes can be identified, matured in the embryology lab and frozen. The procedure was done at the same time as a port insertion for her treatment, to avoid extra time under anesthesia. If and when Chloe has a desire to explore her fertility options, the ovarian tissue can be re-transplanted back into her, with the aim of restoring fertility potential and hormonal function.  

This individualized approach reflects SickKids’ Precision Child Health movement, which aims to tailor care to each child’s unique needs and circumstances. Because fertility risks and preservation options can vary, care plans are developed based on factors like each patient’s treatment plan, age, stage of development and level of fertility risk, helping families navigate a complex decision about the future during an already overwhelming time.  

For Michaeli and Kumar, the program is about more than preserving fertility. It’s about helping patients and families plan for life after treatment.  

“We’re curing over 80 per cent of patients with cancer,” says Kumar. “While we continue to make progress with survivorship, we have to also talk about what life is going to look like after.” 

“It’s not just about surviving,” she adds. “It’s about helping patients live full lives.” 

Since its launch, the program has supported close to 100 patients with fertility-specific interventions and grown into one of the largest of its kind in Canada. The program’s leaders hope to increase awareness of fertility preservation in the paediatric oncology community so that more children and families have the opportunity to make informed decisions about life after cancer.  

Chloe recently celebrated her 12th birthday at SickKids while undergoing treatment. She’s hopeful that soon she’ll be able to finish her treatment, go on a trip to Disneyland, then Mexico to enjoy her favourite pizza place, before returning home to resume her “normal” life, with one more option preserved for her future.