Fix fertility first.

Great strides have been made in pediatric malignancy cure rates. But with the successful ushering of childhood cancer survivors into adulthood comes the ushering of a whole host of late side effects of cancer care, not least of which is reduced reproductive capacity. Especially for our patients who receive any alkylating agents, at least 30 Gy to the pituitary, or even 5 Gy to to the ovaries or testes. Unfortunately, female fertility preservation via harvesting of oocytes (or ovarian tissue in prepubescent girls) remains drastically underutilized due to cost, potential delay in therapy, and infrequent pre-treatment counseling. Which sets the stage for this month’s Journal of Oncology Practice piece which emphasizes early recognition among pediatric cancer survivors of acute ovarian failure and advisement against delayed pregnancy. But really what we should be talking about is early (i.e., pre-treatment) preservation. What should really be this fertility blurb's header: the sooner the better.