Management of fertility preservation in prepubertal patients: 5 years’ experience at the Catholic University of Louvain

Abstract

BACKGROUND Since prepubertal boys cannot benefit from sperm banking, a potential alternative strategy for fertility preservation involves immature testicular tissue (ITT) banking aimed at preservation of spermatogonial stem cells. Survival of spermatogonia has been demonstrated after ITT freezing, which is considered ethically acceptable. We report the results of a pilot program set up for fertility preservation in prepubertal boys. METHODS All boys undergoing ITT cryobanking from May 2005 were identified from our clinical register. Data were collected from medical files. RESULTS Testicular tissue was retrieved from 52 prepubertal patients under 12 years of age and 10 peripubertal patients aged between 12 and 16 years, in whom no spermatozoa were identified in testicular biopsies. Malignant disease accounted for 80.6% of cases; the remaining patients suffered from benign disorders requiring gonadotoxic treatments. Mean ages, Tanner stages and occurrence rates of urogenital pathology were 6.43 ± 3.32 and 14 ± 1.23 years, I and I-IV, and 13.5 and 20% for pre- and peripubertal patients, respectively. Mean volumes of removed tissue were 20.1 ± 8.6 and 42.4 ± 15.6 mm(3) for pre- and peripubertal patients, respectively. No complications occurred during or after tissue retrieval and 93.5% of referred patients accepted ITT storage. The presence of spermatogonia, and thus the potential for later tissue use, was established in all of these patients. CONCLUSIONS The majority of cryopreserved samples showed reproductive potential. Storage was accepted by most parents. All parents and children considered this fertility preservation strategy a positive approach.

Assessment of the optimal vitrification protocol for pre-pubertal mice testes leading to successful in vitro production of flagellated spermatozoa

“…Therefore, fertility preservation should be included in the management of young males with cancer (Wyns et al, 2011). In pre-pubertal boys, no completely validated option is currently available for fertility preservation (Rives et al, 2012).…”

“…In pre-pubertal boys, no completely validated option is currently available for fertility preservation (Rives et al, 2012). Freezing of testicular tissue or cell suspensions has been developed to cryopreserve pre-pubertal testes or SSCs respectively (Wyns et al, 2011). After thawing, SSCs must undergo a maturation process to restore the ability to produce spermatozoa.…”

Eliminating malignant contamination from therapeutic human spermatogonial stem cells

“…The potential of using SSCs to preserve and restore fertility in patients receiving gonadotoxic therapies has been extensively discussed (23)(24)(25)(26)(27)(28)(29)(30)(31)(32). In theory, testicular cells obtained via biopsy prior to cancer treatment could be cryopreserved and then retransplanted following clinical remission.…”

“…In theory, testicular cells obtained via biopsy prior to cancer treatment could be cryopreserved and then retransplanted following clinical remission. Several clinics around the world, including our own Fertility Preservation Program in Pittsburgh (http://www.mwrif.org/220), are now performing testicular biopsies on boys prior to the initiation of cancer therapy in hopes that this tissue can be used in the future to restore fertility (8,9,30,31). However, to make SSC transplantation a realistic clinical option for the prepubertal patient cohort, two major hurdles must be overcome.…”

Evaluation of ovarian and testicular tissue cryopreservation in children undergoing gonadotoxic therapies

“…A study of 14 prepubertal boys undergoing testicular biopsy demonstrated positive post-operative outcomes as well as insight into parental factors influencing a decision to undergo harvesting [17]. Furthermore, a study of 52 prepubertal patients (mean age: 6.43±3.32 years) and 10 peripubertal patients (mean age: 14±1.23 years) reported no significant complications [50]. While our study was different in reporting the bundling with other medical procedures, our overall safety findings of male patients were in accordance with other studies.…”