Restoring Fertility in Sterile Childhood Cancer Survivors by Autotransplanting Spermatogonial Stem Cells: Are We There Yet?

Abstract

Current cancer treatment regimens do not only target tumor cells, but can also have devastating effects on the spermatogonial stem cell pool, resulting in a lack of functional gametes and hence sterility. In adult men, fertility can be preserved prior to cancer treatment by cryopreservation of ejaculated or surgically retrieved spermatozoa, but this is not an option for prepubertal boys since spermatogenesis does not commence until puberty. Cryopreservation of a testicular biopsy taken before initiation of cancer treatment, followed by in vitro propagation of spermatogonial stem cells and subsequent autotransplantation of these stem cells after cancer treatment, has been suggested as a way to preserve and restore fertility in childhood cancer survivors. This strategy, known as spermatogonial stem cell transplantation, has been successful in mice and other model systems, but has not yet been applied in humans. Although recent progress has brought clinical application of spermatogonial stem cell autotransplantation in closer range, there are still a number of important issues to address. In this paper, we describe the state of the art of spermatogonial stem cell transplantation and outline the hurdles that need to be overcome before clinical implementation.

Listening through Narratives: Using a Narrative Approach When Discussing Fertility Preservation Options with Young Cancer Patients

“…Despite clinical practice guidelines recommending that fp options be discussed with all cancer patients 8,9 , many health care providers (hcps) fail to initiate those discussions with adolescents [10][11][12][13][14][15][16] . As a result, adolescents are less likely to have access to fp services and supports.…”

Infertility with Testicular Cancer

“…Since then, there have been further advances allowing long-term propagation of adult and prepubertal human spermatogonial stem cells. 58 One of the major challenges is that germ cells yield a low number of spermatogonial stem cells. To use prepubertal cryopreserved tissue, the spermatogonial stem cells need to be either matured in vitro or autotransplanted.…”

Spermatogonial stem cells: Current biotechnological advances in reproduction and regenerative medicine

“…A proposed solution for this problem is the restoration of fertility via SSC transplantation. Since many of the patients in this situation are prepubertal (i.e., do not yet produce sperm), a current approach consists on banking testicular tissue or cell suspensions prior to the oncological treatment and submitting the patient to an autologous transplantation of the preserved material if fertility problems arise later in life [115] (for recent advances in the methods for preservation of fertility on young male human oncological patients see the comprehensive review from Goossens et al [116] , 2013). A word of caution is valid regarding safety issues when malignant diseases are managed with transplantation procedures.…”