Testicular tissue cryopreservation in prepubertal male children: An analysis of parental decision-making

Abstract

Background Infertility is an unfortunate treatment-related consequence for some pediatric malignancies as well as some non-malignant conditions treated with stem cell transplant. Unlike pubertal males, prepubertal males cannot produce semen for cryopreservation. This manuscript reports on the acceptability and safety of a multi-institutional protocol for offering testicular tissue cryopreservation to families of prepubertal male children at highest risk for infertility. Data on decision influences, decision-making control, and emotional state when considering this option are described. Procedure Prepubertal males facing gonadotoxic therapy were offered testicular cryopreservation. Post-biopsy, patients were followed for acute side effects. In addition, parents and patients were asked to complete questionnaires, whether or not they chose to cryopreserve tissue. Results Seventy-four prepubertal male children were approached. Fifty-seven families (77%) consented to the testicular biopsy; 48 of 57 underwent the procedure. There was one post-operative side effect. Parents who agreed to testicular cryopreservation and those that did not felt in control of this decision. Parents who consented to the biopsy and refusers were not deterred by the experimental nature of the protocol. An important decision-making influence was the risk of the biopsy. Conclusion Biopsy and cryopreservation of testicular tissue from prepubertal male children was performed successfully and safely at three institutions. Parents faced with this option at diagnosis can make an informed decision and weigh carefully the risks and benefits. Although asked to make a decision soon after they were given a difficult diagnosis, parents uniformly felt in control of this decision.

Reproductive issues in sickle cell disease

“…Cryopreservation of sperm in pubertal males is standard and improvement of sperm banking techniques and increased use of intracytoplasmic sperm injection may increase successful outcomes. 63 Cryopreservation of testicular tissue, considered experimental, is an option in prepubertal boys, but is waiting for the development of technology and procedures for restoring human fertility. 63 Preservation of embryos, mature oocytes, and ovarian tissue is an option for females before HSCT.…”

“…63 Cryopreservation of testicular tissue, considered experimental, is an option in prepubertal boys, but is waiting for the development of technology and procedures for restoring human fertility. 63 Preservation of embryos, mature oocytes, and ovarian tissue is an option for females before HSCT. [64][65][66] Cryopreservation of mature oocytes has advanced to the point that this procedure is no longer considered experimental.…”

Identifying and Addressing the Needs of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine Workshop

“…Another experimental option is to remove and freeze testicular tissue, although there is a possibility that cancer cells might be introduced with reimplanted tissue [13,14]. In males receiving radiation therapy, gonadal shielding is also a common procedure to help preserve fertility.…”

Fertility preservation options for children and adolescents with cancer

“…Nevertheless, research shows that parents and survivors are interested in experimental options, demand to be informed, and involved in the decision-making process. 17 The procedure itself is straightforward, and not particularly different from similar interventions done in postpubertal males. It can be coordinated with other interventions that require a general anesthetic, adding on average less than 15 minutes to the total operating room time.…”