Strategies for preservation of ovarian and testicular function after immunosuppression

Gonadal toxicity as a side effect of cyclophosphamide therapy is a common long-term problem in the treatment of a variety of glomerular diseases. In both men and women treated with cyclophosphamide, the consequences of infertility can have great physical and emotional consequences; thus, this issue often has a critical role in the decision to decline treatment with cyclophosphamide. There exists a critical need for strategies for preservation of fertility in both men and women who require treatment with cyclophosphamide. This review explores emerging therapeutic options in this arena, which include sperm and oocyte cryopreservation, medical treatments such as testosterone therapy for men and gonadotropin-releasing hormone agonist therapy for both men and women, and, finally, the relatively new strategy of germ-cell transplantation for both ovarian and testicular tissue, which still remains in the experimental stages.