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Fertility preservation in boys: recent developments and new insights †
E Goossens1, K Jahnukainen2,3, R T Mitchell4
1Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium.
Background:
Infertility is an important side effect of treatments used for cancer and other non-malignant conditions in males. This may be due to the loss of spermatogonial stem cells (SSCs) and/or altered functionality of testicular somatic cells (e.g. Sertoli cells, Leydig cells). Whereas sperm cryopreservation is the first-line procedure to preserve fertility in post-pubertal males, this option does not exist for prepubertal boys. For patients unable to produce sperm and at high risk of losing their fertility, testicular tissue freezing is now proposed as an alternative experimental option to safeguard their fertility.
Objective And Rationale:
With this review, we aim to provide an update on clinical practices and experimental methods, as well as to describe patient management inclusion strategies used to preserve and restore the fertility of prepubertal boys at high risk of fertility loss.
Search Methods:
Based on the expertise of the participating centres and a literature search of the progress in clinical practices, patient management strategies and experimental methods used to preserve and restore the fertility of prepubertal boys at high risk of fertility loss were identified. In addition, a survey was conducted amongst European and North American centres/networks that have published papers on their testicular tissue banking activity.
Outcomes:
Since the first publication on murine SSC transplantation in 1994, remarkable progress has been made towards clinical application: cryopreservation protocols for testicular tissue have been developed in animal models and are now offered to patients in clinics as a still experimental procedure. Transplantation methods have been adapted for human testis, and the efficiency and safety of the technique are being evaluated in mouse and primate models. However, important practical, medical and ethical issues must be resolved before fertility restoration can be applied in the clinic.Since the previous survey conducted in 2012, the implementation of testicular tissue cryopreservation as a means to preserve the fertility of prepubertal boys has increased. Data have been collected from 24 co-ordinating centres worldwide, which are actively offering testis tissue cryobanking to safeguard the future fertility of boys. More than 1033 young patients (age range 3 months to 18 years) have already undergone testicular tissue retrieval and storage for fertility preservation.
Limitations Reasons For Caution:
The review does not include the data of all reproductive centres worldwide. Other centres might be offering testicular tissue cryopreservation. Therefore, the numbers might be not representative for the entire field in reproductive medicine and biology worldwide. The key ethical issue regarding fertility preservation in prepubertal boys remains the experimental nature of the intervention.
Wider Implications:
The revised procedures can be implemented by the multi-disciplinary teams offering and/or developing treatment strategies to preserve the fertility of prepubertal boys who have a high risk of fertility loss.
Study Funding/Competing Interests:
The work was funded by ESHRE. None of the authors has a conflict of interest.
Insights
Testicular tissue cryopreservation is an experimental option to preserve fertility in prepubertal boys undergoing cancer treatment. Over 1033 young patients have undergone this procedure, with ongoing research addressing clinical and ethical considerations.
Area of Science:
- Reproductive Medicine
- Oncology
- Pediatrics
Background:
- Cancer treatments can cause male infertility by damaging spermatogonial stem cells (SSCs) and testicular somatic cells.
- Sperm cryopreservation is standard for post-pubertal males, but not available for prepubertal boys.
- Testicular tissue freezing is an experimental fertility preservation option for prepubertal boys at high risk of infertility.
Purpose of the Study:
- To update on clinical practices and experimental methods for fertility preservation in prepubertal boys.
- To describe patient management strategies for safeguarding fertility in at-risk boys.
- To review progress in preserving and restoring fertility in prepubertal males.
Main Methods:
- Literature search on clinical practices, patient management, and experimental methods.
- Survey of European and North American centers involved in testicular tissue banking.
- Analysis of data from participating centers on fertility preservation procedures.
Main Results:
- Testicular tissue cryopreservation protocols developed in animal models are now clinically offered as an experimental procedure.
- Transplantation methods adapted for human testes are under evaluation in preclinical models.
- Implementation of testicular tissue cryopreservation has increased since 2012, with over 1033 boys undergoing the procedure.
Conclusions:
- Revised procedures for fertility preservation in prepubertal boys can be implemented by multidisciplinary teams.
- The experimental nature of fertility preservation interventions remains a key ethical consideration.
- Further research is needed to resolve practical, medical, and ethical issues before widespread clinical application.
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