Options for Male Fertility Preservation: Pediatric Oncofertility 2017

The testes has a greater chemo and radio sensitivity than the ovaries.

Chemotherapeutic agents used for pediatric cancer treatment readily cross the blood testes barrier and primarily affect cells undergoing spermatogenesis due to their high mitotic rate.

Leydig cells that produce testosterone are less sensitive to chemotherapy but can have sensitivity to radiation at very high doses.

Males have no protective effect of receiving treatment at a younger age, which differs from females.

Retroperitoneal lymph node dissections for testicular cancer can damage sympathetic nerves that control antegrade ejaculation, leading to fertility issues.

Electroejaculation with insertion of a probe into the rectum can harvest a specimen and needs to be performed under general anesthesia.

Sperm cryopreservation should be offered prior to treatment, as the quality of semen analysis and DNA integrity can be compromised after even a single course of treatment.

Stage of puberty development (typically Tanner stage 3 or above) is a better indicator than age for determining when to offer sperm cryopreservation.

Testicular sperm extraction (TESE) involves retrieval of sperm from focal areas of spermatogenesis in the seminiferous tubules for later use with ICSI.

Microscopic assistance in TESE allows better identification of tubules that potentially contain sperm and has improved retrieval rates in adult literature.

Fertility preservation before puberty in males is challenging due to the absence of mature sperm that can be cryopreserved.

Preserving fertility in prepubertal males is contingent on future development of experimental therapies for maturation of spermatogonial stem cells to sperm.

Spermatogonial stem cell therapies developed in animal models include direct transplantation into the testicle, transplantation of testicular tissue as autologous or xenograft, and in vitro sperm maturation, but none have been performed successfully in humans.

Testicular tissue cryopreservation involves harvesting immature testicular tissue prior to treatment initiation and cryopreservation with slow freezing techniques.

At Cincinnati Children's, testicular tissue cryopreservation eligibility includes pediatric males 6 months to 17 years with >80% risk of long-term azoospermia, and adults 18-25 years with 21-79% risk.

The excisional biopsy is coordinated with other surgical procedures to minimize anesthetic risk and expedite treatment initiation, performed through a transscrotal approach.

75% of harvested testicular tissue is stored at Reprotech for patient use and 25% is designated for research at McGee Women's Research Institute.

No successful retrieval of mature sperm or pregnancies from cryopreserved testicular tissue have been reported to date in humans.

Risk categories for testicular tissue cryopreservation are based on chemotherapy regimen, radiation therapy, and cumulative dosing using cyclophosphamide equivalent dosing published by Dan Green in 2014.