Testicular Tissue Banking for Fertility Preservation in Young Boys: Which Patients Should Be Included?

Abstract

Due to the growing number of young patients at risk of germ cell loss, there is a need to preserve spermatogonial stem cells for patients who are not able to bank spermatozoa. Worldwide, more and more clinics are implementing testicular tissue (TT) banking programs, making it a novel, yet indispensable, discipline in the field of fertility preservation. Previously, TT cryopreservation was predominantly offered to young cancer patients before starting gonadotoxic chemo- or radiotherapy. Nowadays, most centers also bank TT from patients with non-malignant conditions who need gonadotoxic conditioning therapy prior to hematopoietic stem cell (HSCT) or bone marrow transplantation (BMT). Additionally, some centers include patients who suffer from genetic or developmental disorders associated with prepubertal germ cell loss or patients who already had a previous round of chemo- or radiotherapy. It is important to note that the surgical removal of TT is an invasive procedure. Moreover, TT cryopreservation is still considered experimental as restoration methods are not yet clinically available. For this reason, TT banking should preferably only be offered to patients who are at significant risk of becoming infertile. In our view, TT cryopreservation is recommended for young cancer patients in need of high-risk chemo- and/or radiotherapy, regardless of previous low-risk treatment. Likewise, TT banking is advised for patients with non-malignant disorders such as sickle cell disease, beta-thalassemia, and bone marrow failure, who need high-risk conditioning therapy before HSCT/BMT. TT retrieval during orchidopexy is also proposed for patients with bilateral cryptorchidism. Since patients with a medium- to low-risk treatment generally maintain their fertility, TT banking is not advised for this group. Also for Klinefelter patients, TT banking is not recommended as it does not give better outcomes than a testicular sperm extraction later in life.

A 10‐year experience in testicular tissue cryopreservation for boys under 18 years of age: What can be learned from 350 cases?

“…Spermatogonia were present in TT in 91% of cases compared to 92% in other publications where patients were referred before starting treatments 11 . Based on a large series, our study supports the notion that previous exposure to low‐risk chemotherapy 20 should not be considered to be a limitation for CTT since it does not impair the chance of finding spermatogonia. By contrast, in cancer patients, chemotherapy prior to CTT could be an advantage since it potentially decreases the risk of malignant cell contamination of the TT 21 .…”

Germline stem cells in human

“…380 Prepubertal boys who suffer from gonadotoxic treatment under pediatric cancer circumstances, e.g., acute lymphoblastic leukemia and testicular cancer, might cause sterile for the rest of their life. 381 Autologous transplantation of SSCs or testicular tissue has been proposed as a strategy for fertility preservation and therapy [382][383][384][385] (Fig. 6).…”

Childhood cancer and hematological disorders negatively affect spermatogonial quantity at diagnosis: a retrospective study of a male fertility preservation cohort

“…At UZB, only children at high risk for infertility (above 80%), which was estimated based on the selected treatment, were included in the fertility preservation programme. Prepubertal patients considered to be at high risk of infertility include the ones receiving high-dose alkylating and platinum-based agents, total body irradiation, or testicular radiotherapy, yet the criteria are not strictly established ( Goossens et al , 2020 ; Delgouffe et al , 2022 ).…”