Expanding Fertility Preservation Options for Males
Cincinnati Children’s recently began offering an investigational protocol for testicular tissue cryopreservation (TTC) that is available to a wide range of male patients who are anticipating gonadotoxic therapy.
TTC involves extracting tissue with spermatogonal stem cells (SSCs) from the prepubertal testicle prior to cancer therapy and freezing them for later use. The main focus of the investigational protocol is to study the feasibility of TTC and to obtain tissue for research on optimizing TTC techniques. The technology to utilize cryopreserved testicular tissue does not yet exist for humans, although some experimental techniques have been promising in animal models.
Part of a comprehensive approach TTC is one component of the Cincinnati Children’s Comprehensive Fertility Care and Preservation Program, a collaboration of subspecialists in gynecology, oncology, urology and pathology. Established in 2009, it was one of the first programs in the United States to focus on fertility preservation in patients receiving intensive therapies for pediatric cancers. “Today, more than 80 percent of these patients survive at least five years after diagnosis, and many grow into adulthood,” says Andrew Strine, MD, a pediatric urologist and co-director of the Comprehensive Fertility Care and Preservation Program. “Future fertility can be of great importance to long-term quality of life, and should not be overlooked during the treatment planning process.”
The team offers a fertility consult to every family that is dealing with a cancer diagnosis or facing a bone marrow transplant for any other reason. In male children and adolescents with cancer, the risk of infertility is greater than it is for their female counterparts due to the relative chemo- and radiosensitivity of the testis. “When we talk to parents and children about the risk of infertility, they often express concern and are a bit taken back, as a majority do not even realize this is something to consider when speaking about the side effects of their treatment,” says Olivia Frias, RN, MSN, CNL, patient navigator of fertility preservation for the Division of Gynecology at Cincinnati Children’s. “But the conversation also makes them feel hopeful, because we are asking them to think about life beyond the immediate and urgent concerns of cancer care.”
Greater risk to males Sperm cryopreservation is still the gold standard for fertility preservation in males who can provide an adequate semen sample. But it is not an option for pre-pubertal patients, and not desirable for others because of personal or religious beliefs.
If a patient or family opts for TTC, a pediatric urologic surgeon does the biopsy, usually as part of another surgical procedure (such as central line/port placement) to minimize the anesthetic risk and expedite the initiation of therapy. Most of the harvested tissue is sent to an independent cryopreservation company, where it is frozen and stored for future use. A smaller tissue specimen is sent to a research laboratory at the University of Pittsburgh that is optimizing TTC techniques. Scientists are exploring the potential of several strategies, including transplantation of SSCs into the testis, autologous grafting and xenografting of testicular tissue, and maturation of testicular tissue in culture.
TTC is available to medically stable males ages 0 months to 25 years who have an intermediate to high risk of infertility due to gonadotoxic therapy. To learn more or refer a patient, please contact Olivia Frias at fertilityconsult@cchmc.org.
