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Fertility Preservation and Restoration in Pediatric Males

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Textbook of Oncofertility Research and Practice

Abstract

The fertility management of prepubertal males facing a gonadotoxic diagnosis or therapy is a challenging clinical objective. The testes of prepubertal patients, especially germ cells, are exquisitely sensitive to damage when exposed to chemotherapy or radiation; therefore, the full extent of their diagnosis and clinical management must be taken into consideration when assessing a patient’s risk for subsequent infertility. This also includes non-cancer patients, stem cell transplant patients, individuals with Klinefelter’s syndrome, and those with other differences in sexual development. All such patients should be consulted for fertility preservation, including sperm cryopreservation for those who can provide sperm, and testicular tissue cryopreservation for those who are unable to provide sperm. If a medical team is unprepared to manage the fertility preservation of a prepubertal patient, they should refer the patient to a team or outside group that is confident in doing so. Currently, there are no clinically proven mechanisms for the maturation or retrieval of sperm from cryopreserved immature testicular tissue; however, many groups worldwide are investigating methods to achieve these ends. Several engineering and biological mechanisms currently being explored as future assisted reproductive technologies for prepubertal patients form the focus of the latter half of this chapter.

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Author information

Authors and Affiliations

  1. Northwestern Feinberg School of Medicine, OB/GYN, Chicago, IL, USA

    Maxwell E. Edmonds

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Kyle E. Orwig

  3. Division of Male Reproductive Surgery and Men’s Health, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Robert E. Brannigan

Authors
  1. Maxwell E. Edmonds
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  2. Kyle E. Orwig
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  3. Robert E. Brannigan
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Corresponding author

Correspondence to Maxwell E. Edmonds .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Northwestern University , Chicago, IL, USA

    Teresa K. Woodruff

  2. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Divya K. Shah

  3. Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA

    Wendy S. Vitek

Review Questions and Answers

Review Questions and Answers

  1. Q1.

    Which of the following persons should be counseled on fertility preservation?

    1. (a)

      Pediatric cancer patients

    2. (b)

      Klinefelters patients

    3. (c)

      Hypogonadal patients

    4. (d)

      Patients with trauma to the gonads, pelvis, or genitalia

    5. (e)

      Stem cell transplantation patients

    6. (f)

      Patients with differences in sexual development

    7. (g)

      Transgender patients

    8. (h)

      All of the above

  1. A1.

    (h)

  1. Q2.

    What is the most common fertility management concern for pediatric cancer patients and their parents, upon reflection after their cancer management?

    1. (a)

      Time

    2. (b)

      Cost

    3. (c)

      Regret

    4. (d)

      Discussing sex and family planning

  1. A2.

    (c)

  1. Q3.

    Which of the following are useful tools to determine a patient’s risk of developing iatrogenic oligospermia or azoospermia?

    1. (a)

      Cyclophosphamide equivalent dosage

    2. (b)

      Serum cortisol

    3. (c)

      Summed alkylating agent dose score

    4. (d)

      (a) and (c)

    5. (e)

      All of the above

  1. A3.

    (d)

  1. Q4.

    What clinical option(s) is(are) there for fertility preservation of pediatric males and pediatric individuals with testes?

    1. (a)

      Sperm banking

    2. (b)

      IVF

    3. (c)

      None, only investigational immature testicular cryopreservation

  1. A4.

    (c)

  1. Q5.

    What new approaches are currently in the pipeline for developing in vitro spermatogenesis?

    1. (a)

      Biomaterial scaffolds

    2. (b)

      Decellularized extracellular matrix

    3. (c)

      Microfluidic culture systems

    4. (d)

      Spermatogonial stem cell culture and transplantation

    5. (e)

      All the above

  1. A5.

    (e)

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Edmonds, M.E., Orwig, K.E., Brannigan, R.E. (2019). Fertility Preservation and Restoration in Pediatric Males. In: Woodruff, T., Shah, D., Vitek, W. (eds) Textbook of Oncofertility Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02868-8_33

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  • DOI: https://doi.org/10.1007/978-3-030-02868-8_33

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