Biomedical Engineering Reference
In-Depth Information
Fig. 11.1 Fertility preservation and restoration in prepubertal boys. This flow diagram presents a
hypothetical case of preserving and restoring fertility in a prepubertal boy who will receive gonado-
toxic therapy (e.g., chemotherapy or radiation) to treat his primary disease or condition. ( a ) Patients
in this category are identified by their physician prior to gonadotoxic therapy. In this setting, the
patient and/or their parent(s)/guardian(s) are counseled of the reproductive risks of the treatment and
are referred for fertility preservation. ( b ) Surgical biopsy of the testis would occur in an expedited
manner prior to therapy to recover a small amount of testicular parenchyma that contains potentially
therapeutic SSCs. Enzymes would then be used to disrupt the seminiferous tubules and produce a
suspension of testis cells. ( c ) The testis cell suspension would be cryopreserved and stored in liquid
nitrogen for future use to restore fertility. ( d ) Gonadotoxic treatment for the patient's primary
diagnosis (e.g., chemotherapy or radiation) would commence immediately after the patient recovers
from testis biopsy surgery (typically within one week and perhaps as early as the next day). ( e ) After
the patient has survived his primary disease or condition (likely five or more years after treatment),
the patient's fertility status would be assessed to determine if intervention is necessary. ( f ) For infertile
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