Biomedical Engineering Reference
In-Depth Information
fertility of preadolescent boys and some adult men who cannot utilize standard of
care approaches (e.g., sperm banking or TESE). However, as discussed extensively
in this volume and chapter, there are new reproductive therapies under development
and may one day offer “fertile hope” to those patients that do not currently have
access to fertility preserving therapies. When no established fertility sparing or
preserving options are available, it may be reasonable to offer harvesting and cryo-
preservation of gonadal tissue as a possible means of fertility preservation. In this
way, patients who bank their testicular tissue prior to gonadotoxic therapy have a
potential resource for future fertility. For instance, patients may have the opportu-
nity to utilize their stored gonadal tissue or cells for fertility restoration procedures
in the future. Since autologous SSC transplantation in humans is experimental and
not proven effective for restoring spermatogenesis or fertility, though, the potential
benefit is not clearly defined. One clinic in the United Kingdom preserved testicular
tissue from 12 patients prior to treatment for Hodgkin's lymphoma and subse-
quently 7 patients received autologous transplants of cryopreserved cells into their
rete testes (Brook et al.
2001
; Radford
2003
). There have been no follow-up reports
to indicate whether these transplants restored spermatogenesis. Regardless of the
uncertainty about whether SSC preservation and subsequent transplantation will
safeguard fertility in human cancer survivors, there is a
potential
benefit to patients
by cryopreserving their tissue that seems to outweigh the risks.
A growing body of literature suggests that parents of boys at risk for future
infertility are interested in fertility-preservation options and place a strong
value on the potential future benefits. A retrospective survey indicated nearly
two thirds of parents of boys with childhood cancer would have allowed collec-
tion and cryopreservation of their sons' testicular tissue for fertility preserva-
tion, had it been available even as an experimental intervention (van den Berg
et al.
2007
). Thus, there is perceived acceptability and desire to undergo
experimental therapy to preserve fertility, as long as treatment for the primary
disease is not compromised (Oosterhuis et al.
2008
). More recently, a study
performed the University of Pennsylvania reported that 76% of parents of eligible
boys (3 months to 14 years) consented to testicular biopsy prior to gonadotoxic
therapy (Ginsberg et al.
2010
).
In addition to the potential fertility-preserving direct benefits to subjects, there
may also be psychological benefits [reviewed by (Schover
2009a, b
)]. As discussed
previously, there is clear parental desire to preserve fertility in childhood cancer
patients, even in cases where only experimental interventions are available (van den
Berg et al.
2007
; Oosterhuis et al.
2008
). Furthermore, around 75% of cancer
patients who are of reproductive age also express a desire for future children and
many are interested in exploring options for fertility preservation (Zebrack et al.
2004
). Many patients that were not informed of the infertility risks before treatment
are angry to learn of their infertility years later (Lee et al.
2006
). Therefore, patients
or parents of children who elect to participate in experimental fertility-preserving
options will have the peace-of-mind that they have prospectively done
something
to
give themselves or their children
a chance
for future fertility where there was a high
risk of infertility in the absence of intervention.
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