An experimental protocol for fertility preservation in prepubertal boys recently diagnosed with cancer: a report of acceptability and safety.
BACKGROUND
Gonadal damage is a consequence of therapy for pediatric malignancies. Prepubertal males have no semen or mature spermatozoa, posing a challenge for fertility preservation. Testicular tissue cryopreservation is a potential option but is still experimental. We report on a pilot protocol that offered testicular biopsy cryopreservation to families of prepubertal boys with newly diagnosed malignancy. The aims were to determine the acceptability and safety of this procedure.


METHODS
Parents of prepubertal boys with diagnoses at highest risk for treatment-related gonadal damage were offered the option of testicular cryopreservation. Half of the biopsy was frozen for the subject's potential future use and the remainder used for research. Data on negative intraoperative and/or 7 day post-operative sequelae of testicular biopsies were assessed. Two to four weeks later, parents were asked to complete a questionnaire on factors influencing their decision to have the biopsy or not.


RESULTS
Since January 2008, 24 boys have met the eligibility criteria but three required immediate treatment and were excluded. Sixteen of 21 families (76%) consented to testicular biopsy, indicating the prospective acceptability of this option to parents of boys aged 3 months to 14 years; 14 underwent the procedure without any negative intra- or post-operative sequelae. Although the time at diagnosis is stressful, families can give thoughtful consideration to this option. Factors such as religion, finance, ethics and the experimental nature of cryopreservation did not play a major role in decision-making.


CONCLUSIONS
Parents of prepubertal boys with cancer are willing to pursue testicular tissue cryopreservation at diagnosis, and testicular biopsy caused no acute adverse effects.
Division of Oncology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd. Wood Building, Room 4301, Philadelphia, PA, USA. ginsbergji@email.chop.edu
J P
JP
Ginsberg
C A
CA
Carlson
K
K
Lin
W L
WL
Hobbie
E
E
Wigo
X
X
Wu
R L
RL
Brinster
T F
TF
Kolon
D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation / Q000379:methods*; D006801:Humans; D007223:Infant; D007248:Infertility, Male / Q000209:etiology / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D011832:Radiation Injuries; D027724:Reproductive Techniques, Assisted; D018570:Risk Assessment; D013737:Testis; D014021:Tissue Preservation / Q000379:methods*