Testicular tissue cryopreservation in prepubertal male children: an analysis of parental decision-making.
BACKGROUND
Infertility is an unfortunate treatment-related consequence for some pediatric malignancies as well as some non-malignant conditions treated with stem cell transplant. Unlike pubertal males, prepubertal males cannot produce semen for cryopreservation. This manuscript reports on the acceptability and safety of a multi-institutional protocol for offering testicular tissue cryopreservation to families of prepubertal male children at highest risk for infertility. Data on decision influences, decision-making control, and emotional state when considering this option are described.


METHODS
Prepubertal males facing gonadotoxic therapy were offered testicular cryopreservation. Post-biopsy, patients were followed for acute side effects. In addition, parents and patients were asked to complete questionnaires, whether or not they chose to cryopreserve tissue.


RESULTS
Seventy-four prepubertal male children were approached. Fifty-seven families (77%) consented to the testicular biopsy; 48 of 57 underwent the procedure. There was one post-operative side effect. Parents who agreed to testicular cryopreservation and those that did not felt in control of this decision. Parents who consented to the biopsy and refusers were not deterred by the experimental nature of the protocol. An important decision-making influence was the risk of the biopsy.


CONCLUSIONS
Biopsy and cryopreservation of testicular tissue from prepubertal male children was performed successfully and safely at three institutions. Parents faced with this option at diagnosis can make an informed decision and weigh carefully the risks and benefits. Although asked to make a decision soon after they were given a difficult diagnosis, parents uniformly felt in control of this decision.
Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jill P
JP
Ginsberg
Yimei
Y
Li
Claire A
CA
Carlson
Clarisa R
CR
Gracia
Wendy L
WL
Hobbie
Victoria A
VA
Miller
John
J
Mulhall
Margarett
M
Shnorhavorian
Ralph L
RL
Brinster
Thomas F
TF
Kolon
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D003657:Decision Making; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007248:Infertility, Male / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D010290:Parents / Q000523:psychology*; D012662:Semen Preservation / Q000523:psychology*; D013737:Testis / Q000166:cytology*; D014021:Tissue Preservation
decision-making; fertility preservation; prepubertal; testicular cryopreservation