Current State of Fertility Preservation in Cancer Patients—What is Established and What is Still Controversial?

2016 ◽  
Vol 12 (01) ◽  
pp. 33
Author(s):  
Kutluk Oktay ◽  
Giuliano Bedoschi ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Care ◽  
Testicular Tissue ◽  
Semen Cryopreservation ◽  
Young Females ◽  
Current State ◽  
Preservation Method ◽  
Prepubertal Boys ◽  
Straightforward Approach

Fertility Preservation is an essential part of cancer care when treating young females and men. While semen cryopreservation is a straightforward approach for postpubertal men and there is the option of experimental testicular tissue freezing for prepubertal boys, the options for females are more tumultuous. The last 17 years brought us established approaches such the embryo and oocyte cryopreservation and the ovarian cryopreservation is ready to join the list. However, there still is no proven medical fertility preservation method and the controversy around the utility of GnRHa continues.

scholarly journals Oncofertility: Pharmacological Protection and Immature Testicular Tissue (ITT)-Based Strategies for Prepubertal and Adolescent Male Cancer Patients

2019 ◽  
Vol 20 (20) ◽  
pp. 5223 ◽  
Author(s):  
Elissavet Ntemou ◽  
Chrysanthi Alexandri ◽  
Pascale Lybaert ◽  
Ellen Goossens ◽  
Isabelle Demeestere
Keyword(s):  
Fertility Preservation ◽  
Fertility Restoration ◽  
Childhood Cancer Survivors ◽  
Testicular Tissue ◽  
Adolescent Male ◽  
Medical Centers ◽  
Preservation Method ◽  
Prepubertal Boys

While the incidence of cancer in children and adolescents has significantly increased over the last decades, improvements made in the field of cancer therapy have led to an increased life expectancy for childhood cancer survivors. However, the gonadotoxic effect of the treatments may lead to infertility. Although semen cryopreservation represents the most efficient and safe fertility preservation method for males producing sperm, it is not feasible for prepubertal boys. The development of an effective strategy based on the pharmacological protection of the germ cells and testicular function during gonadotoxic exposure is a non-invasive preventive approach that prepubertal boys could benefit from. However, the progress in this field is slow. Currently, cryopreservation of immature testicular tissue (ITT) containing spermatogonial stem cells is offered to prepubertal boys as an experimental fertility preservation strategy by a number of medical centers. Several in vitro and in vivo fertility restoration approaches based on the use of ITT have been developed so far with autotransplantation of ITT appearing more promising. In this review, we discuss the pharmacological approaches for fertility protection in prepubertal and adolescent boys and the fertility restoration approaches developed on the utilization of ITT.

Fertility Preservation Options for Patients with Cancer

2010 ◽  
Vol 06 (01) ◽  
pp. 31
Author(s):  
Melissa C Hulvat ◽  
Jacqueline S Jeruss ◽  
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Keyword(s):  
Cancer Patients ◽  
Fertility Preservation ◽  
Term Survival ◽  
Demographic Groups ◽  
Patients With Cancer ◽  
Current State ◽  
Realistic Possibility ◽  
Life Threatening ◽  
Children And Young Adults ◽  
State Of The Science

Improving survival for many cancers that affect children and young adults, together with advances in fertility preservation, make a cancer-free future that includes a family a realistic possibility for patients who desire this option. Although it is difficult for many clinicians and patients to reconcile fears surrounding a life-threatening diagnosis with hope for long-term survival and even a future family, addressing this vital survivorship issue early in the course of diagnosis and treatment is imperative if the fullest range of fertility-preserving options is to be offered. Oncological therapies, including chemotherapy, radiation and surgery, pose various threats to fertility. Children, adolescents and young men and women with cancer have different options for maintaining their ability to have biological children. The current state of the science for fertility preservation in each of these demographic groups is discussed in this article. A multidisciplinary approach to the care of young cancer patients, a timely assessment of threats to fertility and opportunities for intervention provide young cancer patients with the best chance for a healthy future that includes biological offspring.

scholarly journals Fertility Preservation for Cancer Patients: A Review

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Tosin Ajala ◽  
Junaid Rafi ◽  
Peter Larsen-Disney ◽  
Richard Howell
Keyword(s):  
Cancer Patients ◽  
Fertility Preservation ◽  
Cancer Care ◽  
Ethical Issues ◽  
Fertility Treatment ◽  
Term Survival ◽  
Long Term Survival ◽  
Valid Consent ◽  
Cure Rates

Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation.

Fertility preservation for prepubertal boys: lessons learned from the past and update on remaining challenges towards clinical translation

2020 ◽  
Author(s):  
Christine Wyns ◽  
Marc Kanbar ◽  
Maria Grazia Giudice ◽  
Jonathan Poels
Keyword(s):  
Stem Cells ◽  
Fertility Preservation ◽  
Clinical Application ◽  
Germ Cells ◽  
Testicular Tissue ◽  
Reproductive Age ◽  
Reproductive Capacity ◽  
Patient Counselling ◽  
Final Maturation ◽  
Prepubertal Boys

Abstract BACKGROUND Childhood cancer incidence and survivorship are both on the rise. However, many lifesaving treatments threaten the prepubertal testis. Cryopreservation of immature testicular tissue (ITT), containing spermatogonial stem cells (SSCs), as a fertility preservation (FP) option for this population is increasingly proposed worldwide. Recent achievements notably the birth of non-human primate (NHP) progeny using sperm developed in frozen-thawed ITT autografts has given proof of principle of the reproductive potential of banked ITT. Outlining the current state of the art on FP for prepubertal boys is crucial as some of the boys who have cryopreserved ITT since the early 2000s are now in their reproductive age and are already seeking answers with regards to their fertility. OBJECTIVE AND RATIONALE In the light of past decade achievements and observations, this review aims to provide insight into relevant questions for clinicians involved in FP programmes. Have the indications for FP for prepubertal boys changed over time? What is key for patient counselling and ITT sampling based on the latest achievements in animals and research performed with human ITT? How far are we from clinical application of methods to restore reproductive capacity with cryostored ITT? SEARCH METHODS An extensive search for articles published in English or French since January 2010 to June 2020 using keywords relevant to the topic of FP for prepubertal boys was made in the MEDLINE database through PubMed. Original articles on fertility preservation with emphasis on those involving prepubertal testicular tissue, as well as comprehensive and systematic reviews were included. Papers with redundancy of information or with an absence of a relevant link for future clinical application were excluded. Papers on alternative sources of stem cells besides SSCs were excluded. OUTCOMES Preliminary follow-up data indicate that around 27% of boys who have undergone testicular sampling as an FP measure have proved azoospermic and must therefore solely rely on their cryostored ITT to ensure biologic parenthood. Auto-transplantation of ITT appears to be the first technique that could enter pilot clinical trials but should be restricted to tissue free of malignant cells. While in vitro spermatogenesis circumvents the risk linked to cancer cell contamination and has led to offspring in mice, complete spermatogenesis has not been achieved with human ITT. However, generation of haploid germ cells paves the way to further studies aimed at completing the final maturation of germ cells and increasing the efficiency of the processes. WIDER IMPLICATIONS Despite all the research done to date, FP for prepubertal boys remains a relatively young field and is often challenging to healthcare providers, patients and parents. As cryopreservation of ITT is now likely to expand further, it is important not only to acknowledge some of the research questions raised on the topic, e.g. the epigenetic and genetic integrity of gametes derived from strategies to restore fertility with banked ITT but also to provide healthcare professionals worldwide with updated knowledge to launch proper multicollaborative care pathways in the field and address clinical issues that will come-up when aiming for the child’s best interest.

scholarly journals Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients

2019 ◽  
Vol 34 (8) ◽  
pp. 1462-1469 ◽  
Author(s):  
Claudia Massarotti ◽  
Paola Scaruffi ◽  
Matteo Lambertini ◽  
Fausta Sozzi ◽  
Valentino Remorgida ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Ovarian Reserve ◽  
Standard Of Care ◽  
Young Female ◽  
Cancer Relapse ◽  
Preservation Method

Abstract STUDY QUESTION Are there reasons that motivate young cancer survivors to ask for follow-up visits at an oncofertility unit? SUMMARY ANSWER Cancer survivors request oncofertility follow-up visits for the management of treatment-related side effects or ovarian reserve evaluation, even if not (or not yet) wishing for a pregnancy. WHAT IS KNOWN ALREADY Personalised oncofertility counselling before gonadotoxic therapies is considered standard of care for young women with newly diagnosed cancer. However, the long-term follow-up of these patients in an oncofertility unit is not described in the literature other than for the use of cryopreserved material. STUDY DESIGN, SIZE, DURATION We retrospectively examined rates and reasons for the first follow-up visits of 154 consecutive young female cancer patients (age range: 18–40 years) who underwent a pre-treatment consultation between January 2012 and June 2017. Demographic and clinical data were collected, as well as information about the chosen fertility preservation method, if any. PARTICIPANTS/MATERIALS, SETTING, METHODS Rates and reasons for follow-up visits were collected and expressed as percentages. Different reasons were examined in the whole cohort and stratified for type of malignancy. Possible predictive factors for return to the follow-up visit (age, nulliparity, presence of a partner, neoplasm, having cryopreserved material) were investigated through logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE Out of 154 patients, 74 returned to the oncofertility unit (48.1%) for a follow-up visit. The first visit was requested mostly at the end of anticancer therapies (51.3% versus 40.5% during therapies and 8.1% after cancer relapse). Among these patients, only 10.8% returned for the first time because they were actively desiring a pregnancy. For the others, the most common reasons for consultations were management of gynecological adverse effects of therapies (29.7%) and evaluation of ovarian reserve not linked to an immediate desire for a pregnancy (39.2%). Other patients asked for contraception (4.1%), menopause counselling (5.4%), or new fertility preservation counselling because of cancer relapse (10.8%). None of the examined factors were significantly predictive of return to the oncofertility unit. LIMITATIONS, REASONS FOR CAUTION These findings represent the experience of a single centre. A longer duration of follow-up would be needed to provide more precise information on this regard. WIDER IMPLICATION OF THE FINDINGS The role of an oncofertility unit should not be limited to proposing fertility preservation procedures. In the management of young adult cancer patients, the reproductive medical specialist should be considered a key figure not only before but also during and after anticancer treatments to explore salient aspects of gynecological and reproductive health. STUDY FUNDING/COMPETING INTEREST(S) This research did not receive any specific funding. M.L. served as a consultant for Teva and received honoraria from Theramex outside the submitted work. The other authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N.A.

scholarly journals Fertility preservation in boys: recent developments and new insights †

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
E Goossens ◽  
K Jahnukainen ◽  
RT Mitchell ◽  
AMM van Pelt ◽  
G Pennings ◽  
...  
Keyword(s):  
High Risk ◽  
Fertility Preservation ◽  
Patient Management ◽  
Experimental Methods ◽  
Testicular Tissue ◽  
Human Testis ◽  
Clinical Practices ◽  
Future Fertility ◽  
Prepubertal Boys ◽  
Tissue Cryopreservation

Abstract BACKGROUND Infertility is an important side effect of treatments used for cancer and other non-malignant conditions in males. This may be due to the loss of spermatogonial stem cells (SSCs) and/or altered functionality of testicular somatic cells (e.g. Sertoli cells, Leydig cells). Whereas sperm cryopreservation is the first-line procedure to preserve fertility in post-pubertal males, this option does not exist for prepubertal boys. For patients unable to produce sperm and at high risk of losing their fertility, testicular tissue freezing is now proposed as an alternative experimental option to safeguard their fertility. OBJECTIVE AND RATIONALE With this review, we aim to provide an update on clinical practices and experimental methods, as well as to describe patient management inclusion strategies used to preserve and restore the fertility of prepubertal boys at high risk of fertility loss. SEARCH METHODS Based on the expertise of the participating centres and a literature search of the progress in clinical practices, patient management strategies and experimental methods used to preserve and restore the fertility of prepubertal boys at high risk of fertility loss were identified. In addition, a survey was conducted amongst European and North American centres/networks that have published papers on their testicular tissue banking activity. OUTCOMES Since the first publication on murine SSC transplantation in 1994, remarkable progress has been made towards clinical application: cryopreservation protocols for testicular tissue have been developed in animal models and are now offered to patients in clinics as a still experimental procedure. Transplantation methods have been adapted for human testis, and the efficiency and safety of the technique are being evaluated in mouse and primate models. However, important practical, medical and ethical issues must be resolved before fertility restoration can be applied in the clinic.Since the previous survey conducted in 2012, the implementation of testicular tissue cryopreservation as a means to preserve the fertility of prepubertal boys has increased. Data have been collected from 24 co-ordinating centres worldwide, which are actively offering testis tissue cryobanking to safeguard the future fertility of boys. More than 1033 young patients (age range 3 months to 18 years) have already undergone testicular tissue retrieval and storage for fertility preservation. LIMITATIONS, REASONS FOR CAUTION The review does not include the data of all reproductive centres worldwide. Other centres might be offering testicular tissue cryopreservation. Therefore, the numbers might be not representative for the entire field in reproductive medicine and biology worldwide. The key ethical issue regarding fertility preservation in prepubertal boys remains the experimental nature of the intervention. WIDER IMPLICATIONS The revised procedures can be implemented by the multi-disciplinary teams offering and/or developing treatment strategies to preserve the fertility of prepubertal boys who have a high risk of fertility loss. STUDY FUNDING/COMPETING INTEREST(S) The work was funded by ESHRE. None of the authors has a conflict of interest.

scholarly journals Spermatogonial stem cells as a therapeutic alternative for fertility preservation of prepubertal boys

2015 ◽  
Vol 13 (4) ◽  
pp. 637-639 ◽  
Author(s):  
Andrea Giannotti Galuppo
Keyword(s):  
Stem Cells ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Pediatric Cancer ◽  
Male Fertility ◽  
Spermatogonial Stem Cells ◽  
Male Gametes ◽  
Pediatric Cancer Patients ◽  
The Future ◽  
Prepubertal Boys

ABSTRACT Spermatogonial stem cells, which exist in the testicles since birth, are progenitors cells of male gametes. These cells are critical for the process of spermatogenesis, and not able to produce mature sperm cells before puberty due to their dependency of hormonal stimuli. This characteristic of the reproductive system limits the preservation of fertility only to males who are able to produce an ejaculate. This fact puts some light on the increase in survival rates of childhood cancer over the past decades because of improvements in the diagnosis and effective treatment in pediatric cancer patients. Therefore, we highlight one of the most important challenges concerning male fertility preservation that is the toxic effect of cancer therapy on reproductive function, especially the spermatogenesis. Currently, the experimental alternative for fertility preservation of prepubertal boys is the testicular tissue cryopreservationfor, for future isolation and spermatogonial stem cells transplantation, in order to restore the spermatogenesis. We present a brief review on isolation, characterization and culture conditions for the in vitro proliferation of spermatogonial stem cells, as well as the future perspectives as an alternative for fertility preservation in prepubertal boys. The possibility of restoring male fertility constitutes a research tool with an huge potential in basic and applied science. The development of these techniques may be a hope for the future of fertility preservation in cases that no other options exist, e.g, pediatric cancer patients.

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