Male adolescent fertility preservation

Capsule:
Today, most male adolescent cancer patients will survive their initial diagnoses. Unfortunately, most of these patients are not currently provided adequate fertility preservation counseling or care.

Authors:
Jared L. Moss, M.D., Andrew Wonho Choi, B.S., Mary Kate Fitzgerald Keeter, M.P.H., Robert E. Brannigan, M.D.

Volume 105, Issue 2, Pages 267-273

Abstract:

Until the 1960s, few adolescents and young adults (AYAs) survived their initial cancer diagnoses. Now, ∼12,400 AYA patients are diagnosed with cancer each year, and almost 80% will now achieve a long-term cure. This dramatic improvement in survival is primarily due to multimodal treatments and combined chemotherapeutic regimens. Unfortunately, the increase in survival is often accompanied by treatment-related toxicities due to chemotherapy, radiation therapy, and surgical procedures. Despite guidelines published by the American Society of Clinical Oncology and numerous other professional organizations, high percentages of male AYA oncology patients are not properly counseled regarding their fertility preservation options before cancer treatment. Although administering fertility preservation care to adolescent males can be challenging in many ways, numerous studies show that this care can be delivered with high degrees of success and high levels of patient and parent satisfaction. The key to this success at many institutions has been the implementation of formalized integrated fertility preservation programs with infrastructure geared toward the delivery of comprehensive expedited care.

  • msamplaski

    We have well published data that demonstrates that both cryopreservation and patient regret scores show a favorable change when formalized fertility preservation programs are in place. At present though, there is still a gap for many institutions between having these programs in place and executing them. The onus falls on individual physicians to offer fertility preservation to their patients, and allow them the time necessary (which may result in a slight delay in treatment) to execute this. Many of us have seen the unfortunate men who were not offered banking prior to gonadotoxic therapies, with resultant azoospermia, frustration and despair.

  • deepa.bhartiya@yahoo.in

    Dear Prof Brannigan

    Read your article describing effect of radiotherapy and chemotherapy on testicular germ cells and how both are toxic to the gonads and lead to irreversible azoospermia. We wish to draw your kind attention to the work published by our group which shows that a novel population of stem cells in the testis survives oncotherapy because of its quiescent nature (1). These are the very small embryonic like stem cells (VSELs) which can be studied as very small sized (3-5 µm), LIN-/CD45-/SCA-1+ cells by flow cytometry. They comprise 0.03±0.002% cells in normal mouse testis and 0.05±0.005% cells in busulphan (25 mg/Kg) treated testis1. Rather than being depleted– their numbers increase slightly in chemoablated testis. Recently similar VSELs have been reported in testicular biopsies of azoospermic adult survivors of childhood cancer (2) and in azoospermic men with Sertoli cells only syndrome and maturation arrest (3). These VSELs could be manipulated to regenerate the chemoablated testis and thus there is no need to bank testicular tissue prior to oncotherapy (4). Please feel free to refer to following references.

    1. Anand S, Bhartiya D, Sriraman K, Patel H, Manjramkar DD. Very small embryonic-like stem cells survive and restore spermatogenesis after busulphan treatment in mouse testis. J Stem Cell Res Ther 2014; 4:216. doi: 10.4172/2157-7633.1000216.

    2. Kurkure P, Prasad M, Dhamankar V, Bakshi G. Very small embryonic-like stem cells (VSELs) detected in azoospermic testicular biopsies of adult survivors of childhood cancer. Reprod Biol Endocrinol. 2015 Nov 9;13:122. doi: 10.1186/s12958-015-0121-1.

    3. Stimpfel M, Skutella T, Kubista M, Malicev E, Conrad S, Virant-Klun I. (2012) Potential stemness of frozen-thawed testicular biopsies without sperm in infertile men included into the in vitro fertilization programme. J Biomed Biotechnol. 2012,291038.

    4. Bhartiya D, Anand S, Parte S. VSELs may obviate cryobanking of gonadal tissue in cancer patients for fertility preservation. J Ovarian Res. 2015 Nov 17;8(1):75. doi: 10.1186/s13048-015-0199-2.

    Sandhya Anand and Deepa Bhartiya
    Stem Cell Biology Department
    National Institute for Research in Reproductive Health
    Mumbai, INDIA 400 012

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