Perspectives of infertile men on future stem cell treatments for nonobstructive azoospermia

Abstract

Concerns have been expressed about the rapid introduction of new fertility treatments into clinical practice. Patients' perspectives on new treatments and their introduction into clinical practice are unexplored. Two alternative treatments for testicular sperm extraction followed by intracytoplasmic sperm injection in men with nonobstructive azoospermia (NOA), the formation of artificial sperm and autotransplantation of in vitro proliferated spermatogonial stem cells, are in a preclinical phase of development. This study aimed to explore, prior to future clinical introduction, which treatment aspects are valued by NOA patients and would be taken into account in deciding to undergo these future treatment options. In-depth telephone interviews were conducted with 14 men with NOA. Interviews were transcribed, analysed with content analysis and data saturation was reached. Besides the obvious factors, success rates and safety, patients valued 'the intensity of the procedure', 'the treatments' resemblance to natural conception' and 'feeling cured'. Patients supported the development of these treatments and were eager to take part if such treatments would become available in the future. The patient's perspective on innovative treatments can (co)direct reproductive research. More research into the patients' perspectives on innovations and minimal thresholds to be met prior to their introduction into clinical practice is required. Many couples face infertility and seek help for their unwanted childlessness. For men who are infertile because they do not ejaculate sperm cells, the only treatment option is surgically retrieving sperm cells from their testis (testicular sperm extraction, TESE) and this surgery, as well as the subsequent fertilization of an oocyte via intracytoplasmic sperm injection (ICSI), is often unsuccessful. Researchers are currently developing two alternative treatment options for these men involving stem cells. However, concerns have been raised on the need to define when new treatments can be tested on humans. The views of patients who will potentially undergo these treatments need to be heard regarding the new treatments being developed and on when they would be prepared to take part in new treatments. Therefore, this study explored patients' perspectives on current treatment (TESE-ICSI) and the two alternative treatment options by conducting in-depth interviews with 14 infertile men. Two researchers independently analysed the interview transcripts for common themes. Patients' appreciation of alternative treatment options depended on the effectiveness and safety of treatments but also on the intensity of the treatment procedure, the resemblance to natural conception and on feeling cured. Patients supported the development of the proposed new treatment options potentially enabling them to father a child and they were eager to take part in (research on) these alternative treatments. These findings can codirect research on these new treatment options. Moreover, this research is a first step towards incorporating patients' perspectives into defining when to introduce new technologies into clinical practice. © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.