Fertility Preservation and Restoration in Pediatric Males

Abstract

The fertility management of prepubertal males facing a gonadotoxic diagnosis or therapy is a challenging clinical objective. The testes of prepubertal patients, especially germ cells, are exquisitely sensitive to damage when exposed to chemotherapy or radiation; therefore, the full extent of their diagnosis and clinical management must be taken into consideration when assessing a patient's risk for subsequent infertility. This also includes non-cancer patients, stem cell transplant patients, individuals with Klinefelter's syndrome, and those with other differences in sexual development. All such patients should be consulted for fertility preservation, including sperm cryopreservation for those who can provide sperm, and testicular tissue cryopreservation for those who are unable to provide sperm. If a medical team is unprepared to manage the fertility preservation of a prepubertal patient, they should refer the patient to a team or outside group that is confident in doing so. Currently, there are no clinically proven mechanisms for the maturation or retrieval of sperm from cryopreserved immature testicular tissue; however, many groups worldwide are investigating methods to achieve these ends. Several engineering and biological mechanisms currently being explored as future assisted reproductive technologies for prepubertal patients form the focus of the latter half of this chapter.