Fertility preservation in boys facing gonadotoxic cancer therapy

Treatment for childhood cancer can cause infertility in patients who survive to adulthood. Jensen et al. discuss the options for fertility preservation in pre-pubertal and pubertal boys, covering preservation of spermatozoa and testis tissue, as well as psychological and ethical issues, and current challenges to fertility preservation. Patient survival following childhood cancer has increased with contemporary radiation and chemotherapy techniques. However, gonadotoxicity associated with treatments means that infertility is a common consequence in survivors. Novel fertility preservation options are emerging, but knowledge about these options amongst urologists and other medical professionals is lacking. Pre-pubertal boys generally do not produce haploid germ cells. Thus, strategies for fertility preservation require cryopreservation of tissue containing spermatogonial stem cells (SSCs). Few centres worldwide routinely offer this option and fertility restoration (including testicular tissue engraftment, autotransplantation of SSCs and in vitro maturation of SSCs to spermatozoa) post-thaw is experimental. In pubertal boys, the main option for fertility preservation is masturbation and cryopreservation of the ejaculate. Assisted ejaculation using penile vibratory stimulation or electroejaculation and surgical sperm retrieval can be used in a sequential manner after failed masturbation. Physicians should inform boys and parents about the gonadotoxic effects of cancer treatment and offer fertility preservation. Preclinical experience has identified challenges in pre-pubertal fertility preservation, but available options are expected to be successful when today's pre-pubertal boys with cancer become adults. By contrast, fertility preservation in pubertal boys is clinically proven and should be offered to all patients undergoing cancer treatment.

Automated summary

Treatment for childhood cancer may lead to infertility in survivors, but there are options for fertility preservation such as sperm or testis tissue cryopreservation. Physicians should inform patients and parents about the reproductive effects of treatment and provide relevant choices. Fertility preservation options for pre-pubertal boys are limited globally, while preservation for pubertal boys is clinically proven.