Boys who undergo radical treatments, such as chemotherapy or radiation therapy, before puberty often face the risk of infertility due to damage to their testicular stem cells. These stem cells, which are precursors to sperm cells, are particularly vulnerable to such treatments, which can lead to lifelong infertility. However, there is a promising solution: the cryopreservation of testicular tissue, which contains these stem cells and can be reintroduced later in life to restore fertility.
Since prepubescent boys do not yet produce sperm, the preserved tissue does not contain sperm cells. Instead, it holds stem cells that have the potential to produce sperm once puberty is reached. By freezing this tissue, there is the possibility of restoring fertility through transplantation of the tissue when the individual is older.
Researchers from Vrije Universiteit Brussel and Brussels IVF, the reproductive medicine center of UZ Brussel, have taken a significant step forward in this field. They have successfully reintroduced testicular tissue fragments into a man who underwent chemotherapy as a child, which had previously compromised his fertility. This procedure is part of an ongoing research project aimed at determining whether transplanting the preserved tissue can effectively restore fertility.
One Year of Monitoring and Evaluation
The process involves transplanting four fragments of testicular tissue into the testicle and another four into the scrotum. The goal of the transplant is to enable the patient’s body to produce sperm autonomously. Over the course of the year following the transplant, the patient will undergo regular monitoring, including blood tests, hormone levels, ultrasound exams, and semen samples taken every three months.
Because the tissue fragments are not directly connected to the sperm duct, researchers do not expect sperm cells to naturally enter the semen. If the patient desires to have children, assisted reproductive technology (ART) would be required. After one year, the transplanted tissue will be removed and analyzed to determine if it has produced sperm. Additionally, a small tissue sample will be taken from another area of the testis to see if sperm production has been triggered there as well.
Advancing Fertility Preservation for Cancer Patients
Dr. Veerle Vloeberghs, a staff member at Brussels IVF, emphasized that this procedure represents a significant step in scientific research for preserving fertility in children with cancer or blood diseases. She acknowledged that while the procedure aims to restore fertility, success is not guaranteed, and patients may still require ART to conceive. Nevertheless, this advancement offers new possibilities for young adults who otherwise would have had no options for having children.
Addressing Infertility Caused by Chemotherapy and Radiation
Infertility is one of the most common long-term effects of chemotherapy and radiation, especially when these treatments are administered to children before they have reached puberty. This is a particularly concerning issue for young patients undergoing high-dose treatments, as they may face infertility for life. Restoring fertility after such treatments has become a critical area of research, and this new approach offers hope.
Professor Herman Tournaye, Head of Brussels IVF, noted that UZ Brussel was the first hospital in the world to launch a clinical fertility preservation program for young boys with cancer or blood-related diseases in 2002. The program involves the cryopreservation of testicular tissue prior to chemotherapy or radiation therapy, and some of these patients are now reaching an age where they are considering starting families.
Looking to the Future of Fertility Restoration
Professor Ellen Goossens, chair of the “Biology of the Testis” research group, shared that their team has developed methods for both cryopreservation and transplantation in animals, which have now been successfully applied to humans. To date, 141 boys’ testicular tissue has been preserved, offering hope for future fertility restoration. The team is also working on methods for in vitro sperm production, which could provide an alternative to transplantation in cases where cancer cells are detected in the tissue or when other infertility issues arise.
This groundbreaking work offers new avenues for restoring fertility to young boys who have undergone life-saving but fertility-damaging treatments. The ongoing research continues to bring hope for a future where these children have the option to become parents, despite the challenges of their past treatments.
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