K. S. Corkum1,3, T. B. Lautz1,3, B. A. Lockart3,5, E. K. Johnson2,4, E. E. Rowell1,3 1Northwestern University Feinberg School Of Medicine,Department Of Surgery,Chicago, IL, USA 2Northwestern University Feinberg School Of Medicine,Department Of Urology,Chicago, IL, USA 3Ann And Robert H. Lurie Children’s Hospital Of Chicago,Division Of Pediatric Surgery,Chicago, IL, USA 4Ann And Robert H. Lurie Children’s Hospital Of Chicago,Division Of Urology,Chicago, IL, USA 5Ann And Robert H. Lurie Children’s Hospital Of Chicago,Division Of Hematology, Oncology, And Stem Cell Transplant,Chicago, IL, USA
Introduction: Children with a variety of oncologic, genetic, endocrine, and rheumatologic conditions may be candidates for fertility preservation (FP) as part of their comprehensive care. Post-pubertal males have the ability to sperm bank prior to receiving gonadotoxic therapy, but FP options for prepubertal males have been previously unavailable. Testicular tissue cryopreservation (TTC) provides an experimental option for FP for prepubertal males facing potential infertility due to their medical diagnosis or treatment. Limited published data exists regarding surgical technique and outcomes for children undergoing TTC. The aim of this study was to describe our Fertility and Hormone Preservation and Restoration Program’s experience with testicular wedge biopsy for TTC.
Methods: A retrospective review of TTC cases between August 2015 to July 2017 was performed. Patients qualified for the IRB approved experimental TTC protocol if they had a greater than 80% risk of long-term azoospermia from their planned medical therapy. High-risk treatments included total body radiation, testicular radiation, and/or high-dose alkylating chemotherapy. A trans-scrotal wedge biopsy was performed for each patient. A small portion of tissue was sent to pathology, and the remainder sent for TTC.
Results: TTC was performed in 16 patients. Mean age was 9.5 years (range 5 months -18 years). Ninety-four percent were prepubertal. Thirty-seven percent had a musculoskeletal malignancy (Ewing sarcoma, osteosarcoma, rhabdomyosarcoma) and 31% had a primary neurologic malignancy (medulloblastoma, glioma, astrocytoma). Fifty percent of patients had received chemotherapy prior to TTC, with 31% of patients presenting with relapsed primary disease. TTC was performed in conjunction with another procedure, such as a central venous port insertion and/or bone marrow biopsy, in 56% of cases. Two patients underwent testicular sperm extraction at the time of testicular biopsy. Average estimated blood loss was three milliliters. One patient developed scrotal cellulitis after initiation of chemotherapy and required admission for intravenous antibiotics. All TTC cases were performed as same-day surgery or during an existing admission. Average time to the start of medical therapy was eight days with no reported delays. Pathologic analysis revealed normal testicular tissue in 13 patients. In three patients who had received chemotherapy prior to TTC, spermatogonia were present, but in low numbers.
Conclusion: Unilateral testicular wedge biopsy for TTC can be performed safely and can be effectively paired with other necessary procedures under one general anesthetic. The majority of patients in our series had normal testicular tissue on pathology. TTC remains an experimental option for FP for prepubertal males as no spermatogenic recovery or pregnancies from cryopreserved testicular tissues have been reported to date.