Study shows promise of preserving fertility in boys with cancer

Study shows promise of preserving fertility in boys with cancer.

Scientists have moved a step closer to being able to preserve fertility in young boys who undergo chemotherapy and radiation treatments for cancer. The new research, published in Fertility and Sterility, the journal of the American Society for Reproductive Medicine, addresses the safety of an option scientists are developing for boys who aren't sexually mature and cannot bank sperm.

Scientists aim to freeze a sample of the boys' testicular tissue so that when they reach adulthood, spermatogonial stem cells (SSCs) found in the tissue can be reproduced and transplanted back into the patients. These cells are responsible for sperm production throughout adulthood.

"Our study addressed an important safety issue – whether cancer cells that might be present in testicular tissue samples can survive the process to replicate the sperm-producing stem cells," said lead author Hooman Sadri-Ardekani, M.D., Ph.D., an instructor in urology and regenerative medicine at Wake Forest Baptist Medical Center.

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"This is an important consideration because of the potential to re-introduce cancer into the patient," he said. "The research, which involved one of the most common childhood cancers, shows that the cancer cells were eliminated. Based on these findings, we recommend that all boys with cancer be offered the option of storing testicular tissue for possible future clinical use."

Sadri-Ardekani performed the work with researchers at the University of Amsterdam and Avicenna Research Institute in Tehran, Iran, before joining Wake Forest Baptist.

Cancers that can have a high risk of infertility, depending on the treatment, are certain leukemias, Hodgkin's disease, brain tumors and bone cancer. Because of the high survival rates of childhood cancer – close to 80 percent – more cancer patients than ever are reaching adulthood and many face fertility problems.

The current research involved acute lymphoblastic leukemia (ALL) cells, a common type of childhood cancer. Previous research had shown that up to 30 percent of boys with ALL had cancer cells in their testicular tissue.

Several earlier studies have attempted to eliminate cancer cells from biopsy tissue, but they showed contradictory results. The approach of Sadri-Ardekani and colleagues was to investigate whether cancer cells would survive the laboratory protocol they had developed to reproduce SSCs from a small tissue biopsy. This process multiplies the original SSCs by 18,000-fold so there are enough cells to transplant back into the patient when he reaches adulthood.

For the research, ALL cells were taken from three patients' bone marrow. The team then put the ALL cells alone, and ALL cells combined with testicular cells, through the cell-reproduction process.

Even when ALL cells made up 40 percent of the cell mixture being cultured, they were entirely eliminated in 26 days of culture. "This pilot study showed that the culture system not only allowed for efficient propagation of sperm stem cells, but also eliminated ALL cells," said Sadri-Ardekani.

SSC transplantation has not yet been attempted in humans, but has been performed successfully in several species of animals, including monkeys, said Sadri-Ardekani. He noted that before physicians and scientists begin offering SSC transplantation in patients, additional research will be needed, including whether other types of leukemiacells will also be eliminated in the cell-propagation process.

Frequently Asked Questions

Can boys who have cancer treatment still have children when they grow up?

Many boys who undergo chemotherapy or radiotherapy may experience fertility problems in adulthood, but new research is developing promising techniques to preserve their fertility. Scientists are working on freezing testicular tissue before treatment, which could potentially be used to restore sperm production later in life. The NHS recommends discussing fertility preservation options with your child's oncology team before cancer treatment begins.

Is testicular tissue freezing available on the NHS for children with cancer?

Testicular tissue cryopreservation for prepubescent boys is still considered experimental in the UK, though some specialist centres may offer it as part of research programmes. The HFEA regulates fertility preservation services, and NHS funding varies by area, so it's worth speaking to your child's treatment team about what options might be available. Some families may need to explore private options depending on their local CCG or Integrated Care Board funding policies.

What fertility preservation options are available for teenage boys before chemotherapy?

For boys who have reached puberty, sperm banking is the standard fertility preservation method and is typically offered on the NHS before cancer treatment. For younger boys who aren't yet producing sperm, testicular tissue freezing is being developed as a future option. NICE guidelines recommend that all patients of reproductive age should be offered fertility preservation counselling before starting cancer treatment.

Is it safe to use frozen testicular tissue after cancer treatment?

Recent research published in Fertility and Sterility shows promising results, demonstrating that cancer cells can be eliminated during the process of replicating sperm-producing stem cells from frozen tissue. This addresses a major safety concern about potentially reintroducing cancer cells into survivors. While the technique is still being refined, scientists are optimistic about its future clinical application.

Where can I get fertility advice for my child with cancer in the UK?

Your child's oncology team should discuss fertility preservation options with you before treatment begins, as recommended by NICE guidelines. You can also ask for a referral to a fertility specialist, and organisations like Fertility Network UK offer support and information for families facing these decisions. The HFEA website provides information about regulated fertility clinics across the UK that may offer preservation services.

How common is infertility after childhood cancer treatment?

The risk of infertility varies significantly depending on the type of cancer and treatment received, with certain leukaemias, Hodgkin's disease, brain tumours and bone cancers carrying higher risks. Some chemotherapy drugs and radiation to the pelvic area are more likely to affect future fertility than others. Your child's oncology team can provide specific information about the fertility risks associated with their particular treatment plan.

Will my son be able to have biological children if he had cancer as a child?

Many childhood cancer survivors do go on to have biological children naturally, though this depends on the type and intensity of treatment they received. With around 1 in 7 UK couples experiencing fertility issues generally, it's important for survivors to have their fertility assessed when they're ready to start a family. If there are concerns, NHS fertility services can offer investigations and support, with referral typically available after 12 months of trying to conceive.