Puberty development and testicular growth after cryoconservation in prepubertal boys facing gonadotoxic therapies

Background/Objectives: Advancements in oncologic therapies
have improved long-term survival rates in childhood
cancer, but increased the infertility rate among the survivors.
Testicular cryopreservation is the current option in prepubertal
boys at high risk of infertility. As the efficacy of fertility
restoration is still unproven and little data is available about
the puberty development and testicular complications after
biopsy, some clinicians are still sceptic to propose the cryopreservation
in daily practice.
Our aim was to illustrate the feasibility of testicular cryopreservation
in prepuberal patients that undergo gonadotoxic
S521 of S709
therapy, to describe characteristics of testicular specimens and
to provide information of testicular development after biopsy.
Design/Methods: Retrospective review of gonadal biopsies,
biological and clinical records of prepubertal boys with high
infertility risk consented into the Toulouse Children’s Hospital
between 2011-2017. Patients were follow-up by ultrasound
to evaluate the testicular volume and abnormalities and by a
systematic endocrine assessment.
Results: Bitesticular specimens in 16 males (9 ± 2.7 years)
provided an average of 25 slices per patient. None of the
patients had complications during the testicular biopsy. Two
patients had postoperative hematomas and one experienced
hypoesthesia of the scrotum. One patient had persistent
fibrotic lesions 4 years after biopsy. The last evaluation in the
study group (age 11 ± 1.3 years) showed a mean testicular
volume of 1,85 ± 2 ml [CI95%: 0,6 – 3]. A total of 3/28
(10.7%) testes had an epididymal cyst and 4/28 (14.2%) had a
hydrocele.
Conclusions: Testicular cryopreservation can be safely performed
in young patients facing gonatotoxic treatment, is easily
accepted by families with little sides effects in long term
and does not impede the pubertal development of the testis.
Future technologies may allow the spermatogonial stem cell
utilization to provide fertility restoration in cancer survivors.