Fertility Preservation in Prepubertal and Adolescent Males Facing Gonadotoxic Therapies: Recent Developments and New Insights

The options for fertility preservation in children and adolescent males are primarily dependent on whether sperm production has begun. Prior to the onset of spermatogenesis, fertility preservation is currently limited to experimental strategies of testicular tissue cryopreservation to preserve the spermatogonial stem cells (SSCs) for future use to generate functional sperm. For males who are already producing sperm, the focus is on obtaining viable sperm through collection of a semen sample or surgical extraction of sperm. From a practical perspective, decisions on the most appropriate form of fertility preservation are dependent on multiple factors and should be individualized to the patient. The absolute risk of infertility is an important consideration for whether fertility preservation should be offered, particularly for experimental options. Clinical assessment of pubertal status and emotional maturity of the patient are essential for selecting the most appropriate form of fertility preservation. Surgical procedures should be optimized to maximize the chances of successful retrieval of SSCs/sperm, and cryopreservation protocols must be tailored to ensure viability of tissues/cells depending on the nature of the material being stored. In this chapter, we will describe key aspects of testicular development during pre- and peri-puberty and discuss the current status of fertility preservation in child and adolescent males. The use of clinical cases will also provide a practical perspective on fertility preservation in this patient group.