A Report on Testicular Tissue Cryopreservation for Fertility Preservation in Children: Confirmation of Germ Cell Preservation and Few Surgical Complications

Abstract

Background: Testicular tissue cryopreservation (TTC) is an experimental method for fertility preservation in pediatric patients facing a fertility threatening treatment regimen or diagnosis. TTC requires a surgical procedure for the removal of testicular tissue, advanced tissue processing capabilities, and long-term tissue storage at a cryopreservation facility. The goal of this work is to evaluate the surgical and pathologic outcomes of patients enrolled in an ongoing clinical protocol for fertility preservation in children.

Methods: Patients were prospectively enrolled in an IRB-approved protocol from 2015 to 2023 at a single institution. Children were eligible for enrollment if they possessed a fertility threatening diagnosis or required treatment that placed them at high level of increased risk for prolonged azoospermia. In this work we report patient characteristics, surgical outcomes, and pathologic findings of our cohort.

Results: TTC was performed for 144 patients. The median age of patients was 8.89 years (Range: 0.3-24.5 years). Most patients were prepubertal (n = 126, 87.5 %) and carried a diagnosis of malignancy (n = 117, 81.2 %). Overall, 45.8 % of patients received pre-operative chemotherapy. There was a low rate of TTC-related surgical complications (n = 3, 2.1 %). Germ cells were present in 97.9 % (141/144) of samples. Malignancy was discovered in testicular tissue in 1.4 % (n = 2) of patients. Of the initially enrolled cohort, 89.4 % (n = 129) are living.

Conclusions: Testicular tissue cryopreservation is a safe and effective procedure for fertility preservation in the pediatric population. Germ cells were present in nearly all preserved tissue, providing the possibility of future fertility restoration in these children pending further scientific advancement.

Level of evidence: Level III - Prospective cohort study.

Keywords: Fertility preservation; Pediatric oncology; Survivorship; Testicular tissue cryopreservation.