Presentation Authors: Helen Levey Bernie*, Elizabeth A Schofield, Nicole Benfante, John P Mulhall, NY, NY
Introduction: Overall incidence rates of childhood cancer vary between 50-200/million children across the world. Childhood cancer survival rates are high, as are the late effects of gonadotoxic agents, such as infertility, in cancer survivors. While cryopreservation of sperm in adults is widely used, cryopreservation of testicular tissue in pre-pubertal boys has only recently been applied as a means to help preserve future fertility in pre-pubertal boys with cancer. The objective of this study is to present our experience of pre-pubertal pre-chemotherapy fertility preservation.
Methods: All pre-pubertal pre-chemotherapy patients who underwent fertility preservation using testicular sperm extraction (TESE) were analyzed. Parents were informed that: the procedure was experimental, given that it is unknown if the tissue will be of use in the future; the procedure had to be performed under an anesthetic for another procedure (infusion port, bone marrow aspirates); the procedure would not be covered by insurance. A unilateral window technique was utilized as most patients were to undergo chemotherapy within 48 hours of TESE. Safety data including rates of infection, hematoma development or delay in chemotherapy initiation were recorded.
Results: A total of 24 pre-pubertal males who had a mean age of 10Â±5 years, (range 6 months -14 years), constituted the study population. The mean FSH level was 7.9Â±7.3 (range 0.2-19.9) iU/ml. Our cohort had a median Tanner stage of 1, with mean testicular volumes of 4.0 Â±4.0. The most common childhood cancers in this cohort were sarcomas (46%) , lymphomas (13%), and leukemias (13%). The procedure took an average of 22 Â±11 minutes. The tissue was sent to the sperm bank where it was cryopreserved. Viability testing on the first 10 specimens revealed healthy testicular tissue. No wound infections or scrotal hematomas occurred postoperatively. All patients were able to commence chemotherapy on schedule, usually within 24 hours or less of the fertility procedure.
Conclusions: Fertility preservation in pre-pubertal pre-chemotherapy patients is a safe and feasible operation.