“What was expected from this first implant was to demonstrate that this method is safe and feasible,” Orwig said. Ultrasound shows that the testicular tissue of HSU is intact by procedure and that his hormone levels are in the normal range. For now, he still has no sperm in his semen.
More transplants could occur soon. The Orwig team has been banking pediatric testicular tissue since 2011, but some of these patients are now in reproductive age. His group has been granted permission from the institutional review board for transplantation of stem cells and testicular tissue. Clinical trials.
Transplantation of immature testicular tissue is an alternative approach explored by researchers. With that technique, preserved tissue is hidden beneath the skin of the scrotum. The hope is that the tissue matures and eventually produces sperm. in MonkeyOrwig and his team implanted the testicular tissue, and after 8-12 months the grafted tissue was removed, and sperm was extracted from it. They used sperm to fertilize the eggs and transferred the resulting embryos to surrogate from female macaques, resulting in postnatal birth.
To retrieve sperm, tissue slivers are separated from the skin. This is a less invasive procedure than stem cell transplants that require the testis to be opened.
When Orwig’s team first began collecting testicular tissue, he thought that by first separating them from the tissue and then freezing them, he would get more stem cells. They did this with the first few patients, including HSU. However, later they discovered that from freezing the entire tissue, then thawing them to extract the cells, they could get as many stem cells as possible. That meant that HSU could only undergo stem cell transplantation, as only his cells were frozen. Other patients who have frozen the entire tissue have the option to try either stem cells or tissue transplantation.
In January, researchers from Belgium’s Vrije Universiteit Brussel and Brussels IVF announced they had done it. First Testicular Tissue Transplantation Patients who received chemotherapy in childhood. The patient is monitored for one year and the semen is tested for the presence of sperm. A year later, the doctor will remove some of the implanted tissue and check for sperm.
“In these patients who are receiving life-saving cancer therapy, they end up with permanently impaired fertility,” says Robert Brannigan, president of the American Society of Reproductive Medicine and professor of urology at Northwestern University. “It’s hard to say which approach would be a more effective approach, but I think both approaches are really worth research.”
A similar procedure called ovarian tissue transplantation is available to female cancer patients and has resulted in over 200 births worldwide. Adult men who need chemotherapy usually require 2-3 weeks to treat an egg equivalent (egg removal) and may not have time to receive it before the patient begins chemotherapy, which is more advanced than testicular freeze or transplant. If the eggs are not freezing, tissue from the ovaries can be collected and stored for storage.
“It’s great to see us catch up a little bit to provide young men with the same kind of opportunity that we can offer younger women,” says Jonathan Rouse, a pediatric urologist at Duke Health. “Keeping your kids alive is always the number one goal, but then you can live that life is truly the number two goals. That’s what I think this research really has an impact on the future.”
HSU realizes that the technology is still in its early stages and may not work for him. Even if he is unable to give birth to biological children, he hopes these techniques will eventually open options to other pediatric cancer patients. “This is just beginning practice,” he says. “The more support, the more research we have, the more data we have, the better people like me are heading towards the line.”
