Testicular Tissue Banking
In some cases, testicular tissue banking can work for men with no other options. An outpatient procedure, it involves surgically removing a small piece of testicular tissue, which is cut into several pieces and frozen.
Paul Robb, MD Jay Sandlow, MD Ovarian Tissue Banking
Harvesting eggs can take two to six weeks depending on where a women is in her menstrual cycle, but sometimes chemotherapy or radiation can’t be delayed that long. In such cases, ovarian tissue banking may be considered. In this experimental treatment, physicians use minimally invasive surgery to remove a small amount of ovarian tissue or an entire ovary. The tissue or ovary is frozen and stored.
“After the patient has recovered from cancer, we re-implant the tissue, typically over the ovary that remains,” Dr. Robb said. “Eggs may develop and the woman could become pregnant through the natural release of an egg, or through IVF. We’re involved with the Oncofertility Consortium in Chicago, an organization that is actively researching this option, along with options for maturing eggs outside of the body.”
“It’s helpful for patients to meet with one of us to learn about fertility preservation even if they decide to do nothing,” Dr. Robb said. “Knowing comprehensive treatments are available can create a sense of peace.”
Preserving Male Fertility Through Cryopreservation
Because fertilization can now be achieved using just a few sperm, men also have more choices. Freezing sperm through cryopreservation before treatment begins is the best and least costly option. “It may be as simple as providing a semen specimen to our andrology lab for cryopreservation,” Dr. Sandlow said. “Or it may be an appointment to talk about options.”
While it may be possible to retrieve sperm after some cancer treatments, freezing sperm in advance is much more successful. When men or adolescents can’t produce a sample, sperm can often be retrieved surgically, then frozen for later use. This may work for men who cannot ejaculate or for men with very low sperm counts. “If a patient doesn’t have sperm in his semen, we have the unique expertise to retrieve it surgically or through needle aspiration before he starts cancer treatment,” Dr. Sandlow said.
Tissue banking – ovarian and testicular – is a developing technique that may preserve fertility for women and men. Small samples of tissue are removed before cancer treatments begin and are frozen for later use. For women, ovarian tissue is re-implanted in the hope that eggs will eventually release naturally. For men, sperm can be retrieved and used in a specialized IVF procedure. Researchers are also examining an alternative to re-implanting ovarian tissue in which eggs would mature and be fertilized outside the body.
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Embryologists inject sperm to fertilize an egg (left) and monitor embryos in an incubator (right).
Treating More Categories of Patients
Dr. Sandlow would also like to reach more categories of potential fathers. “About 10 percent of men with cancer are of reproductive age,” he said. “And, because men are having children later, even some with prostate cancer have fertility concerns.”
The likelihood of finding sperm after some cancer treatments – even through a surgical extraction – can be as low as 10 percent to 15 percent. The best approach is discussing options before treatment begins. “Preserving fertility is a team approach. We’re able to offer procedures other places can’t,” Dr. Sandlow said.
For more information about preserving fertility, visit froedtert.com/fertility
Estil Strawn, Jr., MD
Sperm can be retrieved later and used to fertilize eggs by intracytoplasmic sperm injection (ICSI), where a single sperm is injected into an egg to attempt fertilization. At the Reproductive Medicine Center, this procedure has produced fertilized embryos and successful pregnancies.
The next step? “A major advancement would involve removing testicular tissue, freezing it, then re-implanting it or growing immature germ cells in a dish,” Dr. Sandlow said. “We can’t do anything for young patients who don’t have mature sperm in their testicles yet. The future of fertility preservation on the male side is going to revolve around pre-pubescent and early adolescent patients.” “While we’re getting better at curing diseases, the cure can leave our patients sterile,” Dr. Sandlow said. “I’m starting to see adult survivors of childhood malignancies who are asking if something can be done.”
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