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Fertility preservation in boys facing gonadotoxic cancer therapy
Nature Reviews Urology ( IF 12.1 ) Pub Date : 2021-10-19 , DOI: 10.1038/s41585-021-00523-8
Christian F S Jensen 1 , Lihua Dong 2 , Murat Gul 2, 3 , Mikkel Fode 1 , Simone Hildorf 4 , Jorgen Thorup 4, 5 , Eva Hoffmann 5, 6 , Dina Cortes 5, 7 , Jens Fedder 8, 9 , Claus Y Andersen 2, 5 , Jens Sønksen 1, 5
Affiliation  

Patient survival following childhood cancer has increased with contemporary radiation and chemotherapy techniques. However, gonadotoxicity associated with treatments means that infertility is a common consequence in survivors. Novel fertility preservation options are emerging, but knowledge about these options amongst urologists and other medical professionals is lacking. Pre-pubertal boys generally do not produce haploid germ cells. Thus, strategies for fertility preservation require cryopreservation of tissue containing spermatogonial stem cells (SSCs). Few centres worldwide routinely offer this option and fertility restoration (including testicular tissue engraftment, autotransplantation of SSCs and in vitro maturation of SSCs to spermatozoa) post-thaw is experimental. In pubertal boys, the main option for fertility preservation is masturbation and cryopreservation of the ejaculate. Assisted ejaculation using penile vibratory stimulation or electroejaculation and surgical sperm retrieval can be used in a sequential manner after failed masturbation. Physicians should inform boys and parents about the gonadotoxic effects of cancer treatment and offer fertility preservation. Preclinical experience has identified challenges in pre-pubertal fertility preservation, but available options are expected to be successful when today’s pre-pubertal boys with cancer become adults. By contrast, fertility preservation in pubertal boys is clinically proven and should be offered to all patients undergoing cancer treatment.



中文翻译:

接受性腺毒性癌症治疗的男孩的生育力保存

随着现代放疗和化疗技术的发展,儿童癌症患者的存活率有所提高。然而,与治疗相关的性腺毒性意味着不孕是幸存者的常见后果。新的生育力保存方案不断涌现,但泌尿科医生和其他医疗专业人员缺乏对这些方案的了解。青春期前的男孩一般不会产生单倍体生殖细胞。因此,生育力保存策略需要冷冻保存含有精原干细胞 (SSC) 的组织。全世界很少有中心定期提供这种选择,解冻后的生育能力恢复(包括睾丸组织植入、SSCs 自体移植和 SSCs 体外成熟为精子)是实验性的。在青春期男孩中,保存生育能力的主要选择是手淫和冷冻保存精液。使用阴茎振动刺激或电射精辅助射精和手术取精可以在手淫失败后按顺序使用。医生应该告知男孩和父母关于癌症治疗的性腺毒性作用并提供生育力保护。临床前经验已经确定了青春期前生育能力保存的挑战,但当今天的青春期前癌症男孩成年时,可用的选择有望取得成功。相比之下,青春期男孩的生育力保存已在临床上得到证实,应该提供给所有接受癌症治疗的患者。使用阴茎振动刺激或电射精辅助射精和手术取精可以在手淫失败后按顺序使用。医生应该告知男孩和父母关于癌症治疗的性腺毒性作用并提供生育力保护。临床前经验已经确定了青春期前生育能力保存的挑战,但当今天的青春期前癌症男孩成年时,可用的选择有望取得成功。相比之下,青春期男孩的生育力保存已在临床上得到证实,应该提供给所有接受癌症治疗的患者。使用阴茎振动刺激或电射精辅助射精和手术取精可以在手淫失败后按顺序使用。医生应该告知男孩和父母关于癌症治疗的性腺毒性作用并提供生育力保护。临床前经验已经确定了青春期前生育能力保存的挑战,但当今天的青春期前癌症男孩成年时,可用的选择有望取得成功。相比之下,青春期男孩的生育力保存已在临床上得到证实,应该提供给所有接受癌症治疗的患者。临床前经验已经确定了青春期前生育能力保存的挑战,但当今天的青春期前癌症男孩成年时,可用的选择有望取得成功。相比之下,青春期男孩的生育力保存已在临床上得到证实,应该提供给所有接受癌症治疗的患者。临床前经验已经确定了青春期前生育能力保存的挑战,但当今天的青春期前癌症男孩成年时,可用的选择有望取得成功。相比之下,青春期男孩的生育力保存已在临床上得到证实,应该提供给所有接受癌症治疗的患者。

更新日期:2021-10-20
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