Stem Cells and Fertility

Abstract

The successful treatment of males with cancer has led to increasing numbers of men and boys interested in life after cancer. One of the top priorities for many of these males is the opportunity to have a family. Most cancer treatments used for common malignancies in men and boys are associated with impaired fertility; for patients receiving alkylating agents or total body irradiation as often used prior to bone marrow transplantation (BMT), severe fertility impairment occurs in most patients. While sperm banking for males, even those as young as 12, facing sterilizing cancer treatment can be effective, this approach requires subsequent use of reproductive procedures such as in vitro fertilization (IVF) or intrauterine insemination to achieve a pregnancy. Most males would prefer to restore their natural ability to father children and avoid these expensive and invasive approaches. No proven method for human male fertility restoration has yet been demonstrated; however, work in many mammalian species and recently in primates has demonstrated that autologous testicular cell transplant (TCT) can restore spermatogenesis after cancer treatment. Promising work in non-primate species has demonstrated the feasibility of in vitro development of mature sperm from neonatal testicular tissue. The safety and efficacy of either approach has not been established in humans. The objective of this chapter is to summarize the uses and potential of spermatogonial stem cells for the treatment of male sterility resulting from pediatric exposure to gonadotoxic agents.