Portal de Periódicos da CAPES

Fertility and progeny

2002; Elsevier BV; Volume: 38; Issue: 12 Linguagem: Inglês

10.1016/s0959-8049(02)00093-x

1879-0852

Angela Thomson, Hilary Critchley, William H. Wallace,

Testicular diseases and treatments

Survival rates for childhood cancer have improved dramatically over the last 30 years such that approximately 70% of children can expect to become long-term survivors [ 1 Wallace W.H.B. Growth and endocrine function following the treatment of childhood malignant disease. in: Pinkerton C.R. Plowman P.N. Paediatric Oncology: Clinical practice and Controversies. 2nd ed.n. Chapman and Hall Medical, London1997: 706-731 Google Scholar , 2 Bleyer W.A. The impact of childhood cancer on the United States and the world. Cancer. 1990; 40: 355-367 Google Scholar ]. However, the successful treatment of childhood cancer with multi-agent chemotherapy in combination with surgery or radiotherapy causes significant morbidity in later life [ 3 Wallace W.H.B. Blacklay A. Eiser C. et al. Developing strategies for long term follow up of survivors of childhood cancer. Br. Med. J. 2001; 323: 271-274 Crossref PubMed Scopus (214) Google Scholar ]. Infertility is one of the more commonly encountered and psychologically distressing complications of treatment and strategies to preserve fertile potential need to be developed. Preservation of fertility is dictated by sexual maturity of the patient with the only available established options being cryopreservation of spermatozoa for the male and of embryos for the female. Options in children are limited and still experimental, but advances in assisted reproduction techniques have focused attention on preserving gonadal tissue for future use [ 4 Schlatt S. von Schonfeldt V. Schepers A.G. Male germ cell transplantation an experimental approach with a clinical perspective. Br. Med. Bull. 2000; 56: 824-836 Crossref PubMed Scopus (32) Google Scholar , 5 Brinster R.L. Zimmermann J.W. Spermatogenesis following male germ-cell transplantation. Proc. Natl. Acad. Sci. USA. 1994; 91: 11289-11302 Google Scholar , 6 Clouthier D.E. Avarbock M.R. Maika S.D. Hammer R.E. Brinster R.L. Rat spermatogenesis in mouse testis. Nature. 1999; 371: 418-421 Google Scholar , 7 Avarbock M.R. Brinster C.J. Brinster R.L. Reconstitution of spermatogenesis from frozen spermatogonial stem cells. Nature Med. 1996; 2: 693-696 Crossref PubMed Scopus (291) Google Scholar , 8 Newton H. The cryopreservation of ovarian tissue as a strategy for preserving the fertility of cancer patients. Hum. Rep. Update. 1998; 4: 237-247 Crossref PubMed Scopus (85) Google Scholar , 9 Oktay K. Nugent D. Newton H. Salha O. Gosden R.G. Isolation and characterization of primordial follicles from fresh and cryopreserved human ovarian tissue. Fertil. Steril. 1997; 67: 481-486 Abstract Full Text PDF PubMed Scopus (247) Google Scholar , 10 Oktay K. Karlikaya G.G. Aydin B.A. Ovarian cryopreservation and transplantation basic aspects. Mol. Cell. Enodcrin. 2000; 169: 105-108 Crossref PubMed Scopus (56) Google Scholar ]. Testicular or ovarian tissue can be harvested and stored before sterilising cancer therapy. Following cure, the stored tissue could be autotransplanted, with restoration of natural fertility, or these stored cells could be matured in vitro until they reach a sufficiently mature stage for fertilisation via assisted reproduction [ 4 Schlatt S. von Schonfeldt V. Schepers A.G. Male germ cell transplantation an experimental approach with a clinical perspective. Br. Med. Bull. 2000; 56: 824-836 Crossref PubMed Scopus (32) Google Scholar , 5 Brinster R.L. Zimmermann J.W. Spermatogenesis following male germ-cell transplantation. Proc. Natl. Acad. Sci. USA. 1994; 91: 11289-11302 Google Scholar , 6 Clouthier D.E. Avarbock M.R. Maika S.D. Hammer R.E. Brinster R.L. Rat spermatogenesis in mouse testis. Nature. 1999; 371: 418-421 Google Scholar , 7 Avarbock M.R. Brinster C.J. Brinster R.L. Reconstitution of spermatogenesis from frozen spermatogonial stem cells. Nature Med. 1996; 2: 693-696 Crossref PubMed Scopus (291) Google Scholar , 8 Newton H. The cryopreservation of ovarian tissue as a strategy for preserving the fertility of cancer patients. Hum. Rep. Update. 1998; 4: 237-247 Crossref PubMed Scopus (85) Google Scholar , 9 Oktay K. Nugent D. Newton H. Salha O. Gosden R.G. Isolation and characterization of primordial follicles from fresh and cryopreserved human ovarian tissue. Fertil. Steril. 1997; 67: 481-486 Abstract Full Text PDF PubMed Scopus (247) Google Scholar , 10 Oktay K. Karlikaya G.G. Aydin B.A. Ovarian cryopreservation and transplantation basic aspects. Mol. Cell. Enodcrin. 2000; 169: 105-108 Crossref PubMed Scopus (56) Google Scholar ]. The future use of harvested gonadal tissue is an exciting new area of gamete biology which raises a wide range of ethical and legal issues. We review the impact of treatment for childhood cancer on future fertility, explore the available clinical and experimental options and the effects such interventions may have on the offspring.