What is Testicular Tissue Freezing?
This is an experimental technique to preserve fertility in men. It is also called testicular tissue cryopreservation or testicular tissue banking.
Testicles, also called testes, are a part of the male reproductive system. They produce sperm and the hormone testosterone. However in young boys who have not yet gone through puberty, they only contain sperm stem cells.
In testicular tissue freezing, doctors freeze the cells in the testicle along with a small section of the surrounding tissue, in order to restore fertility in the future 1 Oxford University Hospitals NHS Foundation Trust. Testicular Tissue Cryopreservation: Parent/Carer. Internet. 2016. Available from: https://www.ouh.nhs.uk/patient-guide/leaflets/files/13065Ptesticular.pdf.
Who would benefit from this procedure?
- Young boys who have been diagnosed with diseases such as cancer, and need to undergo treatment which could affect their fertility. The body only produces sperm after puberty, which is why sperm freezing is not an option for these patients.
- Men who do not produce viable sperm in their semen. This is called azoospermia 2 Human Fertilisation and Embryology Authority. Fertility Preservation. Internet. 2017. Available from: https://www.hfea.gov.uk/treatments/fertility-preservation/.
How does it work?
Step 1: Testing
Firstly you will need to undergo tests for viral infections which may affect how your tissue is stored.
Step 2: Tissue Collection
Doctors collect the tissue in a short surgical procedure, and you will be under general anaesthetic. The surgeons will perform a testicular wedge biopsy.
This means that they will remove a wedge-shaped section of testicular tissue from the scrotal sac. This does not damage the testicles at all, and in most cases you will be able to go home on the same day [1[/mfn].
Step 3: Freezing the tissue
Scientists prepare the tissue with chemicals called cryoprotectants to protect it from damage during the freezing process. Then they freeze the tissue at temperatures of around -170°C using liquid nitrogen.
Step 4: Using the tissue to have a child
At this point in the future, it is likely that new ways of using the tissue will be available to you. Therefore you will be able to discuss the best option for you with your doctor. This may involve surgery to re-implant the tissue.
What are the chances of success?
This is an experimental technique which has only recently come to the UK. There have been promising results in animals, but there have not been any children born using human sperm from frozen testicular tissue yet.
This is because patients have not yet used their frozen tissue, and many patients are young boys who are not yet starting a family. However success rates will become available as this happens [1[/mfn].
Scientists are in the process of developing new ways to use the frozen testicular tissue in future. These include transplanting the tissue back into the patient and maturing the sperm cells from the tissue in the lab.
Therefore in patients with falling fertility who cannot freeze their sperm, testicular tissue freezing may be worth considering. Overall it is a promising way to keep as many options open as possible for you in the future, and it maximises your chances of being able to have a biological child someday.
Is it a good option for me?
There are risks involved with this as there are with any medical procedure, and your doctor will explain these to you. These include a risk of infection, for which doctors will give you antibiotics before the procedure.
Additionally there are higher risks depending on your health. If you have cancer, some types including leukaemia and lymphoma are more likely to contaminate the testicular tissue. However doctors will do everything they can to minimise this risk by screening the tissue before storage.
Furthermore, they will screen the tissue after storage when you want to use the tissue. In the future scientists believe they will have more thorough methods to examine the health of the frozen tissue. Therefore scientists will be able to apply the latest and most accurate techniques to your sample.
As this is an experimental procedure, it is not widely available yet. However there are centres carrying out testicular tissue freezing in Edinburgh and Oxford.
You should discuss your options for fertility preservation with your doctor to form a tailored treatment plan for you. This will help you maximise your fertility and your health.
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Dr. Jones is an experienced consultant in assisted reproduction.
He has worked as a Fertility specialist at Kingston Hospital Assisted Conception and nearly 10 years experience of working in Obstetrics and Gynaecology across hospitals in the UK.
He completed his Masters in Assisted Reproduction Technology and then his PhD, from Imperial College London. Dr. Jones main areas of interest are Single Embryo Transfer, Endometriosis, PCOS and Implantation failure in IVF patients. He is a member of the British Fertility Society and an associate member of the Royal College of Obstetrics and Gynaecology.
- 1Oxford University Hospitals NHS Foundation Trust. Testicular Tissue Cryopreservation: Parent/Carer. Internet. 2016. Available from: https://www.ouh.nhs.uk/patient-guide/leaflets/files/13065Ptesticular.pdf
- 2Human Fertilisation and Embryology Authority. Fertility Preservation. Internet. 2017. Available from: https://www.hfea.gov.uk/treatments/fertility-preservation/