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WASHINGTON — In a groundbreaking development for childhood cancer survivors, a man who overcame cancer in his youth has undergone a pioneering transplant of sperm-producing stem cells. This innovative study seeks to restore fertility in individuals who faced cancer as children.
Experimental Stem Cell Transplant Offers Hope for Fertility Restoration After Childhood Cancer
Jaiwen Hsu experienced a life-altering diagnosis of bone cancer at the age of 11 following a leg injury. While chemotherapy offered a chance at survival, doctors cautioned it could lead to infertility. His parents, seeking options for his future, learned about researchers at the University of Pittsburgh Medical Center (UPMC) who were exploring fertility preservation by freezing testicular cells from young boys with cancer. They enrolled Hsu in this forward-thinking program.
Now 26, Hsu has become the first participant from this program to return as an adult and evaluate the potential of reimplanting these cryopreserved cells to re-establish reproductive capacity.
A Waiting Game with Optimism
“The science in this realm is remarkably nascent, placing us in a period of anticipation,” Hsu, a resident of Vienna, Virginia, stated. “We are hopeful, with fingers crossed for a positive outcome.”
Addressing Infertility in Cancer Survivors
Discussing future fertility might seem premature when a family is grappling with a child’s cancer diagnosis. However, with approximately 85% of children with cancer now surviving into adulthood, infertility emerges as a significant concern for around one-third due to the effects of chemotherapy or radiation.
While young adults facing cancer can utilize options like banking sperm, eggs, or embryos prior to treatment, children diagnosed before puberty lack this choice because they are not yet producing mature reproductive cells.
Pioneering Research at University of Pittsburgh Medical Center
Boys are born with stem cells within the testes, crucial for sperm production triggered by testosterone during puberty. Kyle Orwig, a reproductive scientist at UPMC, with support from the National Institutes of Health (NIH), is dedicated to researching methods to preserve and potentially utilize these testicular cells to reinstate fertility.
The process begins with a minimally invasive procedure to extract a small sample of testicular tissue containing millions of cells, including valuable sperm-producing stem cells. Since 2011, Dr. Orwig’s team has cryogenically preserved samples from approximately 1,000 prepubescent boys.
Assessing the precise number of viable stem cells within each minuscule sample remains challenging. However, in a significant step forward in 2019, Dr. Orwig successfully used preserved testicular tissue from a young male monkey, leading to the birth of a healthy baby monkey through an animal equivalent of IVF.
Human Trials and Future Prospects
By 2023, Dr. Orwig was prepared to reimplant the preserved cells into now-adult cancer survivors. Hsu, although not currently planning a family but intrigued about the long-term implications of his earlier participation, contacted the research team.
“We are managing expectations regarding immediate results,” cautioned Dr. Orwig, whose team performed the transplant of Hsu’s thawed cells in November 2023.
Initial Findings and Continued Research
In a report released online this week, Dr. Orwig indicated that the injection procedure, guided by ultrasound for precise placement, was safe and straightforward. This research is currently undergoing peer review within the scientific community.
Dr. Orwig emphasized that definitive conclusions regarding the procedure’s success are premature. Standard tests might not be sufficient, as animal studies suggest that assisted reproduction techniques were necessary to identify and retrieve minimal quantities of sperm. Nevertheless, he hopes this ongoing investigation will raise awareness among families about fertility preservation options, ensuring the availability of choices should this innovative approach become viable.
Global Research Efforts
Belgian researchers announced a parallel study in January, involving the implantation of testicular tissue fragments rather than isolated cells in a childhood cancer survivor.
“These advancements are remarkably significant,” stated researcher Ellen Goossens of Vrije Universiteit Brussel. While animal model research has shown “considerable promise,” human transplants are essential to definitively determine the efficacy of this technique.
Parallel Research for Female Survivors
Similar research focused on immature ovarian tissue is also underway for female childhood cancer survivors, according to Dr. Mahmoud Salama, director of the Oncofertility Consortium at Michigan State University.
Patient Perspective and Gratitude
Hsu acknowledges that even if his experimental transplant does not yield immediate success, it will contribute valuable insights for future research. He expressed gratitude for his parents’ decision years ago, stating it “provided me with the autonomy to make this decision for myself today.”