Stem cell–based options to preserve male fertility

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Science  22 Mar 2019:
Vol. 363, Issue 6433, pp. 1283-1284
DOI: 10.1126/science.aaw6927

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An increasing number of adult men face subfertility or even permanent infertility due to a loss of spermatogonial stem cells as a side effect of pediatric gonadotoxic treatments, including cancer therapies as well as treatments for benign sickle cell disease or thalassemia (1, 2). Adult men can cryopreserve sperm as a fertility reserve, but prepubertal patients do not have this option. Removal and cryobanking of testicular tissue containing spermatogonia could offer a strategy to preserve the prepubertal individual's germline (1). Although cryobanking has started, there are currently no protocols available to derive sperm from the banked tissue. Advances in this research field are imperative. The primary treatment of severe male infertility is intracytoplasmic sperm injection (ICSI) into an oocyte. Although after its first description in 1992 the implications and risks associated with ICSI have been intensely debated, the technique has developed into a globally accepted therapy and has meanwhile led to the birth of hundreds of thousands of children (3). A major difference of ICSI to natural fertilization is that only a few spermatozoa are required to achieve successful fertilization. Therefore, even inefficient strategies to generate limited numbers of sperm allow treatment of male infertility. On page 1314 of this issue, Fayomi et al. (4) show that sperm isolated from grafted macaque testicular tissue fragments have the full potential to produce a healthy baby by using ICSI. Therefore, autografting of immature testicular tissue may become an option for human male fertility preservation.