Cancer affected prepubertal boys can now preserve their fertility potential

• First of its kind in the country, fertility preservation programto benefit cancer affected prepubertal boys, in collaboration with University of Muenster, Germany and Centre for Fertility Preservation, Manipal University, Manipal.

Mumbai: For the first time in the country, the Centre for Fertility Preservation, KMC Manipal has achieved a milestone by providing fertility preservation care to the cancer affected prepubertal boys.

Gonadal damage leading to infertility is a relatively common consequence of the treatments used to cure childhood cancer as the testes have a low threshold for damage induced by commonly used anticancer drugs and radiation. Although adult patients have established options to preserve their fertility before cancer therapy, the methods for prepubertal boys remain at experimental stage due to incomplete sperm production process (spermatogenesis) in the body before puberty. Recently, studies have shown that boys undergoing oncological treatments are associated with a high risk of infertility, hence should be offered testicular tissue banking (cryopreservation) in order to protect their future fertility.

Fertility preservation centre, which is recently established by the Manipal University has successfully cryopreserved testicular stem cells from two boys diagnosed with lymphoma, a kind of blood cancer. The centre will maintain the immature germ cells until the patients attain adulthood and ready to start their own family. In parallel, centre is researching on the derivation of mature sperm cell from prepubertal tissue.

“India is seeing increased incidence of childhood cancer in boys and due to advancements in cancer treatment, there is a tremendous increase in the number of cancer survivors. However, oncofertility (fertility preservation) researchin India is still in its infancy and we are glad that Fertility Preservation Centre has taken a challenging task to help cancer affected boys” said Dr Vinod Bhat, Vice Chancellor of Manipal University.

The centre has consortium members from specialities such as IVF scientists, Paediatricians, Oncologists, Surgeons and Gynaecologists. “As India does not have such specialized facility, our centre will soon serve as a national resource for cancer affected children so that testicular tissues collected from the other hospitals anywhere in the country can be transported to Manipal for banking purpose”said Dr Satish Kumar Adiga, who is heading the fertility preservation program in Manipal.

Using animal models, several advancements are being made in this direction in Germany and other European countries to successfully cryopreserve pre pubertal germ cells and derive mature spermatozoa outside the bodybut so far, this approach is purely experimental. “We are collaborating with various research institutes in the world including ManipalUniversity to develop a technique of mimicking the entire process of mammalian spermatogenesis in a culture dish”said Dr Stefan Schlattan Adjunct Professor to Manipal University who is also heading the fertility preservation program in Germany and has a special interest in fertility preservation for oncological paediatric patients. “However, due to increased risk, blood born cancers will not be the first choice as it appears difficult to transfer cells from these patients due to absence of efficient sorting of cancer cells and expansion strategies” he added.

“Our collaborator in Muenster and many European partners have opened cryobanks in Europe and that standards are developed to harmonize and optimize procedures. Manipal will soon join these network as a first in India” said Dr Adiga.

Germ cells are retrieved from one of the testicles by a simple biopsy before the commencement of the cancer therapy. ‘This is relatively a simple surgical procedure and does not affect the future sexual function of the children’ said Dr Vijaykumar,a paediatric surgeonwho performed the surgical removal of germ cells from the testis.

“This is a significant step forward towards providing fertility care by our team” said Dr PoornimaBaliga, Dean, Kasturba Medical College, Manipal.

The centre is also involved in cutting edge research onkey issues such as isolation, preservation, and effective derivation of testicular stem cells and their subsequent differentiation into functionally competent spermatozoa by various approaches. “Interestingly, we are seeing promising results with Indian medicinal plants in protectingmale germ cells from cancer treatment induced toxic effects” said one of the senior researchers in the centre Dr Guruprasad Kalthur who has a special interest in chemo protection.

Alexander von Humboldt foundation which is a non-profit organization established by the Federal Republic of Germany to promote international research cooperation is supporting the activities of the centre with other Indian agencies such as Department of Science and Technology and Indian Council of Medical Research.