A man who survived childhood cancer has become the first known recipient of a transplant involving sperm-producing stem cells, in an effort to restore fertility in young cancer survivors.
Jaiwen Hsu was just 11 years old when a leg injury revealed he had bone cancer. Doctors believed chemotherapy could save his life, but it would likely leave him infertile. Hsu’s parents enrolled him in a study at the University of Pittsburgh Medical Center, where researchers were freezing testicular cells from boys with cancer to preserve their future fertility.
Now 26, Hsu is the first adult to test if reimplanting these cells can restore his fertility. “The science is so new that it’s kind of a waiting game,” Hsu said. “We’re crossing our fingers and hoping for the best.”
While the idea of discussing fertility during a child’s cancer diagnosis may seem unusual, 85% of children with cancer survive into adulthood, though about one in three face infertility due to chemotherapy or radiation. While young adults can bank sperm or eggs before treatment, prepubertal children have no such option as they don’t yet produce mature sperm or eggs.
Researchers, funded by the National Institutes of Health, have been exploring how to preserve and use testicular stem cells to restore fertility. Boys are born with stem cells in their testes that can produce sperm once puberty begins. Since 2011, Dr. Kyle Orwig’s team at Pitt has been collecting and freezing testicular tissue from about 1,000 boys.
Though it’s unclear if each sample contains enough viable stem cells, Orwig’s team had success in 2019 when they used frozen testicular tissue from a young male monkey to create a healthy baby through IVF. By 2023, they were ready to transplant the cells back into cancer survivors like Hsu.
In November 2023, Hsu became the first person to receive the transplant, although he’s not yet ready to start a family. “We’re not expecting a miracle,” Orwig said. The procedure, guided by ultrasound, was safe and easy, but it’s still too early to know if it will be successful. Animal studies suggest assisted reproduction techniques will be needed to detect small amounts of sperm.
Orwig hopes the research will encourage more families to consider fertility preservation, offering more options for the future. Similar research has been conducted by Belgian scientists, who implanted testicular tissue rather than individual cells in a childhood cancer survivor.
“These developments are critical,” said Ellen Goossens, a researcher at Vrije Universiteit Brussel. “While animal studies are promising, human transplantations will ultimately determine if this approach works.”
Research into preserving fertility for female childhood cancer survivors is also underway, with Dr. Mahmoud Salama of Michigan State University noting similar efforts involving immature ovarian tissue.
For Hsu, even if his experimental transplant doesn’t succeed, he sees its value in advancing future research. “I’m grateful that my parents made that choice years ago, giving me the option to make decisions for myself today.”
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