It is important to know that these techniques do not protect against the effects of chemotherapy. Your oncologist and radiation oncologist can tell you if these options are appropriate for your son. EXPERIMENTAL OPTIONS FOR SAVING FERTILITY IN PATIENTS BEFORE AND AFTER PUBERTY Testicular tissue cryopreservation is performed in the operating room. A small piece of testicular tissue is removed from one or both testes. The tissue is frozen to be used in the future when the patient is ready to become a parent. If the patient has entered into puberty and the testes are making sperm, the sperm could be removed from the tissue and banked for future use. Sperm production typically starts between 13 and 14 years of age. Patients that have not yet entered into puberty may have testicular tissue frozen for future use. Research is ongoing to develop technology to mature or grow sperm from testicular tissue. This is experimental and untested and there is no guarantee the tissue cryopreservation will be useful in the future. This option should only be performed as part of an Institutional Review Board approved research. Testicular tissue cryopreservation is the only option available for males who have not entered into puberty. This option requires surgery which should be performed before treatment starts. Insurance may or may not pay for this treatment. In addition to the annual storage fees to keep tissue frozen, there may also be additional fees for laboratory studies, processing, and freezing the tissue. Insurance may not pay for these tests. The billing specialists working with the fertility preservation team will be able to provide you information regarding costs and you should check your individual insurance coverage as well. OPTIONS FOR SAVING FERTILITY IN PUBESCENT PATIENTS Sperm banking is an established method of fertility preservation. There have been thousands of successful pregnancies worldwide using this method, even in sperm frozen for decades. Illness, medications, and stress may prevent the body from making sperm. It is possible to bank sperm after the initial dose of chemotherapy, although the sperm count may be low and sperm cells may have been damaged by chemotherapy. Sperm may be obtained in several different ways. The most common method to obtain sperm for freezing is through masturbation. This is typically done at a repro- ductive medicine center. Patients may be asked to provide 1–3 samples of semen which will be frozen for future use. There are other options for retrieving sperm if a young man is not able to masturbate. The most common method is testicular sperm extraction (TESE). This option requires surgery to remove sperm from the testicle. This operation is not offered in most
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