A ONE-YEAR-OLD boy has become the youngest person in Scotland to have part of his testicle removed and frozen after chemotherapy threatened to destroy his ability to have children in future.
The cutting edge research being spearheaded at Edinburgh University has so far treated seven pre-pubescent boys up to the age of 14 since launching in 2016, but the toddler is the youngest patient to date.
Scientists hope that advances in technology will enable them harvest sperm 'stem cells' from the tissue in future and transplant either these, or the whole testicle sample, back into the boy's genitals once he is an adult to restore fertility. A third option could be growing sperm from the stem cells in the laboratory.
The process has been demonstrated successfully in mice, but is yet to be proven effective in humans.
Dr Rod Mitchell, a consultant paediatric endocrinologist who is heading up the research at the Centre for Reproductive Health in Edinburgh, said: "The tissue is being stored for them to use. But at the moment we don't know how we would make that happen. That's what the research is about."
Most of the boys had been diagnosed with cancer, but the procedure is also being offered to patients with other illnesses requiring chemotherapy or radiotherapy. Anything from 10 to 50 per cent of a testicle is removed for cryo-preservation.
Adult males and older teenage boys can easily provide sperm samples to be frozen and stored for future use, the immature sexual organs of younger boys and infants contain only 'stem cells' for future sperm. These stem cells can be destroyed during chemotherapy and radiotherapy, leaving them infertile.
While the majority of children and young people who recover from cancer treatment will suffer no long-term reproductive difficulties, the researchers want to see fertility preservation offered routinely on the NHS to boys and girls undergoing aggressive treatments which put them at higher risk of infertility.
In girls this can mean removing and freezing part of an ovary - a technique pioneered in Edinburgh in 1993 - or in adolescents, using hormones to generate egg production.
Adult cancer patients of reproductive age are already automatically referred to NHS IVF clinics where sperm and egg samples can be taken and stored, but provision for under-18s is patchy throughout the UK.
The situation was highlighted at the first 'UK Fertility Preservation Annual Meeting' in Edinburgh.
Dr Mitchell said awareness of the service among oncologists and clinicians was high in the Lothians region, but poor elsewhere in Scotland. He said: "I think there are some places as well where I think they don't realise this treatment is available. That is one of our biggest aims - to let more people know about it."
Professor Richard Anderson, who is chairing a Scottish Government working group examining how to improve provision of fertility preservation for cancer patients, said there was "no question" it would be extended on NHS Scotland to children and teenagers.
He added: "The question is just who gets it and how we fund it."
Prof Anderson was among the team of Edinburgh scientists who pioneered ovarian cryopreservation in the 1990s. The researchers, who also included Professors David Baird and Hamish Wallace, were the first to show that ovarian tissue obtained via keyhole surgery could be frozen long-term to preserve it fertility and ultimately used to conceive at a later date.
It was a major breakthrough for female survivors of cancer therapy who were facing infertility. At the time, egg freezing was not available.
In 1997, Edinburgh was the first place in the world where ovarian cryopreservation was introduced into clinical practice.
The first baby born as a result of this technique was born last year in England, to a woman who had frozen her ovarian tissue aged eight while undergoing cancer treatment.
Until recently, research into a similar intervention for young boys has lagged behind.
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