Pioneering procedure transplants the testicular tissue of a young man that was frozen before he underwent chemotherapy.
Doctors in Edinburgh have successfully transplanted frozen testicular tissue in what’s could be a huge breakthrough for the preserving male fertility.
In 2023, a then 19 year-old student – who wishes to remain anonymous – with a serious blood disorder had testicular tissue removed and frozen prior to undergoing a bone marrow transplant. That treatment involves high-dose chemotherapy which can permanently damage the cells that produce sperm. Children and young people who undergo such treatment are at risk of infertility in adulthood. Indeed, earlier this year, three years after the young man’s treatment, tests showed no sperm in his semen.
So, in August, doctors at NHS Lothian in Edinburgh transplanted some of his previously frozen testicular tissue back into his body. The trial procedure was underpinned by a decade’s worth of research carried out by the University of Edinburgh. It is the first of its kind operation in the UK and only the second reported worldwide.
The young man has recovered well and will now be closely monitored. In six months’ time, some of the transplanted tissue will be removed and examined to determine whether sperm have been produced. If so, this procedure could lead to more patients who have had testicular tissue preserved before undergoing sterilising cancer treatment to restore their fertility.
There’s a lot of interest in the potential of this technique as a way to restore fertility in boys and young men who undergo cancer treatment and other such treatments at a young ago. For adolescent and adult males, semen freezing is an established method of preserving fertility – but it is not available to prepubertal boys because they do not yet produce sperm. As such, there is currently no established clinical method to restore fertility in boys who undergo such treatments. The pioneering work in Edinburgh could help change that.
Researchers at the University of Edinburgh have spent more than a decade developing a clinical research programme to preserve testicular tissue from boys before they undergo potentially sterilising treatment. The tissue contains spermatogonial stem cells, responsible for producing sperm from puberty onwards. By freezing the tissue before treatment, doctors hope that it can later be transplanted back into the patient and allow sperm production.
A large number of patients could benefit from such procedures. More than 1,200 patients in the UK and 3,100 worldwide have now had testicular tissue stored for potential future clinical use.
The Edinburgh testicular project was established in 2015 through funding from Children with Cancer UK in 2015, and has since grown into a national programme. In 2024, the charity provided further funding to support the transplantation study. The procedure carried out on the young man in Edinburgh follows research in non-human primates, where mature sperm produced by the transplanted tissue were subsequently used in assisted reproduction, resulting in a live birth.
The approach was first demonstrated in a human patient in Belgium earlier this year; the transplanted testicular tissue subsequently produced mature sperm.
The unnamed UK-based patient says: ‘Fertility is something I’ve struggled with personally for a long time. I’ve always wanted to have children of my own but at some point, I found myself starting to slowly accept that that might never be possible for me. Having this procedure has given me genuine hope for the future. We don’t know yet whether it will work, but knowing that there is now even a possibility means more to me than I can really put into words. I’m incredibly grateful to everyone for giving me this opportunity and for all the work that has made it possible. I also hope that being part of this research means that, in the future, other young people in the same position can have that hope too.’
Rod Mitchell, Professor of Developmental Endocrinology at the University of Edinburgh’s Institute for Regeneration and Repair and Consultant Paediatric Endocrinologist at NHS Lothian, and the leader of the study, adds: ‘This is a big step towards helping boys facing treatments that damage their fertility to have children of their own. Ten years ago, we started our research programme to freeze and store pieces of testicle from boys before they start chemotherapy, to preserve their fertility. We are beginning to see some of these young men return to explore their fertility options. This study offers real hope for future fertility in boys facing cancer treatment.’
Tracey Gillies, Medical Director at NHS Lothian, says: ‘This landmark procedure is an important step forward for young people whose future fertility may be affected by the treatment they need to overcome serious illness. The collaboration between NHS clinicians and researchers at the University of Edinburgh highlights the strength of clinical research in Edinburgh and our shared commitment to improving outcomes for patients across Scotland. This is a significant piece of world-leading work, and we are grateful to the patient and his family for helping advance research that could transform care for others in the future.’
Photo: César Badilla Miranda / Unsplash
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