Prévention des risques d’infertilité liés aux traitements antitumoraux dans le cancer du testicule

In recent years, chemo- and radiotherapy for cancer patients have become increasingly successful, and sustained remissions have been achieved. However in young men, most of the current therapies still presently induce temporary or permanent infertility without any means of prediction. This is also true in the case of testicular cancer which is now the most frequent cancer in young adults males. Moreover, this problem is particularly crucial in patients with a testicular cancer since they have a poor semen quality before any antitumoural therapy. The present paper largely based on data accumulated over 25 years at CECOS Paris Cochin reviews the modalities and clinical usefulness of semen cryopreservation in young men with testicular cancer. Recent use of cryopreserved semen samples through ART has provided a growing number of pregnancies. These new data strongly demonstrate that semen cryopreservation should be offered to all men diagnosed with a testicular cancer since it provides the only reasonable chance of establishing a pregnancy after therapy.     

Place de l'autoconservation de sperme chez l'homme: Analyse d'une étude rétrospective

Cryopreservation of semen of patients with malignant diseases (testicular cancer. Hodgkin' disease and lymphoma) is a realistic option to preserve fertility of young patients before chemotherapy and/or radiation or sugery. We show here the results of a retrospective study in Cecos-Tours of cryopreservation between 1980 to 1990 and its outcome in 1995, in comparison with the national retrospective study of French Cecos Federation.This survey demonstrates an increase in cryopreservation demands and in the % of cryopreserved semen, especially in testicular cancer where semen alterations are significantly more important, because of the progress in assisted reproductive technology, particularly the efficacy of ICSI in low spermatozoal densities.In the absence of a real spermatogenesis protection in human, semen cryopreservation is an absolute indication before such treatments detrimental for fertility potential.     

Semen from rainbow trout produced using cryopreserved spermatozoa is more suitable for cryopreservation

Oocytes from three female rainbow trout Oncorhynchus mykiss were inseminated separately with untreated or cryopreserved semen, which had been produced using either untreated (three males) or cryopreserved (three males) spermatozoa. In half of variants, the cryopreservation did not significantly affect fertilization efficiency. Regardless of whether the sperm donors were produced from cryopreserved or intact semen, insemination of oocytes with their intact sperm resulted in the same percentage of eyed embryos (94.4 and 94.3%, respectively). When eggs were inseminated with cryopreserved semen, the use of sperm from males produced with cryopreserved spermatozoa resulted in a significantly higher percentage of eyed eggs than in case of donors produced with intact sperm (89.6 and 81.7%, respectively). The production of rainbow trout using cryopreserved sperm does not appear to negatively affect reproductive abilities of male progeny and semen from donors, which were produced using cryopreserved sperm, is more suitable for cryopreservation than the semen from donors produced with intactspermatozoa.     

Cryopreservation of Human Ovarian Tissue

New and often aggressive treatment schemes allow the successful healing of many young patients with cancer, but the price the young women have to pay is high: many of them lose ovarian function and fertility. Due to the improved long-term survival of adolescents and young women with malignancies undergoing gonadotoxic chemotherapy, preservation of future fertility has been the focus of recent ubiquitarian interest. A feasible solution is the cryopreservation of ovarian tissue. Ovarian tissue, after thawing, can be used in three different ways: 1. grafted into its normal site (orthotopic); 2. grafted into a site other than its normal position (heterotopic), necessitating recourse to in vitro fertilization (IVF); 3. grown and in vitro matured in order to obtain metaphase II oocytes for an IVF program. It is believed that protein supplementation, in cryopreservation solution, is essential for improving ovarian tissue cryopreservation. The aim of this study was to evaluate the ultrastructural appearance of human ovarian tissue cryopreserved in 1.5 M 1,2 propanediol (PROH), 0.2 M sucrose using different protein sources: fetal calf serum (FCS), plasmanate or syntetic serum substitute (SSS). Fresh and frozen/thawed ovarian tissues were compared by transmission electron microscope (TEM), to evaluate the appearance of stromal and follicle cells as affected by different protein sources. Our data indicate that FCS is a better protein support for ovarian tissue cryopreservation when compared to SSS or Plasmanate. In addition the follicles are more resistant to the cryopreservation with respect to stroma.     

Apyrene sperm from the triploid donors restore fecundity of cryopreserved semen in Bombyx mori

Female moths of Bombyx mori were artificially inseminated with cryopreserved semen. The fertility of inseminated females varied from 0% to 76.9% depending on the strain. Addition of fresh semen from triploid males, which are infertile but whose semen includes intact apyrene sperm, greatly improved fecundity of cryopreserved semen from normal males. Frozen apyrene sperm from the triploid donors also improved the fecundity of females, inseminated with cryopreserved normal semen, but less than fresh semen from triploid males. Fertilization success in B. mori requires the presence of both, intact eupyrene and apyrene sperm. Our results show that eupyrene sperm tolerate the cryopreservation process better than apyrene sperm. Hence, we recommend to add apyrene sperm from the triploid donors as helper sperm routinely to cryopreserved semen in artificial insemination. This may advance the application of cryopreservation as a routine technique to maintain silkworm resources. The technique may also be applicable to other moth and butterfly species which, like B. mori, possess eupyrene and apyrene sperm.     

Ovarian Stem Cells (OSCs) from the Cryopreserved Ovarian Cortex: A Potential for Neo-Oogenesis in Women with Cancer-Treatment Related Infertility: A Case Report and a Review of Literature

Cancer treatment related infertility (CTRI) affects more than one third of young women undergoing anti-cancer protocols, inducing a premature exhaustion of the ovarian reserve. In addition to ovarian suppression by GnRHa, oocyte and cortex cryopreservation has gained interest in patients with estrogen-sensitive tumors for whom the hormonal burst to prompt the multiple follicular growth could provide a further pro-life tumor pulsing. On the other hand, cortex reimplantation implies a few drawbacks due to the unknown consistency of the follicles to be reimplanted or the risk of reintroducing malignant cells. The capability of ovarian stem cells (OCSs) from fresh ovarian cortex fragments to differentiate in vitro to mature oocytes provides a tool to overcome these drawbacks. In fact, since ovarian cortex sampling and cryopreservation is practicable before gonadotoxic treatments, the recruitment of OSCs from defrosted fragments could provide a novel opportunity to verify their suitability to be expanded in vitro as oocyte like cells (OLCs). Here, we describe in very preliminary experiments the consistency of an OSC population from a single cryopreserved ovarian cortex after thawing as well as both their viability and their suitability to be further explored in their property to differentiate in OLCs, thus reinforcing interest in stemness studies in the treatment of female CTRI.     

Effects of media,fertilization technique,extender, straw volume,and sperm to egg ratio on hatchability of cyprinid embryos,using cryopreserved semen

To enable cryopreservation of fish semen to become an efficient, routine technique, much more detailed information is required. Therefore, the present study was conducted to investigate various fertilization techniques and media, straw volumes as well as optimal semen volume for cryopreservation. The bleak (Chalcalburnus chalcalburnus) was used as the main model for investigation. Using frozen-thawed semen the fertilization rate was similar up to the morula stage, independent of the fertilization technique. Thereafter, in egg batches fertilized using the wet technique most embryo development stopped. In egg batches fertilized using the dry technique, embryonic development proceeded normally. For cryopreserved semen full activation of sperm motility was obtained at ratios of fertilization media (hatchery water and all tested types of saline solutions) to semen of 10:1. Sperm motility rate was much higher in the saline solutions than in water. In contrast hatching rates were higher when water was used as fertilization medium. Therefore, the requirements necessary for optimal sperm motility and optimal sperm-egg contact were different and so for these parameters optimal levels could not be achieved. When adjusting the freezing and thawing conditions 0.5ml straws as well as larger straws (1.2ml) proved suitable for cryopreservation of cyprinid semen. The highest fertilization rates were obtained with sperm to egg ratios of (1.3-2.5) x 10(6):1 and were 77-92% of fresh semen control. This was also similar for Ch. nasus, R. meidingerii, B. barbatus and C. carpio and suggests that the cryopreservation requirements of spermatozoa are not species specific.     

Génotoxicité des chimiothérapies et radiothérapies: Quelles sont les conséquences pour le spermatozoïde humain?

The prognosis of cancer in young men of childbearing potential has been considerably improved over recent decades as a result of therapeutic progress. Chemotherapy and radiotherapy have well known effects on spermatogenesis. Apart from quantitative and qualitative impairment of spermatogenesis, animal studies have also demonstrated nuclear lesions (aneuploidy, presence of adducts, DNA fragmentation, etc.) and sometimes lesions affecting the F1 and F2 generations. Chromosomal studies of human spermatozoa after radiotherapy have demonstrated an increased frequency of chromosomal anomalies. The first studies concerning the effects of chemotherapy used the heterospecific fertilization technique to demonstrate spermatozoal chromosomal anomalies. More recently, thefluorescence in situ hybridization (FISH) technique has been used to study several chromosomes on a large number of spermatozoa. The results of various studies based on small sample sizes vary as a function of the therapeutic protocol administered and the time of sperm collection in relation to the end of treatment. We studied 5 patients who provided a semen sample 6 to 17 months after completing the BOE chemotherapy protocol (Bleomycin, Etoposide, Cisplatin). We demonstrated an increased rate of aneuploid and diploid spermatozoa. The results of our study and those reported by R. Martin et al. [45, 47] suggest the possibility of a transient effect of chemotherapy on gamete chromosomes. Other studies, conducted in the context of Hodgkin’s disease, have demonstrated the transient nature of the aneuploidy effect. Apart from the harmful action on chromosomes, treatments could also damage spermatozoal DNA. Studies conducted on larger sample sizes and using other methods of analysis therefore appear to be essential. In the meantime, it appears preferable to systematically propose semen cryopreservation before treatment and to provide very cautious advice to patients desiring a pregnancy soon after completion of treatment.     

Inter-sample variability in post-thaw human spermatozoa

Semen cryopreservation is a useful tool for preserving fertility in men who have been diagnosed with cancer and will undergo chemotherapy, radiotherapy or testicular surgery. Semen is also commonly cryopreserved prior to its use in assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection. The post-thaw quality of banked sperm can vary, which may negatively affect fertilization rates. The objective of our study was to assess the pre-freeze and post-thaw variability of sperm parameters in patients who used our sperm banking services. Multiple samples obtained after a short period of sexual abstinence were examined for variation in sperm characteristics. Semen samples showed a high degree of post-thaw inter-sample variability in sperm motility, motion characteristics, and percentage cryosurvival rate compared with the pre-freeze inter-sample variability. Further research is necessary to understand the mechanism(s) responsible for this variability. This may also assist clinicians utilize semen samples with optimum semen quality in ART procedures.     

Utilisation des spermatozoïdes cryoconservés: fréquence et résultats

Semen cryopreservation has become a major activity of CECOS units. In 2002, 2,323 patients were referred to a CECOS unit for semen cryopreservation prior to radiotherapy or chemotherapy. Cryopreservation of one or several semen specimens was performed for 2,124 patients, which represents a total of more than 60,000 straws per year. The two diseases mainly concerned by cryopreservation prior to treatment with a high risk of sterilization are testicular cancer (about 40% of requests) and lymphomas (about 30% of requests). Specimens are generally stored for several years. The most frequent indications are testicular cancer (40% of the patients) and lymphomas (30% of the patients). Due to the continuing improvement of treatment, the subsequent fertility prognosis of patients has improved over recent years, but often remains difficult or even impossible to predict. An assessment of the effective use of these frozen gametes and the results obtained therefore appeared to be interesting. During 2002, 304 men requested the use of their cryopreserved semen. More than 1,000 straws were thawed and used for insemination (195 insemination cycles, 12 pregnancies obtained) orin vitro fertilization (25 conventional IVF cycles, 8 pregnancies; 257 IVF-ICSI cycles, 57 pregnancies). A retrospective cumulative study conducted in 2001 with the collaboration of 15 of the 23 CECOS units calculated, for each year, among patients in whom cryopreservation could be performed, the percentage of patients who subsequently requested the use of straws between the date of cryopreservation and 2001. This percentage varied between 5% and 10%, depending on the time since freezing. Calculation of the percentage of patients for whom destruction of straws was performed, either at the patient’s request, or because of the patient’s death, was also performed according to the same methodology. The percentage of destruction because of the patient’s death varied between 5% and 9%. The percentage of destruction of straws at the patient’s request was close to or greater than 15%, when the storage time exceeded 3 years. The percentage of patients lost to follow-up remains low in these indications for cryopreservation, ranging between 3% and 6% depending on the year. These data are globally coherent with the data reported in the literature. Although the use of straws is not the most frequent outcome of semen cryopreservation, freezing of gametes must nevertheless always be proposed to patients, as their subsequent fertility often remains difficult to predict. Progress in methods of medically assisted procreation also allow a good chance of pregnancy even when few viable spermatozoa have been preserved.     

The effect of antioxidants on the quality of cryopreserved semen in two salmonid fish, the brook trout (Salvelinus fontinalis) and the rainbow trout (Oncorhynchus mykiss)

Until now the supplementation of cryopreservation extenders with antioxidants has not been examined in teleost fish. Therefore, the present study investigated whether addition of antioxidants (catalase, superoxide dismutase, peroxidase, reduced glutathione, reduced methione, mixtures of reduced and oxidized glutathione or methionine) to the cryopreservation extenders could increase the quality of frozen-thawed semen of brook trout, Salvelinus fontinalis, and rainbow trout, Oncorhynchus mykiss. In brook trout and rainbow trout semen post-thaw fertility and motility were evaluated and in brook trout additionally the membrane integrity, DNA integrity, and sperm lipid peroxidation were evaluated. The tested antioxidants affected the motility parameters, DNA integrity, and fertility of cryopreserved semen, but not the membrane integrity. Most of the observed effects were negative and only minor positive effects were found. In brook trout 1.5 mmol/l reduced methionine and a mixture of 1.5 mmol/l oxidized and reduced glutathione increased the swimming velocity of frozen-thawed semen. One hundred U/l catalase, 1.5 mmol/l reduced glutathione, and 1.5 mmol/l reduced methionine slightly, but not statistically significantly increased the semen post-thaw fertility. However, these effects were not detectable in rainbow trout. Antioxidative stress or damage seems to play no role during cryopreservation, as also in the lipid peroxidation test no differences were obtained between fresh and cryopreserved semen. Therefore, for routine cryopreservation extender supplementation with antioxidants is not recommended in brook trout and rainbow trout.     

Cryopreservation of boar semen and its future importance to the industry

Whereas AI has arguably been the most important management tool leading to improved herd productivity, long-term storage of semen brings forth additional advantages to producers of agriculturally important animals and the AI industry. Semen cryopreservation greatly facilitates the distribution of agriculturally desirable genes, rapidly increasing herd productivity. Of particular importance to the pig industry, the use of frozen semen would help to control transmission of certain pathogens, thereby protecting the health status of the herd. Moreover, a reserve of cryopreserved semen would minimize the effects of a sudden outbreak of a contagious illness or a natural disaster. Successful cryopreservation of boar semen is necessary for international sales. Finally, effective gene banking depends on the availability of functional, cryopreserved germplasm. Despite these potential advantages of long-term semen storage, porcine sperm are notoriously sensitive to cold temperatures, and frozen-thawed semen is not routinely used by the industry. The objective of our laboratories is to develop protocols for efficient long-term storage of porcine semen using cryopreservation. We hypothesize that since the sperm plasma membrane is the primary site of cold-induced damage, reinforcing the membranes with molecules having particular properties, such as cholesterol, will improve the ability of boar sperm to withstand cold temperatures and cryopreservation protocols. Based on our data, such approaches should help alleviate the problems with sperm function after cooling, thereby resulting in better survival and motility characteristics, and reduced non-regulated capacitation and spontaneous acrosome reactions.     

New aspects of boar semen freezing strategies

Although cryopreserved boar semen has been available since 1975, a major breakthrough in commercial application has not yet occurred. There is ongoing research to improve sperm survival after thawing, to limit the damage occurring to spermatozoa during freezing, and to further minimize the number of spermatozoa needed to establish a pregnancy. Boar spermatozoa are exposed to lipid peroxidation during freezing and thawing, which causes damage to the sperm membranes and impairs energy metabolism. The addition of antioxidants or chelating agents (e.g. catalase, vitamin E, glutathione, butylated hydroxytoluene or superoxide dismutase) to the still standard egg-yolk based cooling and freezing media for boar semen, effectively prevented this damage. In general, final glycerol concentrations of 2-3% in the freezing media, cooling rates of -30 to -50 degrees C/min, and thawing rates of 1200-1800 degrees C/min resulted in the best sperm survival. However, cooling and thawing rates individually optimized for sub-standard freezing boars have substantially improved their sperm quality after cryopreservation. With deep intrauterine insemination, the sperm dose has been decreased from 6 to 1x10(9) spermatozoa without compromising farrowing rate or litter size. Minimizing insemination-to-ovulation intervals, based either on estimated or determined ovulation, have also improved the fertility after AI with cryopreserved boar semen. With this combination of different approaches, acceptable fertility with cryopreserved boar semen can be achieved, facilitating the use of cryopreserved boar semen in routine AI programs.     

The use of pentoxifylline to improve motility of cryopreserved equine spermatozoa

Pentoxifylline was evaluated as a method to increase motility of cryopreserved equine spermatozoa. In a preliminary experiment, pentoxifylline (3.5 mM or 7.0 mM) was added to extended semen that was chilled to 4 degrees C. Motility was evaluated at 8-h intervals for 48 h. The addition of 3.5 or 7.0 mM pentoxifylline appeared to increase the motility of chilled spermatozoa compared to controls. Based on these results, similar concentrations of pentoxifylline were added to semen either before or after cryopreservation. The addition of pentoxifylline (3.5 or 7.0 mM) to semen before cryopreservation significantly (P < 0.001) decreased total and progressive motility compared to controls. However, the addition of pentoxifylline (3.5 or 7.0 mM) to cryopreserved semen immediately after thawing significantly (P < 0.01) increased total and progressive motility compared to controls. These results indicate that pentoxifylline enhanced the postthaw motility of cryopreserved equine semen when added after thawing. Further research is required to evaluate the effect of pentoxifylline on the fertility of cryopreserved equine semen.     

Strategies for the storage of Ancylostoma caninum third-stage larvae

Although cryopreservation protocols for storage of hookworm larvae have been described, the circumstances under which the technique is necessary to ensure larval survival are not well defined. The motility of infective-stage larvae (as judged by observation) and their ability to migrate through canine skin in vitro were measured over a 7-mo period in worms held at room temperature and worms that had been cryopreserved at the start of the experiment. Cryopreserved worms showed motility and migration proportions of 45.6-48.0% and 26.8- 34.0%, respectively, throughout the experiment, compared with percentages of 92.7 and 84.1%, respectively, in the original fresh worms. Larvae held at room temperature showed a gradual decrease in motility and migration ability over the experimental period. Motility and migratory ability of cryopreserved larvae was only significantly higher (P < 0.01) than room temperature-stored larvae from 4 and 5 mo onward, respectively.     

Smooth muscle cell injury after cryopreservation of human thoracic aortas

The cryopreservation protocol we use for arterial reconstructive surgery has been studied to evaluate smooth muscle cell (SMC) structural integrity and viability before implantation. Samples of human thoracic aortas (HTA) were harvested from five multi-organ donors. Sampling included unfrozen and cryopreserved specimens. Cryopreservation was performed using RPMI with human albumin and 10% Me(2)SO in a controlled-rate freezing apparatus. Thawing was accomplished by submerging bags in a water bath (39 degrees C) followed by washings in cooled saline. In situ cell preservation as investigated by light and transmission electron microscopy showed that SMCs from cryopreserved HTA had nuclear and cytoplasmic changes. A TUNEL assay, performed to detect DNA fragmentation in situ, showed increased SMC nuclear positivity in cryopreserved HTA when compared to unfrozen samples. 7-AAD flow cytometry assay of cells derived from cryopreserved HTA showed that an average of 49+/-16% cells were unlabeled after cryopreservation. Organ cultures aimed to study cell ability to recover cryopreservation damage showed a decreasing number of SMCs from day 4 to day 15 in cryopreserved HTA. In conclusion, the cryopreservation protocol applied in this study induces irreversible damage of a significant fraction of arterial SMCs.     

猪精液冷冻保存影响因素的研究进展及展望

由于在经济生产中的重要意义,猪精液冷冻保存技术成为研究的焦点。早期的研究多集中在对冷冻保护剂和冷冻方法的筛选与优化上,为猪精液冷冻保存进行了深入的探索。但研究表明,无论采用何种冷冻保护剂、何种冷冻方法都损害了精子的受精能力,并伴随有蛋白质的丢失、表达量的改变、功能活性的增减等,这种研究现状迫使该领域的研究向充分揭示冷冻对精子损伤的机理方向转移,希望通过揭示冷冻保存所导致的蛋白质结构和功能改变的实质,充分阐明冷冻损伤的机理,为猪精液冷冻保存提供理论依据,并最终促进猪精液冷冻保存技术的快速发展。     

The cryopreservation of high concentrated PBMC for dendritic cell (DC)-based cancer immunotherapy

Peripheral blood mononuclear cells (PBMC) have been accepted as a unique material for cancer immunotherapy using dendritic cells (DC) or activated lymphocytes that are being developed as an alternative or adjuvant to conventional therapies such as surgery, chemotherapy and radiation treatment. Although successful cryopreservation of large numbers of PBMC is critical for the immunotherapy, subsequent functional study of the effects of PBMC cryopreservation on differentiation into immune cells has not been well defined. In this study, over 1.0 × 10⁸ cells/ml PBMC were cryopreserved as long as 52 weeks using a controlled-rate freezer (CRF) and stored in a vapor phase of liquid nitrogen tank. The effect of PBMC cryopreservation on differentiation into DC was studied by comparing the phenotypic and functional properties of immature DC (iDC) and mature DC (mDC) derived from cryopreserved PBMC to those from fresh PBMC. The results show that cryopreservation of PBMC at a fairly high cell concentration does not significantly affect cell recovery, viability, or phenotypes of PBMC. After differentiation into DC, iDC and mDC derived from cryopreserved PBMC had their typical phenotypes and function equivalent to those derived from fresh PBMC. Therefore, the improved cryopreservation process of PBMC described in this study is available for DC-based cancer immunotherapy.     

Addition of procyanidine to semen preserves progressive sperm motility up to three hours of incubation

Several studies on semen physiology and sperm fertilizing capacity have shown a beneficial effect of antioxidants. Procyanidine is a natural antioxidant, more efficient compared with vitamin C and E, with many applications in the food, agriculture, pharmaceutical and cosmetic industry. Thus, we tested whether the addition of procyanidine to the semen of infertile men has a beneficial effect on spermatozoa during their in vitro incubation and during the cryopreservation process. Semen samples of 25 infertile men were divided in to two aliquots, in which procyanidine was added or not. Semen analysis, measurement of sperm DNA fragmentation index (DFI) and measurement of reactive oxygen species (ROS) were performed 3 h after incubation at 37 °C and after sperm cryopreservation and thawing. In-vitro addition of procyanidine to semen of infertile men resulted in a lesser decrease in progressive motility [−4 (−31:+6) vs. −6 (−31:+5), p < 0.001] and total motility [−5 (−29:+3) vs. −9 (−32:+2), p < 0.001] after 3 h of incubation compared with no addition of procyanidine. Sperm morphology was decreased only in the control group after 3 h of incubation [2 (0:+6) vs. 1 (0:+4), p = 0.009]. Furthermore, a larger increase in sperm DFI was observed in the control compared with the procyanidine group [9 (−7:+27) vs. 3 (−3:+18), p = 0.005] after thawing of cryopreserved semen samples. In conclusion, in-vitro addition of procyanidine to the semen of infertile men exerts a protective effect on progressive motility during handling and after 3 h of incubation as well as on sperm DFI during the process of cryopreservation.     

Conservation de tissu testiculaire et maturation in vitro de la lignée germinale pour préservation du potentiel de reproduction avant traitement anticancéreux chez le garçon pré-pubère

Sperm auto-conservation before chimioradiotherapy allows preservation of future reproductive possibilities in case of malignancy in young adult male. Because of the lack of mature spermatozoa, such possibilities cannot be offered for boys before puberty, even though the rate of cure of childhood malignancies is high. This paper reviewed recent advances in reproductive technology, which open the field of withdrawal of immature germ cells in prepubertal boys for in vitro maturation and cryopreservation for future paternity. It has been shown that the main steps of male meiosis have been driven in vitro, allowing to obtain round spermatids from pachytene spermatocytes in the rat. In mice, cryopreserved round spermatids have been used for oocyte fertilization and gave rise to normal living pups. In humans pregnancies and living babies have been reported after microinjection of round spermatids in cases of azoospermia. One pregnancy has been obtained with a cryopreserved spermatid. Thus the project of withdrawal of testicular tissues before sterilizing treatment, in vitro maturation of spermatogonia into round spermatids and cryopreservation of immature germ cells for future use for assisted fertilization does not seem unrealistic since each step has been done individually. However developing animal models is necessary to study not only the efficiency of the whole procedure but also to check its harmlessness before clinical trials.