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Every year many women worldwide are diagnosed with cancer. More than 90% of cancer patients undergo invasive cancer therapy, such as chemo- and radiotherapy . Most chemotherapy regimens include the alkylating agent cyclophosphamide, which is known to cause a significant loss in ovarian follicle reserve, and may result in infertility and early menopause. The irreversible destruction of germ cells after using both radio and chemotherapy is due to a direct apoptotic effect on oocytes . On the other hand, advances in oncological treatments and better screening programs have significantly improved the life expectancy thus increasing the population of young cancer survivors. Therefore, protection against iatrogenic infertility caused by cancer therapies is considered indispensable to allow patients to have a chance to conceive in the future and to have their own genetic offspring.
Over the last several decades, survival rates for childhood cancer have steadily increased. Spermatogonial stem cells are responsible for the continual production of spermatozoa throughout adult life. Autotransplantation is considered more acceptable than allotransplantation or xenotransplantation, although both of the latter have been used successfully in mouse models. Spermatogenesis in vitro from biopsied germ cells is considered to be an excellent alternative for pre-pubertal boys with malignancies, particularly of hematopoietic origin, who carry a risk of relapse after transplantation. Despite significant advances in spermatogonial cell biology and subsequent fertility management, malignant contamination remains one of the main concerns surrounding autologous transplantation. The potential for transferring tumor cells within cryopreserved and subsequently cultured and/or expanded testicular tissue back into the patient is of paramount concern. Children most at risk of transmitting cancer cells include those with a haematological malignancy such as acute leukemia.