ESHRE good practice recommendations on fertility preservation involving testicular tissue cryopreservation in children receiving gonadotoxic therapies†.

study questionHow should fertility preservation in child and adolescent males receiving gonadotoxic therapies be managed? SUMMARY ANSWER: There were 44 recommendations formulated to provide guidance on all aspects of fertility preservation in prepubertal boys and adolescent males in whom it is not possible to obtain sperm by established methods including semen cryopreservation and surgical sperm extraction; the recommendations covered topics from setting up a fertility preservation program, determining who is eligible, and counselling, to the practical aspects of the testicular tissue biopsy and cryopreservation. WHAT IS KNOWN ALREADY: For young males facing gonadotoxic treatment, there are limited options for fertility preservation. For those who are unable to produce sperm (children and adolescents) testicular tissue cryopreservation is being increasingly offered prior to gonadotoxic treatment for potential future clinical use to restore fertility. STUDY DESIGN, SIZE, DURATION: This Good Practice Recommendations (GPR) article was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, if available. PARTICIPANTS/MATERIALS, SETTING,

methodsESHRE appointed a European multidisciplinary working group with expertise in paediatric oncology, paediatric endocrinology, human tissue banking, and surgery, as well as reproductive specialists and researchers, who have demonstrated leadership and expertise in fertility preservation in prepubertal boys and adolescent males. The recommendations were formulated based on the expert opinion of the working group, while taking into consideration the published data. The draft document was then open to ESHRE members for online peer review and was revised in light of the comments received. MAIN RESULTS AND THE ROLE OF CHANCE: The multidisciplinary working group formulated 44 recommendations to provide guidance on all aspects of fertility preservation by testicular tissue cryopreservation, from setting up a fertility preservation program, determining who is eligible and counselling, to the practical aspects of the testicular tissue biopsy and cryopreservation. LIMITATIONS, REASON FOR CAUTION: These guidelines offer valuable direction for healthcare professionals taking care of children and adolescents facing gonadotoxic treatment. Their purpose is to promote knowledge among clinicians and to enable patients to make informed decisions based on realistic expectations. WIDER IMPLICATIONS OF THE

findingsThis article provides not only good practice advice but also highlights the areas that need further research. This research, when well-conducted, will be key to making progress in the area of fertility preservation in children and adolescents. STUDY FUNDING/COMPETING INTERESTS: All costs relating to the development process, including meetings and technical support for this project, were funded by the European Society of Human Reproduction and Embryology (ESHRE). There was no external funding of the development process or manuscript production. RTM was supported by a UKRI Future Leader Fellowship. The other authors disclosed no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A. DISCLAIMER: This Good Practice Recommendations document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation.ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type.Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.