Doctors plan first testicle transplant

SCIENTISTS ARE preparing to carry out the first testicle transplant on a boy undergoing cancer treatment who would otherwise have become infertile.If the operation is successful medical researchers believe it will open the way for thousands of infertile men to have such transplants as an alternative to fertility treatment.

The news follows the case of an American woman of 30 whose early menopause was reversed by a pioneering ovary transplant. The procedure was masterminded by Roger Gosden, professor of reproductive biology at Leeds University.

Peter Schlegel, a reproductive specialist at the New York Hospital-Cornell Medical Centre, said yesterday he expects to receive ethical approval for the testicle transplant before the end of the year. It will be performed on a boy whose testicles are removed and frozen prior to cancer treatment that can cause sterility. The testicles will be replaced once treatment has ended and the boy has reached puberty.

Dr Schlegel emphasised that there are still many technical and ethical difficulties associated with testicle transplants, which could also include transplants between brothers, but he is confident the procedure will become routine within the next decade. "There are problems associated with connecting the many small blood vessels and nerves, there is the problem of tissue rejection and there is the ethical difficulty of producing sperm from another man," Dr Schlegel said. "I am sure testicular transplants between men will be done in the next 10 years and there are a number of groups other than ours who are working on it."

Dr Schlegel said that existing treatments for male infertility are not suitable for all sterile men and there are many situations where testicle transplants, perhaps between two brothers or between a father and a son, could become the preferred option. Carrying out testicle transfers on boys undergoing cancer therapy would provide clear medical advantages that would make approval from his hospital's ethics committee more likely. "I have had dozens of requests from patients for this to be done"

If the technique is shown to work well on boys, it would provide the necessary impetus for testicle transplants to be performed on adult men with fertility problems, Dr Schlegel said. Experiments on animals have already shown that testicle transplants are possible and Dr Schlegel's team has demonstrated that testicle transfer within the same animal is a relatively straightforward surgical procedure.

Although it is possible to take immature sperm from a testicle and inject it directly into an unfertilised egg, this procedure cannot always be done with certain categories of male infertility. Dr Schlegel envisages that these men might prefer to accept a testicle transplant from a donor who is a close relative and so be able to father a child "naturally" rather than having their partner undergo artificial insemination.

However, just as ovary transplants provide the opportunity for a new lease of life to older women, some men might see testicle transplants as offering a way of boosting their sex hormone levels, invigorating their stamina and improving their sex lives.

Reversing the menopause, page 10

Deborah Orr,

Review, page 5