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For a boy who has not gone through puberty and cannot produce sperm, the principal option offered by some specialist programs is testicular tissue cryopreservation: removing a small sample of testicular tissue and freezing it before treatment that could damage fertility. It remains experimental. No current technique has been proven to use a prepubertal boy’s stored tissue to produce sperm, achieve a pregnancy or result in a biological child. The decision should be made urgently, when feasible, with the treating team and a pediatric fertility-preservation specialist.
Why puberty and sperm production determine the options
Fertility preservation is not one interchangeable procedure for every child. The key question is whether sperm can be obtained now. Before puberty, boys generally do not produce mature sperm, so routine semen collection and standard sperm banking are not usually possible. Once puberty has begun, sperm may be obtainable even if the boy cannot provide a semen sample.
| Clinical situation | Possible approach | Evidence status | Main practical issue |
|---|---|---|---|
| Prepubertal boy who cannot produce sperm | Testicular tissue cryopreservation under a clinical trial or another approved experimental protocol | Investigational; future fertility use is unproven | Access depends on an experienced pediatric program, protocol eligibility and treatment timing |
| Pubertal or postpubertal male who can produce a semen sample | Sperm collection and cryopreservation | Established fertility-preservation approach | Collection must be feasible before gonadotoxic treatment |
| Pubertal or postpubertal male who cannot provide a semen sample | Testicular sperm extraction (TESE) followed by sperm cryopreservation | ASCO recommends offering this before cancer treatment when appropriate | Requires a procedure and assessment by a qualified team |
The American Society for Reproductive Medicine (ASRM) describes the prepubertal procedure plainly: “Testicular tissue cryopreservation is an experimental technique performed under institutional review board (IRB)- approved protocols.” The current ASCO guideline update likewise limits this approach to a clinical trial or an approved experimental protocol. These classifications matter: freezing tissue is possible, but its eventual use to restore fertility has not been established.
Testicular tissue cryopreservation for prepubertal boys
What is collected and frozen
A specialist obtains a biopsy or other sample of testicular tissue containing immature germ cells and then cryopreserves it. The tissue is stored for possible use years later, when technologies might be able to mature the cells into sperm or otherwise use them to restore reproductive function. The exact biopsy method, amount of tissue, anesthesia, storage arrangements and follow-up depend on the child and the center’s protocol.
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What the procedure can and cannot promise
The purpose is to preserve a biological resource before a planned therapy that may impair the testes. It is not the same as banking mature sperm. Stored tissue does not currently guarantee that sperm can be produced, that the sperm would be usable, that a pregnancy could occur or that a future child would be genetically related to the boy.
Two future strategies specifically identified by ASRM are in-vitro spermatogenesis (attempting to develop sperm outside the body) and germ-cell transplantation (returning relevant cells to the testis). Both remain under development. A family should therefore understand the procedure as preservation for possible future research or clinical use, not as a proven treatment that completes fertility preservation today.
What is known about experience with the procedure
ESHRE’s 2025 good-practice recommendations address how programs should be organized, how patients should be selected and counseled, and how biopsy and cryopreservation can be performed. Their introduction reports that a survey of centers offering the procedure indicated that more than 3,000 patients had undergone testicular tissue cryopreservation. That figure counts procedures, not successful fertility restorations. The same recommendations state that clinical applications using the stored tissue remain unproven.
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Consequently, the number of children who have had tissue frozen should not be read as a success rate, a live-birth rate or evidence that an individual child will later be able to father a biological child. The available professional guidance does not provide a clinical outcome statistic that can predict an individual result.
When sperm banking or TESE may be an option instead
If a boy has entered puberty and can produce sperm
Once sperm production has begun, the established approach is to collect and cryopreserve sperm before fertility-threatening treatment. The treating team must determine whether there is enough time for collection and whether the sample is adequate for storage. This situation is clinically different from a prepubertal boy who has no mature sperm to collect.
If puberty has begun but a semen sample cannot be provided
ASCO’s 2025 guideline update says testicular sperm extraction (TESE) with sperm cryopreservation should be offered before cancer treatment begins when appropriate. TESE is a procedure to retrieve sperm directly from testicular tissue. Whether it is suitable depends on pubertal development, the disease and planned therapy, anesthesia considerations and the expertise available at the center.
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TESE should not be presented as a routine substitute for prepubertal tissue cryopreservation. It is relevant when sperm production may already have started, whereas a truly prepubertal boy generally has immature tissue rather than retrievable mature sperm.
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How a family typically proceeds
- Ask for a fertility-risk assessment immediately. The treating clinician should explain how the specific illness and proposed treatment may affect future fertility. ASRM recommends prompt counseling and referral when treatment could threaten fertility.
- Confirm pubertal status and whether sperm can be obtained. The team may determine whether the boy is producing sperm, whether semen collection is realistic and whether TESE is relevant. If he is prepubertal and cannot produce sperm, ask specifically about testicular tissue cryopreservation.
- Request referral to an experienced pediatric program. Ask whether a local or regional center performs the procedure under an IRB-approved protocol, clinical trial or other approved experimental pathway. Availability is not uniform.
- Review the protocol before consenting. The program should explain the biopsy, anesthesia, expected scheduling, tissue-processing method, storage, follow-up and how future decisions about the tissue will be handled.
- Coordinate preservation with essential treatment. Fertility procedures must be scheduled so that necessary cancer or other medical treatment is not delayed. The treating specialists and preservation team should agree on the safest sequence.
- Document consent, assent and storage instructions. Parents or guardians provide consent according to applicable rules, while the child’s age and understanding determine what assent can be sought. The family should know who can authorize later use, transfer or disposal of stored tissue.
The procedure itself is only one part of the decision. Eligibility, anesthesia suitability, the amount of tissue that can be safely sampled, storage duration, monitoring and costs all require individualized discussion.
Questions to ask the treating and fertility teams
- What fertility damage is expected from this child’s specific disease and proposed treatment, and how certain is that estimate?
- Has puberty begun, and is the child producing sperm?
- Could semen collection or TESE be considered, or is the child too early in puberty for either approach?
- Is testicular tissue cryopreservation available through an experienced pediatric program?
- Is the proposed procedure part of a registered clinical trial, an IRB-approved protocol or another approved experimental program?
- What exactly will the biopsy involve, including anesthesia, timing and procedure-specific risks for this child?
- How will the tissue be processed, where will it be stored and what follow-up visits or tests are planned?
- How long can the tissue be stored, and what happens if the family moves or the storage facility changes?
- What are the charges, insurance or public-coverage rules, and possible future storage fees?
- What consent is required from parents or guardians, what assent can the child provide, and who will make decisions about later use?
- How will the preservation plan be coordinated with treatment so that medically necessary therapy starts on time?
Limitations, uncertainties and potential burdens
Experimental status
The central limitation is scientific: no established clinical pathway currently turns a prepubertal boy’s frozen testicular tissue into proven future fertility. A center may offer the procedure because research is advancing, but offering it does not mean the stored tissue can now be used successfully.
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Individual eligibility
General recommendations cannot determine whether a particular child qualifies. The answer may depend on the planned treatment’s gonadotoxicity, the child’s health, pubertal development, testicular condition, urgency of therapy, anesthesia risk and the protocol’s inclusion criteria.
Timing and treatment priorities
Preservation is time-sensitive when therapy is expected to damage fertility, yet the underlying illness remains the priority. A specialist team must balance the time needed for counseling and biopsy against the need to begin treatment. “Before treatment” is a goal when feasible, not a reason to postpone essential care without the treating oncologist’s agreement.
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Tissue may remain stored for many years while techniques evolve. Families should understand the center’s policies for storage, contact information, transfer, future consent, disposal and communication if the child reaches adulthood. These administrative choices are part of preservation planning, even though they do not increase the tissue’s current biological potential.
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How the professional guidance fits together
ASRM’s 2026 committee opinion provides current US guidance that identifies prepubertal testicular tissue cryopreservation as experimental and calls for IRB-approved protocols, prompt counseling and referral. The 2025 ASCO guideline update distinguishes established sperm preservation and TESE in pubertal or postpubertal males from investigational tissue preservation in boys who cannot produce sperm. ESHRE’s 2025 recommendations focus on good practice for programs performing testicular tissue cryopreservation in children receiving gonadotoxic therapies.
Together, these recommendations support a practical rule: determine first whether mature sperm can be obtained; if it cannot, discuss tissue cryopreservation only through an appropriately approved specialist program and explain clearly that future fertility use remains unproven.
Bottom line for families making a time-sensitive decision
For a genuinely prepubertal boy who cannot produce sperm, testicular tissue cryopreservation is the principal fertility-preservation option currently being offered in some specialist programs, but it is investigational. Sperm cryopreservation—and, when appropriate, TESE with sperm cryopreservation—applies once puberty has begun and sperm may be obtainable. Ask for immediate, coordinated counseling from the treating team and a pediatric fertility-preservation specialist, and base the decision on the child’s treatment plan, an approved protocol, procedural considerations and a realistic understanding that future fertility or a biological child is not guaranteed.
Quick Recap
Authoritative guidance
- ASRM: Fertility preservation in patients with medical indications: a committee opinion (2026)
- ASCO: Fertility Preservation in People With Cancer: ASCO Guideline Update (2025)
- ESHRE: Good practice recommendations on fertility preservation involving testicular tissue cryopreservation in children receiving gonadotoxic therapies (2025)
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