Relationship between spermatogonial stem cell survival and testis function after cytotoxic therapy

This review, with substantial bibliography, concludes that the acute effects of radiation and cytotoxic drugs are a result of toxicity to the most sensitive of the germ cells, which in most cases are the differentiating spermatogonia. Long-term sterility or reduction in sperm production depends directly on killing of spermatogonial stem cells. For a variety of cytotoxic agents, the same relationship holds between the stem cell survival index and the prompt recovery level of sperm production (at 56 days), the maximal recovered level of sperm production, and the time required for fertility to return. It also appears that the spermatogonial stem cell is the target for long-term sterility in man following cytotoxic therapy. It is not known whether the delay in recovery is a result of this direct damage to the stem cell or an effect on another target cell in the tissue. Data obtained in both experimental animals and man indicate very little direct changes in the secretory cells and other stromal cells of the testis, and there is no evidence as yet that any alterations in these cells adversely affect sperm production or reproductive performance. (UK)