One interesting component of this case was that the patient was taking melantonin. We were never able to obtain the dose or the indication for this medication. In researching this subject we discovered a study in which melantonin was used to protect spermatogenesis in rats with injury from testicular ischemia and with reperfusion injury.1 It was a small study that concluded melatonin acts as an antioxidant helping to protect spermatogenesis during an ischemic-reperfusion injury. This same institution has produced several studies in rats that favor a protective effect of melatonin. 2,3,4 We were unable to find any information on melatonin in human cases.
An obstacle encountered during this patient’s care was the discussion of sperm banking. This is not an easy subject to discuss due to several factors: the patient’s embarrassment regarding the method of obtaining the specimen, parent’s concerns of misuse of the specimen, and the issue of obtaining informed consent. As medicine advances and assisted reproduction technology progresses, these issues will need to be addressed.
Making physicians more cognizant of these issues and teaching healthcare professionals how to deal with them is paramount. In this regard, one must mention the pilot program for fertility preservation at Children’s Hospital of Philadelphia. Gingsberg et al. describe in the protocol set up at their hospital for discussing such issues in a timely manner and parent’s response to the protocol. 5 While most facilities will not have the resources to have this type of multidisciplinary team in place, it is not unreasonable for an institution, department, or practice to have a protocol available for just such an event.