Cryopreservation of semen (optional)

 

Overview

For almost 40 years, sperm cryopreservation has been used routinely to preserve fertility in men undergoing cancer treatment and to assist infertile couples to conceive. Furthermore, sperm banking raises ethical concerns, such as whether sperm donation should be anonymous and if sperm can be used posthumously by the surviving spouse without the patient's permission.

 

What is Cryopreservation of semen?

Semen cryopreservation (also known as sperm banking or sperm freezing) is a method of preserving sperm cells. After cryopreservation, sperms can be utilized forever. It can be utilized for sperm donation when the receiver prefers the treatment at a different time or location, or as a method of preserving fertility for men undergoing vasectomy or other treatments that may impair fertility, such as chemotherapy, radiation therapy, or surgery.

 

Who should consider sperm freezing?

The first successful pregnancy using frozen sperm was described in 1953, and sperm freezing has since been recommended for male cancer patients prior to radiation therapy treatment.

However, that is not the sole rationale for sperm freezing. Many more variables contribute to sperm cryogenic preservation being a proactive decision. While not a complete list, these are some of the more prevalent reasons why people contemplate sperm freezing and preservation.

 

Sperm freezing for cancer patients

Fertility may be compromised in up to 75% of cancer patients as a result of cancer therapy. These are life-saving procedures, and infertility is not an excuse to avoid them. However, as cancer medications and survival rates improve, we can, fortunately, focus on the quality of life of cancer survivors, including their opportunity to have a family whenever and wherever they desire.

Some cancer therapies, such as chemotherapy, hormone therapy, radiation therapy, surgery, and bone marrow transplants, have been shown to reduce male fertility. These therapies might cause irreparable harm in rare cases.

Radiation therapy, for example, has been proven to induce gonadal damage, leading in azoospermia (inability to create sperm) in individuals. Similarly, chemotherapy has been proven to have an effect on the Sertoli and Leydig cells, which are both required for spermatogenesis (sperm production)

Cryopreservation and sperm storage have made it possible to have children in the future in a safe and effective manner. Fertility preservation may be one of the numerous inquiries and talks you'll have with your doctor before beginning any type of cancer therapy.

 

Sperm freezing for trans women

Transgender people who produce sperm may aspire to have biological children in the future, fertilizing either a partner's egg or a donated egg with their sperm. Sperm freezing allows for this and is suggested prior to commencing gender-affirming hormone treatment (typically estrogen and androgen-blockers).

A study examined over 40 years of research on the effects of cross-sex hormones on trans women's sperm quality and testicular function. The review discovered that estrogen and/or anti-androgen medication slowed or stopped spermatogenesis in the majority of instances, as well as morphological alterations to the testicles.

The effect of medical gender change on fertility, as well as the ability of spermatogenesis to rebound if estrogen therapy is discontinued, appears to be diverse and individual. While some patients continued spermatogenesis with gender-affirming hormone therapy, others ceased making sperm entirely, and others developed azoospermia for 4-5 months after discontinuing the medication.

Trans women can protect their capacity to become genetic parents by storing their sperm prior to hormone therapy, avoiding the necessity for long-term discontinuation of hormone treatment later on.

Historically, many trans persons did not receive proper reproductive counseling before beginning hormone therapy. This appears to be changing. From 2006 to 2016, the number of transgender sperm bankers grew by 18% when compared to cisgender sperm bankers. 

 

Sperm freezing & thawing process

 

Step 1: Preparation

Some tests should preferably be conducted prior to sperm freezing. In general, you'll want to freeze the healthiest possible sample.

Before freezing your sperm, you should check for sexually transmitted illnesses and infections that might affect sperm quality. This is also done to prevent transmission to partners during artificial insemination, and it is necessary in many states if you want to utilize your frozen sperm for in vitro fertilization (IVF).

A sperm analysis is also advised, which will give you information on your sperm volume, sperm count, sperm concentration, sperm motility, and sperm morphology. If your sperm quality metrics aren't where you want them to be, you may start applying sperm-improving lifestyle modifications including diet and exercise. You may also have instructions to follow from your doctor or fertility professional.

 

Step 2: Producing a sample

If you decide to attend a fertility clinic or sperm bank, you will most likely be required to fill out some paperwork first. Then, in a secluded collecting chamber, you'll generate your sample via manual stimulation to ejaculation (masturbation).

For others, the prospect of making an appointment and providing a sample in a clinical setting might be intimidating. In these circumstances, at-home sperm analysis and freezing kits, such as Legacy's, provide another option.

You will be provided an at-home sperm freezing kit that includes a safe storage jar for collecting your sample at home. You'll combine your sample with a transport medium to keep it safe for transportation. Then, you may arrange for your sample to be picked up the same day and shipped overnight.

 

Step 3: Processing and analyzing sperm

After receiving sperm, it is measured to determine semen volume before being "washed" with a sterile medium. The sperm is subsequently separated from the seminal fluid and transport medium by centrifugation.

Under a high-powered microscope, this procedure allows lab staff to see just the sperm. Computer-assisted sperm analysis (CASA) technology is used by many laboratories, including ours, to assure precise and consistent assessments of the essential sperm parameters: sperm count, motility (how many sperm are moving), and morphology (how many sperm are properly shaped).

 

Sperm freezing step 4: Post-thaw analysis

This quality test is an important step in sperm freezing and storage. The post-thaw analysis includes freezing and then thawing a tiny amount of Your sample is to simulate the thawing circumstances your sperm will encounter when it is ready to be utilized. We then re-analyze sperm quality criteria to determine whether the sperm in your sample is viable after thawing.

It is common for measures such as sperm motility to decline somewhat after being frozen and thawed. According to recent research, around 80% of sperm will survive the thaw.

This small decrease has no substantial impact on pregnancy rates. Data reveals that around 10 million sperm are generally required for effective intrauterine insemination. Normal, healthy sperm quality characteristics result in at least 40 million sperm per ejaculate.

A post-thaw analysis provides you with an accurate estimate of the number and quality of sperm you may have after thawing, which is useful information for the healthcare practitioner who will be dealing with the sample in the future.

 

Step 5: Cryopreservation and Storage

Liquid nitrogen is used to freeze sperm. In cryogenic vials, sperm is gently combined with a cryoprotectant, a chemical that sucks water out of the sperm cell to prevent harm while freezing. They are then immersed in liquid nitrogen to achieve a temperature of -196 C or lower. Finally, the sperm vials are moved to liquid nitrogen storage tanks to keep the temperature low for long-term sperm preservation.

 

Options for using frozen sperm

Please call our andrology lab a few weeks before you believe you'll need the samples so we can remove them from long-term storage. We will need a physician's requisition order on file if you intend to utilize the samples for artificial insemination (IUI). Please contact and make an appointment to pick up your sample after you've determined when you'll need it.

Before performing insemination, many doctors ask patients to undergo extra testing such as blood tests or a recent pap and pelvic check. To minimize delays, consult with your doctor ahead of time.

Frozen sperm can be used in a variety of ways, including intrauterine insemination (IUI), in vitro fertilization, and IVF with intracytoplasmic sperm injection.

1. Intrauterine insemination (IUI)

Couples with normal pre-cryopreservation sperm characteristics (20 million motile sperm and >50% motility) may be able to conceive by intrauterine insemination. Cryopreserved sperm is thawed, cleansed, condensed in a tiny amount, and put into the female's uterus on the day of predicted ovulation. This method, which may be done in a doctor's office, is the least expensive medically assisted reproduction approach and has a pregnancy rate of 15% every cycle.

The ideal amount of post-thaw motile sperm for intrauterine insemination pregnancy is 10 million/insemination. Couples may prefer to attempt this approach first while retaining enough frozen sperm for use in the IVF cycle if a pregnancy is not achieved through intrauterine insemination. Some or all of these costs may be covered by health insurance.

     2. In vitro fertilization (IVF)

Couples with fewer than 20 million cryopreserved motile sperm are likely to require IVF and embryo transfer. IVF speeds up the fertilization process by inseminating eggs outside the body. This method produces embryos that are transferred to the uterus three to five days following egg retrieval. Just over half of women who have egg retrieval and IVF have a continuing pregnancy. Pregnancy rates after IVF-ET fall as the female partner or individual supplying the eggs' age increases. An IVF-ET operation might cost between $11,000 and $13,000. Some or all of these costs may be covered by health insurance.

     3. IVF with intracytoplasmic sperm injection (ICSI)

ICSI is an IVF procedure that involves injecting a single sperm directly into an egg. It is especially effective in situations of male-factor infertility where sperm motility is poor. When compared to fresh sperm, conception rates using frozen sperm in IVF with ICSI are comparable.

 

How Many Samples Should I Freeze?

The amount of sperm you should freeze is determined by your family planning objectives, sperm count, and sperm quality after thawing. Each sperm sample normally provides four vials. One vial of sperm is equivalent to one try at IUI, which has a success rate of 10-20%. When using IUI, it is suggested that you freeze 3-5 vials for each pregnancy you wish to achieve.

You don't need to freeze as many sperm samples if you want to use them for IVF using intracytoplasmic sperm injection (ICSI), a procedure that involves injecting one sperm into the egg to fertilize it before transferring it into the uterus. Because there are generally hundreds of thousands (or millions) of sperm in one vial, a single vial of sperm may be utilized practically indefinitely in ICSI.

If you want to have a big family in the future, you will most likely want to save more samples than someone who only intends to have one child. If your sperm count or quality is lower than expected following analysis, you may be advised to save additional samples. Because sperm quality might vary, we encourage making repeated "deposits." In an ideal world, you would freeze many samples and use your best samples whenever possible in the future.

 

How much does it cost to freeze sperm?

The cost of freezing sperm at a fertility clinic or sperm bank near you will vary greatly based on your location and the facility you pick. The first testing and sperm freezing can cost up to $1,000, with an extra $300-500 (or more) per year for continuous sperm preservation.

Unfortunately, most medical insurance in the United States does not cover sperm preservation and storage (unless in rare cases where it is required prior to cancer therapy or other medical treatment).

Legacy's at-home sperm freezing kits remove the financial stress of future planning. We provide various customizable choices for testing and freezing your sperm, including monthly, yearly, and lifelong storage, all at a fraction of the cost of traditional sperm freezing.

 

Sperm Viability after Cryopreservation

When frozen sperm is thawed, approximately half of the motile sperm retains its motility. Each sperm sample will have a different sperm count, motility percentage, and post-thaw survivability. Poor-quality sperm does not freeze as well as regular sperm. The amount of motile sperm that must be cryopreserved before being used in medically assisted reproduction procedures ranges from fewer than 10,000 (in vitro fertilization with micromanipulation) to 20 million (artificial insemination). 

 

Risks of sperm cryopreservation

Sperm appear to be less vulnerable to cryopreservation damage than other cell types due to the high fluidity of the membrane and low water content (which is only about 50%).

Regardless, cryopreservation may cause unfavorable alterations in sperm shape and function. Several damaging processes, such as thermal shock with the formation of intracellular and extracellular ice crystals, cellular dehydration, and osmotic shock, have been reported to occur during the freezing and thawing of human sperm, affecting the sperm's ability to fertilize an egg for a viable pregnancy. However, it appears that this type of damage only affects a sperm's capacity to generate a pregnancy. Donor sperm pregnancies do not appear to have a greater risk of defects.

 

Conclusion 

Sperm cryopreservation (freezing) is a method of storing sperm at extremely low temperatures for future use. Some medical illnesses, as well as some forms of surgery, chemotherapy, and/or radiation therapy, might harm sperm. After equilibration, the sample is uniformly distributed among pre-labeled cryopreservation vials, including a test thaw vial, and placed in a liquid nitrogen vapor, followed by liquid nitrogen storage. The test vial is thawed after the samples have been frozen to ensure the survival of the sperm. Sperm may be securely kept in liquid nitrogen for many years with this sperm-freezing procedure.