| Treatment Options:
Sperm Freezing (Cryopreservation) While the idea of freezing human male gametes, or sperm, has been experimented with since the late 1700s, it was not until 50 years ago that we were able to freeze sperm in such a way that it could be thawed and it could fertilize an egg. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably. With the use of modern techniques, cryopreservation of sperm to preserve an individual’s ability to reproduce has become successful, safe, and widely available. The absolute longevity of cryopreserved semen samples has yet to be determined. However, it was not until the 1950s that the methods for cryopreserving human sperm were refined. In 1953 the first human birth from frozen semen occurred. Since then ongoing research has aided in the development of more sophisticated procedures and techniques for freezing and storing human sperm. Subsequently in 1998, the first birth was achieved using sperm frozen for 20 years.
Sperm are frozen by adding a "cryoprotectant" solution to the sample, mixed gently in a small plastic cryovial and then placed in liquid nitrogen vapors until frozen. | | Cryopreservation of patient samples
Patients are typically referred to the Andrology Laboratory for sperm cryopreservation by their care-provider. Many patients have been referred for semen storage by physicians working in specialties other than fertility, and often arrive with little or no information about cryopreservation, or the use of cryopreserved samples to achieve pregnancy. A short consult to give patients an opportunity to ask questions and clarify anything they might want to know about these topics, is offered prior to the collection of the sample. | | How cryopreservation is performed
After a semen sample has been collected, it is placed on a warming block maintained at 37°C, to liquefy. At this time the semen sample is mixed in a 1:1 ratio with a freezing medium that allows the semen sample to survive the freezing and storage process. The semen and freezing medium mixture is divided up into one-milliliter portions and placed in special containers called cryovials. The freezing medium used contains cyroprotectants. Cryoprotectants are chemicals that help remove water from the cells being frozen. If the water is not removed from the sperm, ice crystals will form inside of the cell and break up it up, resulting in cell death.
Semen samples are slowly frozen in liquid nitrogen vapors. Once the semen samples have been frozen in the liquid nitrogen vapors they are placed in special containers where they are stored in the liquid nitrogen until they are needed. Liquid nitrogen has a temperature of -196°C, compared with a temperature of -20°C found in the average home freezer. The very low temperature essentially halts all metabolic activity in the cell, allowing them to be frozen and stored for very long periods.
There is a considerable amount of variability, but each semen sample typically yields from one to six vials, though it can occasionally be higher. Each vial of a patient’s semen sample is labeled with the patient’s name, the date, and a unique number recorded on the side. This information will be used to catalog the semen sample into the storage facility. If the samples are to be used within 60 days of collection, they are stored in accessible liquid nitrogen tanks at the laboratory; otherwise they are stored at the Andrology Long Term Storage Facility. | | Test Thaw Procedure
The survival rate of sperm after cryopreservation is also highly variable. In situations where loss of a small portion of the semen is not critical, it is recommended that one of the cryovials be thawed to assess how successfully an individual’s semen can be stored and thawed. | | Reasons for cryopreservation: |
| Vasectomy | The majority of men who choose a vasectomy as a form of birth control see it as a permanent decision. However, unexpected changes in a patient’s life such as a new marriage or death of a child or spouse can give rise to the desire to have more children. Vasectomies can be surgically reversed, but success is widely variable, and the surgery is expensive and invasive. Additionally, after an initially successful reversal, the ducts through which the sperm travel often develop scar tissue and become obstructed. As most individuals plan for a vasectomy well in advance; cryopreservation prior to having a vasectomy provides an effective form of insurance against a change in future plans. | | | Treatment for malignant disease | Hodgkin’s disease, leukemia, testicular cancer, and other malignancies often occur in juveniles, young adults and others who haven’t started or completed their families. Fortunately, early detection and improved therapies have dramatically increased the survival rate for these diseases. Unfortunately, the chemotherapeutic agents and radiation therapy used to treat these diseases affect the production of sperm. The response to treatment varies considerably, depending on how far the disease has progressed prior to treatment, the type and quantity of agents used, and the specific individual’s reaction to the treatment. While many patients who have undergone chemotherapy will eventually have a return of sperm production to varying degrees, some therapies, such as treatment with platinum based agents, result in a high probability of sterility. Even though the time between diagnosis and initiation of treatment is short, there is often a window of several days in which a patient can cryopreserve his semen. | | | Prior to Artificial Insemination | One common cause of male infertility is a low concentration of sperm in the ejaculate. For some, the collection of one or more samples to be cryopreserved and later combined with a fresh sample and used for artificial insemination may be helpful in achieving a pregnancy. | |
| Prior to the absence of the partner | For couples going through cycles of artificial insemination or IVF, it can be frustrating when responsibilities or obligations require a spouse to be absent. If it is anticipated that the male partner will be unavailable during the optimal time for the procedure, it is possible to cryopreserve a semen sample prior to his departure as a backup in the event he is prevented from providing a sample at the time of the procedure. While this may not be optimal, it can often keep the time and finances invested in a procedure from being wasted due to unforeseen circumstances. | Semen Storage Agreement
Once a client has determined a need for cryopreservation, a Semen Storage Agreement will be signed at the time of collection for short and/or long term storage.
Payment for the current storage period must be paid in advance, and is based in part on the number of vials to be stored. Please see the Fee Schedule and Policy for current prices for sperm freezing, storage and preparation. A client (or, in the event of his death, his legally authorized representative) may terminate a Storage Agreement at any time by requesting and completing an Order for Destruction form (contact the Andrology Lab to obtain an Order for Destruction form). Please carefully read and complete the entire form. Please note: the original signature must be witnessed by a UUHSC employee or a Notary Public. The original written notice must be received and acknowledged by the University before the agreement is terminated. If you have questions about payments or need to change the address on your storage account please contact University Medical Billing at (801) 238-6618 or Toll Free at (886) 778-5985. | Use of Cryopreserved Sperm to achieve pregnancy
The absolute longevity of cryopreserved semen samples has yet to be determined, but children have been born from samples preserved for over 20 years, though the sperm are certainly capable of surviving longer lengths of time.
Cryopreserved sperm are generally used in two different ways to achieve pregnancy. The first way is with artificial insemination. At the appropriate time in the woman’s cycle, an appointment is made to prepare one of the cryopreserved samples by carefully thawing and washing the semen sample. Please ask your physician to fax a sperm preparation requisition to (801) 581-6127, before the sample is prepared.
When a sample is thawed, it is removed from the liquid nitrogen and placed in water until it has reached a liquid state. Once liquid, it is placed on a 37°C block, and allowed to warm to that temperature prior to being prepared for use. By thawing the sample in stages, the sperm are protected from thawing too quickly, which results in the sperm heads swelling and rupturing as water moves back into the cells.
The washing procedure removes the cryoprotectants and seminal fluid, and concentrates the sperm into a volume appropriate for insemination. Depending on the quality of the sample, the doctor may have more than one vial prepared at each attempt. Once the sample is prepared, the patients will take it to their care provider to have the artificial insemination performed.
If there is known female factor infertility, or sperm are not available in sufficient quantity or quality, IVF can be another option. Advantages to this procedure include a much higher pregnancy rate and the ability to use semen samples with a very low concentration or poor motility. Disadvantages include high costs (in the range of $9,000 – 11,000) and numerous visits to the clinic. Pregnancy rates currently range from 50-70% and can further be discussed by the physician. | Requirements for Recipients of Prepared Sperm
Please ask your physician to fax a sperm preparation requisition to (801) 581-6127, before the sample is collected. The order needs to have your name, requested sperm preparation and the doctor’s signature. | |
Physicians
