Sperm Cryobanking

Frozen sperm must be stored in extremely cold temperatures (-196 F), but in order to insure that the fewest possible sperm are damaged, the freezing must be gradual. Generally, the following procedure is followed: If the sperm hasn’t been previously tested, a comprehensive semen analysis should be performed on the first specimen in order to give you a complete picture of your sperm quantity and quality. Make sure that your sperm bank conducts a thorough semen analysis before banking. This will give you significant information on the quality of the sperm, which helps determine how it can be used when you desire to initiate a conception.

Each subsequent specimen is analyzed prior to freezing to assess concentration, motility, forward progression, semen quality, and total number of moving sperm. Immediately after the specimen is analyzed, and prior to freezing, a special fluid (a cryoprotectant) is added to aid the freezing process. This helps the sperm survive the freezing and the subsequent thawing process, which is performed when they are ready to be used or tested. The combination fluid (semen plus cryoprotectant) is then divided into portions and placed in separate vials. Each vial holds up to 2cc’s. (A teaspoon is 5cc’s.) A small amount of the combination fluid (specimen and cryoprotectant) is placed in a separate vial (test or T- vial). This is usually about 0.2 cc’s or less. The test tubes are gradually frozen. After 30-60 minutes they are transferred into liquid nitrogen tanks for permanent frozen storage. After a minimum of 24 hours has elapsed from the time of the initial freezing, the test vial is thawed and tested again to ascertain from each specimen how well the sperm survived the freezing, in terms of number of sperm, percentage moving, and quality of the movement.

From these results, we will be able to project with reasonable accuracy the quantity and quality of moving sperm that will be found in each of the storage vials when they are thawed for use in the future.

Vial Labeling: Each vial is assigned a unique accession number, and is labeled with six pieces of information: Patient’s full name Banking Date MAZE Laboratories Accession number Patient’s date of birth Patient’s social security number Vial Storage: The vials are placed in temporary storage until you are finished banking, and all of your blood work comes back and shows that you are negative for infectious diseases. Then they are placed into permanent storage, in large tanks. Within the tanks, there are individual racks, with numbered slots. Each vial goes into a unique slot, the identity of which is recorded and then saved in multiple locations, so it can be easily and accurately found. One tank versus two tanks.

At Maze, we store almost all patients’ specimens in two different tanks, in two different locations. This is added protection, in case there was ever a problem with a tank. Though the chances of this happening are extremely low, we believe it’s worth taking the added precaution of a second tank. How are the tanks monitored? Each tank has its own continuous temperature monitoring system. If the temperature increases even slightly, to a few points above -196 F, then the alarm goes off. (The sperm are still safe at temperatures way above this.) The alarm is then sent through an automatic calling system to alert our staff, one of whom is on call at all times, who will rectify the situation. The system has a large back up battery in our offices, and then a backup generator connected to this. It is important that you ask a sperm bank how their tanks are monitored prior to considering using their services. We have been amazed that some banks do not have continuous monitoring, and no alarm system whatsoever. They rely entirely on periodic checks of the tanks.

In order to use your frozen sperm, the recipient will need to work with an ob/gyn, usually a specialist in female infertility, even if she has no fertility issues. There are two main methods used, intrauterine inseminations (IUI’s), and in vitro fertilization (IVF).

Intrauterine Inseminations (IUI’s):  For an IUI (which is also done frequently for couples with infertility using fresh sperm) the frozen sperm are thawed and then processed or washed prior to being placed in the woman’s uterus with a small catheter. The sperm must be processed because many of the components of semen and the cryopreservative should not be placed directly in the uterus. (When a couple has intercourse, the sperm push their way through the cervical mucous, and leave behind the rest of the fluid naturally.) The sperm then need to make their way up the woman’s fallopian tubes, where fertilization usually takes place. (In fact, during the processing, the sperm are placed in a nurturing solution which mimics the fluid found naturally in a woman’s fallopian tubes.) Many sperm bind to the egg, and then finally one breaks through to fertilize the egg.

In order for IUI’s to have a reasonable chance of success, the specimen needs to have many moving sperm, as so many are lost as they make their way up the tubes. Thus, IUI’s are not considered a reasonable option, unless the total number of moving sperm in the specimen, after thawing, is 10 million. Several frozen vials can be combined in order to reach the 10 million number. However, it is projected that your vials once thawed, will on average contain fewer than 2-3 million moving sperm, per vial, you probably should not try to use them for IUI’s. IUI’s have a lower success rate than IVF, and thus you would have to assume that it will take 2-3 cycles on average to have a reasonable chance of achieving a conception. If each of your vials yields more than 10 million moving sperm, a single vial could be used for each IUI. If each of your vials yields 3-9 million, you would probably use more than one vial per IUI. Thus, the men whose numbers are in this intermediate range, 3-9 million moving sperm post thaw, will need to bank the most vials, if they want to try to achieve a conception with IUI’s. The advantages of IUI’s are that they are less invasive for the woman and less expensive. This is why they are preferred to IVF in many cases, if it is a reasonable option based on both the quality and quantity of the sperm, and on female factors.

In Vitro Fertilization (IVF): With IVF, the woman is given hormones to make her produce many eggs. These eggs are then harvested, by placing a needle that goes through the vagina and into the follicle containing each egg. (This is done under general anesthesia, but most women have very little discomfort afterwards.) Originally, each egg was placed in its own dish, and the sperm put into the dish, to try to achieve fertilization. This is called conventional IVF, and each egg needs about one million moving sperm to have a reasonable chance for fertilization to take place. However, in most cases involving frozen sperm, an individual moving sperm is taken and injected directly into an egg, which is called ICSI (Intra-cytoplasmic sperm injections). For ICSI to be a viable option, a man only needs one moving sperm per egg to be available. Thus, with the advent of ICSI, it became worthwhile for men with extremely low counts to bank their sperm, because they then had reasonable chances of achieving a conception.

In order to decide how many specimens to bank, it is important to understand how they will ultimately be used, when and if you need them. One of the most important advantages of Maze Cryobank is that its medical director, Michael Werner, MD, is a specialist in male infertility. He will be reviewing the results of your bankings as they are happening, and helping you decide how many specimens make sense in your particular case. Active decisions must also be made, in real time, as a particular specimen is being prepared, in terms of how many vials are made from it, and what volume they should be. This will depend on several factors, including the volume of the ejaculate, the quality and quantity of the sperm, and how many bankings you will have time for prior to beginning treatment.

The number of specimens you should bank will depend on several variables:

1. How Many Sperm You Have in the Post-Thaw Specimen. As can be seen above, if you have enough sperm in the post-thaw specimens to do IUI’s, you will want to have enough vials to do several IUI’s and have some vials left over so that you can do some IVF’s in case the IUI’s are not successful. Thus, men with total post thaw motile counts of greater than 10 million sperm/vial, will want to have on, average, 12-15 vials. The men with total post thaw motile counts between 3-9 million/vial, will probably want almost 20 vials, so that some can be pooled to get up to 10 million for each IUI attempt. Some vials should be reserved for IVF if the IUI’s are not successful. Most men with post thaw motile counts of less than 2 million will probably only need 10 vials. Each vial can be used for an IVF, and there are very few situations where more than 10 IVF’s could be reasonably anticipated. Some men have extremely low numbers of sperm in the ejaculate, and some, if not all, of their specimens would be anticipated to have very low numbers of moving sperm post-thaw. In these cases, sometimes many specimens are banked to make it more likely that any moving sperm will be found post-thaw. In other words, sometimes multiple vials may be needed even for an IVF, in order to find enough moving sperm to have one for each egg.

2. How Much Time You Have to Bank. Before Beginning Treatment Some men are banking sperm because they are very ill and treatment is imminent. They may only have time for one or two specimens before treatment is started. We often receive specimens from hospitalized patients who are too sick to be discharged from the hospital prior to treatment. We try our best to make sure that each man gets 10 vials. We divide them up to give us more options in terms of using them (see above.)

3. Who Your Partner is Going to Be. Many men bank who are already partnered with a particular woman. Some may even already have children, but know they want more, or want to leave the option open. If possible, they should bank enough sperm for IUI’s and then IVF if necessary, as described above. Many heterosexual men bank, without knowing who their partner will be. They will want to leave open the option of having enough sperm for IUI’s and then IVF if necessary. They will want to have the option of initiating several conceptions. Many gay men bank their sperm in anticipation of becoming fathers. Most will need to use a donor egg and a gestational surrogate. In these cases, IVF must be used, and 10 vials are usually needed. If they may be in a situation where the woman carrying the child is also supplying the eggs, then IUI’s are an option, and more vials may be needed.

Once you are ready to initiate a conception, you will need to begin working with an ob/gyn. If IUI’s are being considered, some general ob/gyn’s are comfortable with this process and will stay involved. In most cases, a specialist in female infertility, called a reproductive endocrinologist (RE) will be involved. The female infertility specialist will want to know the quality and quantity of the vials you have stored, as well as the woman who will be both supplying the eggs and carrying the child (which may be the same woman or two different women), prior to deciding how to best use them to achieve a conception.

Often, Dr. Werner, an expert in male infertility and andrology, will work with you and your female infertility specialists to determine the best course of action. Once the number of vials to be used in a particular cycle has been determined, it will be your responsibility to contact our laboratory to release the specimens. You will also need to contact your RE’s lab so they are prepared to receive them. We will help make this easy for you. You then have the option of renting a small portable tank, and transporting the specimen yourself. Or you can have us ship the specimen in a larger tank for you.

How long should I store my sperm? Pregnancies have been initiated with sperm that have been frozen (cryopreserved) for up to 21 years. However, there is no indication that sperm cryobanked for even longer are not capable of initiating a conception. Thus, it is important to bank your sperm for any of the indications listed above, no matter how long you think it may be before you would use them, or even if you are not sure you ever plan to have a family. You should bank for as long as you think you may need the sperm. You should hope for the best outcome in terms of sperm production post treatment, and plan for the worst.

If you are young, and not anticipating trying to initiate a conception for a while, then you should bank for the maximal contractual time, which is 10 years. (Always remember that you can contract for additional time once your contract comes close to expiring.) If you are in a relationship, you should try to anticipate the farthest out you would like children for, and store for this period of time. In some situations, there is only a minimal chance that a drug or surgery will cause infertility. In this case, you may want to bank for only a year or two. Then, if post treatment testing shows good return of sperm and/or ejaculation, the frozen sperm can be destroyed.

How long should I wait after treatment to check my sperm production? Different courses of treatment have higher or lower probabilities of causing temporary or permanent damage to the sperm producing cells. Many men whose sperm counts go down dramatically during and right after treatment will have return of sperm production over time. Sometimes, their post treatment counts are even better after a period of time than the ones they banked prior to treatment. This is because their original condition (i.e. cancer or other medical conditions) can itself suppress their sperm production. Once the condition has been treated, the sperm production may improve on its own. This may be true even of men with testicular cancer. The cancer in this testicle may be suppressing production of sperm in the opposite testicle. Once the cancer is removed, and if your body recovers from treatment, your specimens may be better after the orchiectomy than prior to it. Unfortunately, they may also be worse, if there is damage to the remaining testicle from treatment, or if the remaining testicle never had good sperm production to begin with.

In general, we would suggest waiting at least a year after treatment to check your semen analysis. If the one year post treatment semen analysis is worse than the banked specimens, we generally suggest you keep the banked specimens and re-check the semen analysis in another year. Some men may go down to zero for prolonged periods of time, and then gradually have some sperm production. The longer you are out from treatment, without the return of sperm, the less likely it will return.

Men with infectious diseases can bank their sperm at Maze Cryobank. Men with known infectious diseases immediately have their specimens placed in a special tank, reserved only for specimens of men with that disease. We have two separate tanks, one each for specimens of men with Hepatitis B and Hepatitis C. These specimens are NEVER placed in tanks with specimens of men without this particular infection.