- What is cryopreservation/sperm banking?
- What is the process for banking sperm?
- Designated Donor Sperm
- Choosing a sperm bank
What is Sperm Banking and Why Should I Consider It?
WHAT IS CRYOPRESERVATION/SPERM BANKING?
Cryopreservation is the process of freezing tissue. In the case of sperm cryopreservation, a man’s semen is frozen for future use. A sperm cryobank is a facility that collects, stores and freezes the sperm.
Sperm banking is used in a variety of different situations. Most commonly, men bank sperm because they are about to undergo treatments or take medications which may affect their sperm production. However, there are many reasons and here are a few.
For example, you may want to consider cryobanking if:
- You will be undergoing a treatment for cancer which may impair your sperm production or quality (e.g. chemotherapy, radiation).
- You will be taking any ongoing medications which may impair your sperm production or quality (e.g. sulfasalazine, methotrexate).
- You will be undergoing any procedure which could affect your testes, prostate, or your ability to ejaculate (e.g. prostate resection, colon surgery or retroperitoneal lymph node dissection).
- You have a medical condition which is beginning to affect your ability to ejaculate (e.g. multiple sclerosis, diabetes).
- You are undergoing a vasectomy.
- You think you may want to put off fatherhood until later in life, which can negatively effect sperm quality.
- You are entering a line of work where you may be introduced to reproductive toxins.
- You have a very low number of moving sperm in your ejaculate. Over time, all men’s sperm production deteriorates. Thus, many men with low numbers of motile sperm in their ejaculate will have their sperm production deteriorate over the course of months or years to the point where there are no longer sperm in the ejaculate. Also, all men have variability in their semen analyses, even over a short period of time. If you have only very few sperm in your ejaculate, it is very possible that when you go to produce a fresh specimen for an in vitro fertilization (IVF) cycle, there will not be sperm present that day. The frozen sperm can then be used as a backup. Fortunately, all studies indicate that fertility rates are identical for fresh versus frozen sperm, as long as moving (motile) sperm are found. Thus, all men with very low numbers should bank both for longer term and shorter term use.
- As part of your infertility treatment, you will be undergoing a procedure where sperm may be harvested (e.g. vas reconstruction, testicular biopsy). These sperm can then be stored and used later in conjunction with advanced reproductive techniques.
Other reasons to consider sperm banking include:
- Men with Klinefelter’s Syndrome (who have an extra chromosome) may have either low numbers of sperm in their ejaculate or none. However, many of them may be producing low levels of sperm in their testicles. Over time, their production drops off. If sperm are ever found in the ejaculate, they should be immediately cryopreserved. Many male infertility (andrology) experts feel that these men should undergo testicular sperm extraction with banking.
- Trans male to female adolescents should consider banking. Many, if not most, will ultimately undergo hormone treatment that will stop sperm production. This may be irreversible, and even if it isn’t, they will be very reluctant to go back onto medications that dramatically increase their testosterone levels, which would be necessary for the initiation of sperm production. Thus, at the very beginning of the transition, their sperm should be banked. Many trans male to female individuals end up being gay and thus partnering with a woman. In these couples, biological children related to both partners can be conceived, sometimes quite easily, with insemination alone..
- Testicular cancer most commonly presents during adolescence, though it is rare. Sometimes these patients at the time of presentation, and even prior to surgery, have no sperm in the ejaculate (are azoospermia.) This may be because whatever process made their affected testicle more prone to cancer is also affecting the other, in terms of sperm production. It could also be that the cancer in one testicle is inhibiting the production of the sperm in the other testicle. Sometimes, at the time of the removal of the testicle with cancer, some of the tissue may be removed and examined for sperm production. If sperm is found, it could then be frozen for later usage. This, of course, needs to be coordinated with a specialist prior to the surgery.
Can I bank sperm if I have Hepatitis?
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.
WHAT IS THE PROCESS FOR BANKING SPERM?
Sperm banking is, in most cases, a simple and straightforward process. It is not time consuming or “appointment intensive.” Although the process differs slightly between cryobanks, the basic procedure is the same:
- An appointment is set with the laboratory to meet with a lab representative, review your case history and medical background, and fill out necessary paperwork.
- Many labs require an initial test freeze of the sperm before actually conducting the banking and they may require that you return for a second appointment. However, there is no advantage to this. In our lab, a full analysis is done on the first specimen (which requires very little of the specimen.) If it is adequate for cryopreservation, it is then processed and frozen. It is important not to waste this specimen, as often there is a small window of time to bank a man’s sperm, before treatment begins. This leaves only enough time for a man to produce and bank a limited number of specimens.
- You may be given a choice of producing a specimen at home or at the lab site. If you choose to collect at a laboratory you will be given a private room. Visual material may also be made available to you. If you choose to collect at home you will be given clear and exact instructions. Ideally, if you produce the specimen outside of the laboratory, it would arrive at the lab within 60 minutes. However, though this is ideal, many of the sperm will still be alive hours after production. Do not assume that if your specimen does not reach the laboratory within an hour it is useless. Also, do not assume that just because you are hospitalized more than an hour away from the bank, that you will be unable to cryopreserve your sperm. It is important to ask all of these questions when arranging your appointment.
How is sperm actually frozen?
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.
How is sperm stored?
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
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.
How will my specimens ultimately be used?
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.
How many specimens should I bank?
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.
How do I get my sperm from the bank?
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.
Sometimes, the sperm of a man who is not a woman’s sexual partner is wanted to initiate a pregnancy. In this case, the conception will not be achieved through intercourse. In theory, in some of these situations, the fresh sperm could be taken and placed inside the woman’s vagina. These are referred to as self-inseminations. (Many sexually intimate couples have achieved pregnancies this way, especially in situations where the man has issues with erections or intravaginal ejaculation.)
However, legally, a physician cannot be involved in the transfer of fresh sperm from a man who is not the sexually intimate partner of a woman. In fact, for the sperm to be legally used in many states, the man needs to be tested for genetic diseases and sexually transmitted infections. Also, he needs to undergo a full physical exam and medical history. Assuming all is well, the sperm are then frozen and kept (“quarantined”) for a minimum of six months, and then the man is retested for the sexually transmitted infections. This quarantine and retesting ensures that the man did not have an infection, at the time of the sperm production that would not yet have shown up in his testing; this infection could put the female recipient as well as the ensuing fetus at risk.
In New York State, the license and process for banking designated donor sperm is the same as it is for anonymous sperm donation. Maze Cryobank has this license, and does sperm banking for designated donors on a regular basis.
Indications for banking sperm as a designated donor
There are several reasons to obtain sperm from a designated donor:
- A man produces no sperm, and a known man (usually a relative, sometimes a friend) is chosen to donate his sperm. Depending on the quality of the sperm, IUI’s may be done, but sometimes IVF is needed.
- Lesbian couples or individuals want to select a known man to be the biological father of their (her) child or children.
- Gay men will usually undergo surrogacy to achieve a conception. Usually donor eggs are used. The eggs are then fertilized using IVF. The embryos are then transferred into the uterus of a woman who is different than the egg donor, who carries them through a pregnancy. The laws of surrogacy are rapidly changing and different in many states and countries. Some programs do not require men wishing to pursue surrogacy to go through the process of banking their sperm as a designated donor. However, the laws are in flux, and some programs do require this, as an embryo conceived with his sperm will be placed in a surrogate who is thus theoretically at risk for a sexually transmitted infection. The safest course for gay men is to bank the sperm as designated donors, though in certain situations this may turn out to be unnecessary, as regular banking (which is simpler and cheaper) would have been adequate.
What is the process of banking sperm as a designated donor?
This process has many steps and will be reviewed with you at the time of scheduling your appointment. However, the following is an overview of the process:
- A specific contract is signed by both the sperm donor, and if known at the time of the banking, the recipient and (if applicable) her partner.
- A full physical exam must be done during the banking process.
- Genetic testing is performed.
- Infectious disease studies are performed, no more than one week before or after every specimen is produced. Thus, to maximize the number of specimens that can be banked, with the least amount of testing, the man is usually encouraged to bank frequently over the course of two weeks. The infectious disease testing is done right in the middle of the banking period so that it is performed within the seven days of both the first and last bankings.
- The sperm are collected and processed similarly to any specimen processed for sperm cryobanking (see above.) However, the sperm are then “quarantined” for a minimum of six months, and the man re-tested for sexually transmitted infections, prior to the sperm being released for use.
- An individual or couple, with their female infertility specialist, can request a waiver of the six months, and ask that the sperm be released early, which can often legally be done. However, the remaining sperm vials (those that were not released early) cannot be kept in long term storage if the man does not repeat the infectious disease testing a minimum of six months after the last banking.
Why does Maze offer designated donor sperm banking, despite its complexity?
At Maze we believe that all individuals who desire to be parents should have the means available to them. Donor sperm, designated donor sperm, donor egg, surrogacy, and advanced reproductive techniques are all tools available for couples or individuals to fulfill their dreams. We feel that as a medical community, these must all be available, and thus we are one of the few banks that has taken on this project.
CONSIDERATIONS WHEN CHOOSING A SPERM BANK
There are numerous considerations that come into play in choosing a sperm bank. These include:
- Safety of your specimens — separated into different tanks, each with constant monitoring
- Clinical expertise of director — both from a scientific point of view, and a clinical point of view
- Location and convenience
Specimens stored in two different tanks:
Almost all of our patients bank multiple vials. For virtually all of the patients, some of your vials will be kept in a tank in our Westchester office, and the rest in our NYC office. Though tank malfunctions are extremely rare, having two tanks builds in an extra safety net in case of an unforeseen disaster, either to a particular tank or a particular location.
It is highly recommended that the status of each and every tank be monitored continuously. Some labs have no tank monitoring, except periodic manual checks.
At Maze, each tank is continuously monitored 24/7/365. If the temperature or level falls, an alarm goes off, which then phones our lab technician or physician on call. The alarm system has a battery backup, and a generator back up as well.
We would suggest you ask any sperm bank you are thinking of using how they monitor their tanks.
Michael A. Werner, MD, the owner and Medical Director of Maze, is a board certified urologist, with a fellowship in male infertility, andrology, and male sexual dysfunction. He supervises the entire process of sperm banking, including helping decide how many vials to divide a particular specimen into, and how many times a man should bank. He works closely with the female infertility specialist when it comes time to use the vials. This comes from his knowledge base in the field of fertility as well as in his scientific knowledge of sperm production, analysis, processing, and freezing. His knowledge also often comes into play in situations where men have problems producing specimens.
Maze Cryobank has two locations. One is in Westchester County, in Purchase (right by the intersections of I-95, I-287, and the Hutchinson River Parkway.) The second is at 40th Street and Park Avenue, two blocks from Grand Central Station in New York City.
We have early morning, evening, and weekend hours. It is often important to get several specimens banked quickly before treatment begins. We go out of our way to make sure you can do this.