Sperm Banking

Paternal age has increased dramatically in the US in the past 40 years, and the trend seems to be continuing. The average age of paternity has gone from 27.4 to 30.9 years in the last 40 years.

Unfortunately, increased paternal age has significant negative effects on conception rates, pregnancy outcomes, and the health of the offspring. The children of older men are at higher risk for genetic disorders, congenital abnormalities, neurodevelopment disorders, and malignancies. The American Society of Reproductive Medicine and the American Urological Association have issued joint male infertility guidelines, which include the suggestion that; “Clinicians should advise couples with advanced paternal age (≥40 years) that there is an increased risk of adverse health outcomes for their offspring (3).”

If a man at or over 35 is projecting it will be five or more years before attempting a conception, it may be wise to bank for him to bank his sperm.

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 is no longer sperm in the ejaculate. 

Fortunately, all studies indicate that fertility rates are identical for fresh versus frozen sperm, as long as moving (motile) sperm are found. So, even men with very low numbers should bank both for longer term and shorter term use.

Men with very low numbers can have their sperm processed by our lab, using Extended Sperm Search and Micro-freeze (ESSM). We can find and freeze sperm in situations where other labs can’t.

In order for Men to make sperm, the testes need to be producing a very high concentration of testosterone. When Men go on TRT (take external testosterone), it will shut down a Man’s production of testosterone in his testes.
For this reason, t’s important for Men to consider banking sperm prior to treatment. Men who start on TRT feel dramatically better, so it can be difficult to stop treatment. Once a Man stops TRT, sperm production usually comes back, although this not guaranteed. (especially if pre-treatment sperm production was very low to begin with).

Men who have a low testosterone with clinical symptoms can also be treated with selective estrogen receptor modulators (SERM’s) or hCG to increase their production of testosterone, thereby preserving sperm production. However,  Men will report feeling better using TRT as opposed to using select estrogen receptor modulators.
For Men who are interested testosterone replacement therapy (TRT) and are considering children in the future, we strongly recommend that men bank their sperm prior to starting treatment.

In order for Men to make sperm, the testes need to be producing a very high concentration of testosterone. When Men go on TRT (take external testosterone), it will shut down a Man’s production of testosterone in his testes.
For this reason, t’s important for Men to consider banking sperm prior to treatment. Men who start on TRT feel dramatically better, so it can be difficult to stop treatment. Once a Man stops TRT, sperm production usually comes back, although this not guaranteed. (especially if pre-treatment sperm production was very low to begin with).

Men who have a low testosterone with clinical symptoms can also be treated with selective estrogen receptor modulators (SERM’s) or hCG to increase their production of testosterone, thereby preserving sperm production. However,  Men will report feeling better using TRT as opposed to using select estrogen receptor modulators.
For Men who are interested testosterone replacement therapy (TRT) and are considering children in the future, we strongly recommend that men bank their sperm prior to starting treatment.

A vasectomy should be considered a permanent method of sterilization. However, many men and/or their partners would like to keep the option of having children open for the future. Life circumstances do change (including a couple’s change of heart, man’s change in partner, tragedy). If sperm have been cryopreserved a pregnancy can be attempted without a surgical intervention to either reverse the vasectomy or harvest sperm. If the quality of the sperm is high enough, inseminations may be attempted with the frozen sperm. If not, IVF is the option of choice. Dr. Werner will work with you and your partner’s doctor if you decide to use the frozen sperm, on how to best utilize it.

Once deciding on a Vasectomy, many men and or couples are anxious to get it done quickly. Sperm banking can usually be done within a week.

Certain medications are known to decrease sperm production and possibly increase the chance of abnormal offspring, both while you are taking them AND for the 6-12 months after you discontinue.

Here we have included a published table reviewing medications that can affect sperm production.

Certain occupations expose men to increased heat or toxins, which can decrease sperm production.  These include:

• Industrial Chemicals
• Pesticides, heavy metals, painting materials
• Radiation Exposure-including X rays
• Increased Testicular Temperature: The testes need to stay below body temperature, which is why they are located outside a man’s body.  Frequent exposure to heat can cause a decrease in sperm production. This includes:
• Truck driving for long periods of time
• Professional Cooking (bakers, chefs, pizza makers)

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 combined fluid (semen plus cryoprotectant) is then divided into portions and placed in separate vials. Each vial holds up to 2 cc’s (a teaspoon is 5 cc’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.  This is to ascertain from each test thaw specimen how well the sperm survived the freezing and subsequent thawing, 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:

1. Patient’s full name
2. Banking Date
3. MAZE Laboratories
4. Accession number
5. Patient’s date of birth
6. Last four digits of the 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 mucus, 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, called HTF, or Human Tubal Factor.) Many sperm bind to the egg’s outer membrane, 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 and so many sperm need to bind to each egg prior to fertilization.

Thus, IUI’s are not considered a reasonable option, unless the total number of moving sperm in the specimen, after thawing, is between 5 and 10 million. Several frozen vials can be combined in order to reach the 10 million number. However, if 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 so 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.

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 each follicle containing an 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, the specimen is thawed and an individual moving sperm is taken and injected directly into an egg, which is called ICSI (Intracytoplasmic 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.

To decide how many specimens to bank, it’s important to understand how they will 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 banking as they are happening, and helping you decide how many specimens make sense in your particular case.

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. However, in these cases we now usually recommend Extended Sperm Search and Microfreeze (ESSM).

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 want to leave the option of having enough sperm for IUI’s and then IVF if necessary.

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 enough. 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.

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 a longer time, 10- 20 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.

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.

Tank Monitoring:

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.

Clinical Expertise:

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.

Location:

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 633 3rd Avenue (between East 40th and 41st Streets, three blocks from Grand Central Station in New York City.

Hours:

We have early morning and evening hours Monday-Friday. 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.