CHAPTER 123 Sperm Banking
Men undergoing some types of medical therapy such as chemotherapy, radiation therapy, or surgery face the real possibility of temporary or permanent infertility. An option to preserve fertility potential is to freeze (cryopreserve) sperm before undergoing these other medical treatments. Cryopreservation of sperm, or sperm banking, involves the freezing of sperm in liquid nitrogen followed by long-term storage for future use. Unfortunately, patients who may benefit from cryopreservation of sperm are not always aware of their options or may not even be considering their future fertility, considering the stress of their present situation. Therefore, a well-informed health care provider who is able to appropriately discuss cryopreservation with the patient is an invaluable resource.
Cryopreserved sperm was first used to achieve successful pregnancy in 1953. Because of moral controversy surrounding assisted reproductive techniques at the time, it would be another 10 years before use of cryopreserved sperm for artificial insemination would gain popularity. A technique using liquid nitrogen for freezing of sperm was developed in 1963. Over the years, other technical developments, such as the addition of cryoprotectants and the advancement of assisted reproductive techniques, have been introduced. With the advent of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), even men with very few, poor-quality sperm can achieve fertility, with pregnancy rates approaching 50% per cycle.
One of the most important patient populations that may need this service is reproductive-age men who will undergo gonadotoxic chemotherapy for malignancy. Testicular cancer, leukemia, and lymphoma are the most common malignancies that may have reproductive consequences, either from the treatment or the disease itself. Cytotoxic chemotherapeutic regimens often result in acute azoospermia as defined by the absence of sperm in the ejaculate. Depending on the regimen used, only half of these men will recover spermatogenesis, and there is no precise way to predict who will do so. Even before receiving any cytotoxic therapy, these patients often have suboptimal semen quality as a result of their systemic disease, and therefore every effort should be made to cryopreserve any sperm they might have before initiating chemotherapy.
Radiation therapy, often used for certain testicular tumors and Hodgkin’s disease, is also gonadotoxic, and appropriate individuals should be offered sperm cryopreservation before treatment. Even if the radiation is administered to distant sites and the testes are shielded, fertility can be impaired owing to scatter radiation.
Nonmalignant conditions may also require gonadotoxic treatment. Conditions such as autoimmune disorders, inflammatory bowel disease, or organ transplants may require immunosuppressive or cytotoxic therapies that impair fertility. These patients should be offered sperm banking if it is known that their treatment may lead to infertility.
Because up to 5% of men receiving a vasectomy will eventually request a restoration of their fertility, it is reasonable to offer sperm banking before vasectomy. Men who are undergoing vasectomy reversal may choose to have sperm extracted at the time of reconstructive surgery in the event that the reconstruction fails in the future.
Men with a history of spinal cord injury may require electroejaculation or surgical extraction for sperm retrieval. They may also choose to have sperm banked as a matter of convenience instead of undergoing repeated procedures.