Sperm storage

Any male of reproductive age undergoing treatment which is likely to impair his fertility is suitable for sperm storage. These include:

• Chemotherapy and radiotherapy
• Surgery such as vasectomy, prostate, bladder, spinal
• Gender re-assignment

In addition, some men may wish to store their sperm as part of a treatment for infertility although such storage is not usually ‘long term’.

In simple terms the truthful answer is nobody knows. In some situations, for example surgery to remove the testicles or a vasectomy procedure the outcome is assured but in cases where men have been given chemo- or radio- therapy as part of their treatment it is very difficult for us to predict if you will become infertile and whether or not this infertility will be permanent. Because of this we rely on carrying out a semen analysis 12 months after you finish your treatment.

You will usually be referred to Cambridge IVF for sperm storage by your medical consultant who will arrange an appointment with a member of our team as soon as possible to fit in with your treatment plan. Men wishing to self refer to store sperm should contact Cambridge IVF directly and make an appointment to speak to one of our doctors; you will be offered an appointment at the earliest mutual convenience. A series of three sperm freeze appointments is usually offered, time permitting, to allow us to freeze as much sperm as you may realistically wish to use in the future.

Of course they can! You can be accompanied by anyone you choose, your friend or relative can even sit with you during the consenting and counselling process if you prefer, we want the process to be as comfortable for you as possible. If you wish to be seen alone please make this clear to your companion as we would not wish to unintentionally breach your confidentiality and will confirm with you that you are happy to have them party to our discussion before we talk to you. If you are under 18 years of age you should attend for your appointment with a parent or legal guardian but again, you may request that you give your consent alone if you would prefer.

Before we can store sperm for you we need your consent. This is a legal requirement and we will ask you to consider and complete a series of consent forms which we will go through with you before you produce your semen sample. The forms not only allow us to legally store your sperm but also lay down your wishes regarding communication with your GP and also if you wish your details to be included in any hospital or financial audit we may wish to perform. The counselling and consent process will usually take between 30 minutes and an hour depending on the number of questions you have based on reading this information and other information we have provided to you prior to your consent session.

There are four key areas we need to consider when we take legal consent to the storage of your sperm, these are:

1. Whether or not you wish to include the name of a partner on your consent form to specify the person your sperm should be used to treat. If you do not currently have a partner this can be left blank.
2. What should happen to the stored sperm in the event of your death or mental incapacitation. It is important that we know your wishes before we store your sperm. It may be possible to register a deceased partner as the parent of a child, but all of these implications must be discussed with you at the time of consent.
3. Whether or not you wish to consent for the use of your sperm in assisted conception treatments such as IVF and the creation of embryos using your partner’s eggs and how these embryos should be used and stored and what should happen to them in the event of your death or mental incapacitation as described above.
4. How long you wish to consent for your sperm to be stored within the constraints of the regulations and guidelines covering sperm cryopreservation which we will discuss later in this information.

It is important that you answer these questions as clearly as you can leaving nothing open to interpretation as your wishes on these issues are required by law before we freeze your sperm.

After you have given consent you will usually be asked to try to produce a sample of your semen. We are aware this is not the easiest thing to ask you to do in a hospital environment and we have provided a private and comfortable room for your use. Samples are normally collected by masturbation into a sterile container we will provide. In some cases where it is not possible for you to attend the clinic to produce a sample we can accept samples produced on a hospital ward or in your home as long as they are delivered to the unit within 60 minutes of production. We recommend that where possible within the time constraints of your treatment you abstain from any sexual activity for two days prior to producing your samples to maximise the quality of each sample.

Once you have produced your sample it will be analysed in our laboratory and the number of sperm, their ability to swim and their appearance (morphology) assessed. If the sample is suitable for freezing a solution known as a cryoprotectant is added to the sample to protect the sperm during the freezing process and it is prepared for freezing. Samples are loaded into straws which are labelled with your full name, date of birth, a unique clinic number and the date of storage and then are slowly chilled down and stored in liquid nitrogen. The samples will remain in our cryostore for as long as you have consented to their storage or you notify us that you wish them to be disposed of or moved elsewhere.

At the time of freezing we will remove a very small amount of sperm and load this into a straw that we will use as a test thaw after the freezing process is completed. This is done so we can tell you how well your sperm have survived the freezing and thawing process to give you as accurate an indication of the quality of your stored sperm as possible. Some sperm will die during the freezing and thawing process, it’s a very unnatural process for a sperm and not one they are well equipped to tolerate. It may be that your sperm are particularly susceptible to freezing and none survive. Although this is unlikely it’s important we know this now rather than in five years time or so when you wish to use the samples.

We will also need to carry out certain number of tests to make sure that you are clear of sexually transmitted infections, including HIV, Hepatitis B and C. The tests are performed to allow us to store your sperm appropriately in a screened or viral positive storage facility as appropriate and may be funded by the NHS or in some cases you may have to pay for them. The cost for the tests in such circumstances is available in the Cambridge IVF schedule of fees. Additional tests may be performed depending on your personal circumstances and you will be informed if we plan to carry out further testing during your appointment. If any of the test results return indicating an infection we will notify you and arrange an appointment for you to see a medical practitioner. In such cases it may not be possible for us to store your samples.

The statutory storage period for which sperm can be frozen is for up to 10 years. You can of course decide to freeze for a shorter period. You can also at any time prior to the sperm being transferred decide that you no longer want it to be kept in storage – for more information on the implications of this, please see our patient information on ‘consent to treatment’ in particular the section on ‘withdrawing, varying and restricting consent’. In certain circumstances, the law allows sperm to be stored for up to 55 years. For this to be applicable, a registered medical practitioner will need to certify in writing that the patient is prematurely infertile or likely to become infertile due to medical intervention. This written opinion will need to be renewed at least every 10 years during the 55 year storage period.

In cases where your fertility may have been impaired, you will be invited to return to Cambridge IVF for a review appointment annually for three years after the storage of your sperm. At this time you can produce a semen sample, and we can assess your testicular function, and therefore review whether there is any need to continue with the storage of your samples, and if so, for how long. You will sign some consent forms regarding the storage of your sperm, indicating your wishes as to its usage. You should ensure that you read the form carefully before signing it. Signing the form indicates you have read and are happy with the information and terms and conditions of the storage procedure. Signing the consent also enables us to contact any interested third party such as your family members, GP or referring consultant, enabling us to gather information on your wellbeing, or in the event of your death.

The law does not allow us to keep your sperm in storage beyond the date you have consented to. We will be in touch with you a few months before the end of the storage period to find out what you wish us to do. It is important that you keep in touch with us, in particular that you notify us of any change of address. If the storage limit is up, and you have not consented to extending this limit, we are obliged by law to let any stored sperm samples perish, even if we have not been able to trace you first.

If you have been referred by a specialist before embarking on treatment which is likely to affect your fertility it is unlikely that you will have to pay anything towards the freezing and storage of your sperm. This is conditional on the fact that you attend the clinic regularly to demonstrate that your fertility is still impaired. Should your fertility return you can choose to keep the samples in store but NHS funding would no longer cover the storage cost and you would be required to pay an annual storage fee or alternatively the samples can be disposed of.

If you have been referred by your GP or self referred prior to vasectomy, gender re-assignment surgery or infertility treatment it is highly likely that you will be required to pay for the freezing and storage of your samples. A bill will be sent to you annually for the ongoing storage of your samples and you can opt to have them removed from storage and destroyed at any time.

In many cases, where sperm have been frozen prior to chemotherapy for example, fertility may return after your treatment is completed. This can happen within months or can take several years. We therefore advise men in such groups to arrange for a repeat sperm test six months after your treatment concluded and annually thereafter. This is the only way we can provide you with accurate information and advice on either contraception or starting a family. The six month review will be arranged by Cambridge IVF automatically, you should telephone the clinic to book annual appointment if required thereafter. Further information on semen analysis, storage and testing can be found on these pages.

To use your frozen sperm to start a family you and your partner will need some form of fertility treatment. This could take the form of a simple insemination or more involved forms of treatment such as IVF (in-vitro fertilisation) or ICSI (intra-cytoplasmic sperm injection). In some cases this treatment may not be available to you on the NHS and there may be a significant cost implication. To start on a cycle of treatment a referral letter will be required from your GP in the first instance. Cambridge IVF will then arrange you an appointment to speak with one of our medical staff who will review your case and recommend the most appropriate treatment to enable the best possible chance of a pregnancy using the samples you have stored. It should be remembered that although we will do our utmost to help you we can never guarantee the success of any treatment you undertake.

The Human Fertilisation and Embryology Authority (HFEA) state that where a person providing sperm has died or becomes mentally incapacitated there must be written consent for the subsequent use of their sperm. The legal HFEA consent forms ‘GS’ and ‘MT’ must be completed correctly reflecting your wishes and naming your partner prior to or on the date the samples were stored to allow this to occur. Your named partner is then able to make an application to Cambridge IVF to use the samples for fertility treatment in accordance with your wishes. Such cases would be considered by our ethics committee in their own right and on an individual basis. It is also possible register a person posthumously as a parent of a child resulting from treatment. Your named partner is equally at liberty to move the samples to another fertility clinic elsewhere in the world or to request that the samples are disposed of. Within the first six months of your death or mental incapacitation we will not accept an application to use or destroy the sperm from a named partner as we want to ensure that people have time to grieve and adjust to such a huge change in circumstances before they consider the fate of the stored samples. This is a local policy at Cambridge IVF which we believe is in your best interest your partners but is not a legal requirement and the samples can be moved elsewhere at any time should you request it.

We realise this is not an easy situation for you to consider and this all may be confusing and emotional for you at the moment but it’s very important we capture your wishes correctly and we hope it will become clearer when you attend the clinic.

Sperm quality and quantity can be poor for a number of reasons which may or may not be related to your current condition. If you have been unwell for a long period of time this will most likely have affected your fertility. In the event that your sample is very poor and we do not think it is possible to freeze it we will tell you at the time. We will arrange a second appointment for you to confirm or refute the findings of the first analysis to make sure you have the best possible chance of storing sperm. In most cases sperm will be frozen and living sperm seen in the test thaw procedure meaning that at least one of our assisted conception techniques will be possible using the samples to help you father a child.

When exposed to chemotherapy drugs sperm can undergo changes which could lead to an abnormality in the unborn baby. For this important reason it is strongly advised that you use some form of contraception for up to 12 months following on from the end of your chemotherapy. In addition, we would suggest that you seek the advice of a medical professional before ceasing contraception and trying for a baby. It is important you realise and consider that although some treatments will cause permanent infertility or sterility many treatments will not and your fertility may well return. It is for this reason that we strongly recommend you attend the clinic here or any other fertility clinic for that matter to have your sperm quality checked annually.

You can modify your consent or request so that your sperm is disposed of at any time within the period of consent. An application to dispose of sperm should be made in writing to Cambridge IVF. Before samples are disposed of the consent and your letter are checked by two members of our team and the disposal itself is performed and witnessed by two members of the team. Once the sperm have been discarded we will write to you and inform you this has been done.

Absolutely! We are ultimately nothing more than custodians of your stored samples and we will do everything we can to look after them. If for whatever reason you wish to relocate the samples we are happy to facilitate this. Samples can only be relocated to a UK centre which holds an HFEA long term storage license or to an overseas fertility centre following an export directive which is approved by the HFEA. In the first instance you can write to the unit here and we will guide you through the process. Although we do not charge a fee to assist with the transfer of the samples, Cambridge IVF only allow the transport of samples using an approved courier service and the cost of the transfer will be your responsibility.

You can contact us at any time to change a consent form. For example if you and your partner were to split up and you wanted to remove her right to use the samples or, in time, add a new partner. The new form will supersede the old one from the date it is signed and there is no limit to the number of times you can modify consent, we will file them in your confidential patient records.

We do everything we can to maintain a high quality cryostore here at Cambridge IVF. We have a system in place that monitors the cryostore continually and will alert us immediately if there is the slightest suggestion of a problem. We use a high security storage system to reduce the theoretical risks of cross contamination between samples. Even with our exacting standards and commitment to quality in everything we do, we cannot provide a guarantee that your samples may not be affected in the event of an ‘act of god’, civil disturbance, catastrophic equipment failure or any other unexpected and abnormal occurrence which may affect our service or facilities.

To minimise the chances of this happening we will split your samples between two different storage containers to ensure that all is not lost in the still highly unlikely event that one individual container were to fail.

Then don’t hesitate to contact us! Our team have a wealth of experience and are available to help you Monday to Friday between the hours of 08:30 and 16:30. If we can’t take your call immediately, we will be back in touch with you just as soon as we can.

At Cambridge IVF we are well placed to offer you both initial and ongoing support. We work with a qualified and independent counsellor who is available to you and has experience of working with men in similar situations. Please contact us on 01223 349010 if you feel you would like an appointment to speak with our counsellor confidentially.

The laboratory team at Cambridge IVF have a combined experience of over 25 years in performing the range of tests which in combination provide a complete and accurate semen analysis. The lab is inspected by CPA (Clinical Pathology Accreditation) and tests are performed in accordance with the guidance set out by the World Health Organisation (WHO), the British Andrology Society (BAS) and the Association of Biomedical Anthologists (ABA). The laboratory subscribes to the National External Quality Assurance Scheme (UKNEQAS) for semen analysis.

If you have any questions regarding any part of the Andrology Service provided by Cambridge IVF please do not hesitate to contact us using any of the contact details on the back of this information at any time between the hours of 08:00 and 16:00. If you are unhappy with any part of the service or wish to speak to someone about an issue relating to your care please contact our lead clinical scientist or if you prefer, the Patient Liaison Service (PALS) at Cambridge University Hospitals (CUH).