Semen
is cryopreserved in men who are not able to produce
a sample on the day of oocyte retrieval (due to
performance anxiety), who are oligospermic, or
azoospermic (post-MESA, PESA, or TESA). In men with
azoospermia, epididymal or testicular samples are
usually cryopreserved until the day of oocyte
retrieval. On the day of oocyte retrieval, the semen
sample(s) are thawed, the cryoprotectant is removed,
and ICSI is performed.
Semen
cryopreservation is an extremely important procedure
for men (and even boys as young as 14) who want to
preserve their fertility potential after cytotoxic
treatment for cancer. The significance of notifying
the patient of the potential risk of iatrogenic
sterility as early as possible cannot be
overemphasized. Physicians often are aware early
during the diagnostic process that the patient will
most likely need to receive potentially sterilizing
cytotoxic therapy, although the exact diagnosis,
stage, and treatment regimen have not yet been
decided. This time should be used to initiate and
complete the cryopreservation procedure.
The
banking of at least three semen samples with at
least a 48-hour period of abstinence between samples
is recommended. This usually requires 5 to 8 days to
complete. Additional samples (four) and longer
abstinence periods (72 hours) to achieve higher
total sperm counts may be considered. But fewer
samples with shorter times are often obtained
because of the need to initiate anticancer therapy
quickly, and it is important to avoid possible
increased genetic damage in sperm collected after
the start of therapy.
Because of
the low overall success rate with artificial
insemination using banked semen in the past, it had
been recommended that only samples with high sperm
counts and motilities be stored. Currently, the
success of in vitro fertilization (IVF) and
intracytoplasmic sperm injection (ICSI) make
cryopreservation of all samples containing any live
sperm appropriate. The facts that the cost of sperm
banking is relatively low and that sperm may be
stored fro years make this approach very cost
effective.
