Detailed inform­a­tion and a list of ref­er­ences can be found in Chapter 3.3 of the Fer­ti­PRO­TEKT book, “Indic­a­tions and fertility pre­ser­va­tion methods for onco­lo­gic­al and non-onco­lo­gic­al disorders”, which can be down­loaded free of charge.

Back­ground

Male germ cells (sperm) can be cryo­p­reserved (frozen) before chemo­ther­apy or radio­ther­apy and in the case of a loss of function of male gonads (testes), are used to conceive a patient’s own child.

Cryo­p­reser­va­tion of sperm is a complex, but easily con­trolled process and enables about 50% of the sperm to survive the cryo­p­reser­va­tion. Since approx­im­ately 250 million sperm are present in an ejaculate on average, the surviving sperm are usually enough to fertilize egg cells at a later date. The technique of cryo­p­reser­va­tion is already several decades old and is estab­lished in all IVF and andrology centres (male medicine). If no sperm are present in the ejaculate (this is called azoo­sper­mia), then testic­u­lar tissue can be frozen.

Efficacy

When using assisted repro­duc­tion methods (IVF or ICSI), the pregnancy rate after using cryo­p­reserved (otherwise normal) sperm is not lower than when using non-frozen sperm.

Risks

With the offer of pre­vent­at­ive treatment, cryo­p­reser­va­tion of sperm is not asso­ci­ated with any risks for the patient. The removal of testic­u­lar tissue is a surgical procedure that must be performed in spe­cial­ized centres and is asso­ci­ated with minimal surgical risk. The start of onco­lo­gic­al therapy may have to be postponed by a few days because of the procedure.

Costs

The costs of cryo­p­reser­va­tion are made up of the clinical coun­selling and treatment costs, the labor­at­ory costs of cryo­p­reser­va­tion and required tech­no­logy and cost of long-term storage and this may vary between institutions.

  • Cryo­p­reser­va­tion (freezing and storage for 1 year): ca. 500 Euros
  • Storage for each sub­sequent year: ca. 300 Euros

Procedure

One or several sperm samples must be supplied to one centre for the cryo­p­reser­va­tion of sperm. Cryo­p­reser­va­tion and storage of sperm is a complex process and puts high demands on the respons­ib­il­ity and reli­ab­il­ity of labor­at­ory personnel. In Germany, labor­at­or­ies who perform cryo­p­reser­va­tion of sperm require an author­iz­a­tion in accord­ance with AMG § 20b and a license in accord­ance with § 20c AMG for their later use. HIV and hepatitis tests, which are no more than 3 months old, must also be available.

Removal of testic­u­lar for tissue testic­u­lar sperm extrac­tion (TESE) is performed after opening the scrotal skin and exposing the testicles on both sides under local or general anaes­thesia and after appro­pri­ate pre­op­er­at­ive patient coun­selling. Removal using microsur­gic­al or micro­scop­ic­ally assisted tech­no­logy (micro-TESE, mTESE) is optimal; altern­at­ively mul­ti­loc­u­lar removal from different areas of the testes (standard TESE) can be used, paying par­tic­u­lar attention to the pre­ser­va­tion of testic­u­lar blood flow and precise control of bleeding during surgery. This treatment should be carried out in spe­cial­ized centres.