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.
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.
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.
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.
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
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.