Semen storage

Semen cryopreservation is a way of helping you safeguard your fertility by storing your sperm at extremely low temperatures. The first successful use of sperm that had been stored at -196◦C in liquid nitrogen was in the 1950s, and since then, sperm storage has become a routine, widely practiced procedure. People are offered the opportunity to store their sperm samples for a variety of different reasons, and the doctor who referred you to our clinic will be able to give you more specific information about why it has been recommended for you.

For some people, sperm storage will be short-term, with a view to using the samples in fertility treatment soon after freezing them. Other people will require longer-term sperm storage because they are undergoing treatments that could affect their sperm production, or the DNA in their sperm e.g. chemotherapy or radiotherapy. It is not always possible to predict what the effects of these treatments will be, or if they will affect fertility permanently.

People who freeze their sperm samples before treatments such as chemotherapy, radiotherapy or pelvic surgery are advised to return to the Fertility Laboratory a year or so following the completion of their treatment to have a sperm test and review their storage needs.

You will usually be referred to us by the consultant who is treating you. The law requires everybody who stores sperm samples to be tested for viruses such as hepatitis B, hepatitis C and HIV, and these tests are often arranged by your consultant at the time of your discussion about sperm storage.

Once the Fertility Laboratory has received your referral details and the results of your blood tests, we will contact you to book an appointment.

Your first appointment will take a little longer than others as we will ask you to complete some forms which include information forms for our records as well as legal consent forms. These enable you to specify the length of time you would like us to store your samples for, how you would consider using your samples in the future, as well as what you would like us to do with your samples if anything were to happen to you. A member of the laboratory team will review the forms with you to ensure that you are fully informed and happy to proceed, and you will have the opportunity to ask us any questions or discuss any concerns you may have. This consenting session can last between 30 minutes and an hour.

We will then supply you with a sterile specimen pot and ask you to write your name and date of birth on the pot. You will also be asked to complete a production form. When there is a private production room available, we will show you to the room and advise you where to deliver your sample for freezing. In order for your sample to be produced under optimal conditions, and to reduce any risk of contamination, we ask that the sample is produced by masturbation directly into the sterile pot. Please do not use lubricants/spermicidal condoms/withdrawal method to produce your sample. Once you have delivered your sample to the laboratory you are free to leave.

If you have difficulty producing a sample at the clinic it is possible to produce a sample off site and bring it in to us. If you intend to produce a sample off-site you must make prior arrangements with us. In addition, the sample must be kept at body temperature and delivered to the clinic as soon as possible and within an hour of production accompanied by a signed production form.

Once we have your semen sample in the laboratory, we analyse it to ensure that it is suitable for freezing. Once we have established that there are live sperm present, we add a cryoprotectant to help protect the sperm during the freezing process. We then split your sample into several small containers for freezing and subsequent storage. Your samples are stored in liquid nitrogen storage tanks, located on the premises, and will remain there until you make contact with us to discuss their use or disposal, or until your legal consent forms expire. This is why it is extremely important that we do not lose contact with you – if your consents expire, we are legally required to discard your sample.

We will arrange to discuss the results of your storage with you after your appointment. Depending on the quality and quantity of the samples that we store for you, we will discuss whether further appointments will be beneficial for you.

Unfortunately, there are times when a person’s sperm sample is unsuitable for storage, because it would not be usable for fertility treatments in the future. This may be because none of the sperm in the sample are alive, or because no sperm were seen at all. In these instances, the sample is discarded, and we will contact you to discuss the next step. It may be helpful for you to speak with our counsellor, and we can arrange this for you.

Please bring some photographic ID with you so that we can keep a copy in your file. There are a few things to consider before your appointment:

1. Who to bring with you

Not everybody will wish to bring someone along to their appointment with them, but you are welcome to if you would like. Please be aware that as we discuss consent and the process of sperm banking, some sensitive issues may arise that you do not wish to discuss in front of your companion. To preserve the confidentiality of our discussions and your treatment, please make it clear to your companion whether or not you would like them to be present for those discussions.

2. Abstinence

Where time permits, it is preferable to have a period of abstinence before providing a sample for storage. If you have the time available, please try and avoid ejaculation for 2-5 days before your appointment.

3. Questions

The idea of sperm storage and fertility preservation will mean something different for everyone, so have a think about any questions you’d like to ask at your appointment. It may also be possible to provide you with the consent forms in advance of your appointment to give you a chance to consider them, and any questions arising from them.

You may choose how long you would like to store your sperm for, but the maximum length of time you can consent to store for is 10 years at a time. The law allows a maximum of 55 years of storage in total, but you must renew your consent every 10 years, even if the time you have put on your consent forms is longer than 10 years. The law is very clear about this. Consent must be renewed during the ‘renewal period’ which starts 1 year before your consent expires. We will contact you before your ‘renewal period’ starts and will send ‘keeping in touch’ letters every couple of years until then.

NHS funded sperm storage is subject to medical need and there may not be NHS funding to store your sperm for the whole length of time you wish to store. If you can no longer store on the NHS, we will ask you to pay or move your samples to another clinic. We will let you know if this affects you. Recent semen analysis results are useful when reviewing for extended storage and we regularly offer semen analysis (sperm test) appointments and results discussions.

Please remember that if we are unable to contact you and your storage consent expires, we will berequired by law to discard your stored samples.

We use a cryoprotectant which helps to protect the sperm; however, some damage is inevitable, and is caused during the cooling and warming processes. The extent of this damage is not affected by length of time that the sperm are stored for.

During your appointments with us we will give you the opportunity to discuss options relating to the storage and use of your samples, and we’ll answer any questions you have too. It may be, however, that you would like to explore any fertility-related issues raised during the process further.

We have a specialist counsellor available, and an appointment can be made for you at any time during the storage of your samples. Some people find counselling useful when making decisions about their stored samples, when coming to terms with bad news, or to talk about general worries about fertility and relationships.

Please let us know if you would like to see our counsellor and we can arrange this for you.

It is essential for you to keep us updated with any changes in your circumstances, particularly in relation to your consent forms (e.g. you split up with the partner you named in your forms, or recently got married), or your contact details (e.g. you move house). It is important to remember that you can update your consent forms at any time – please contact us.

Please check that you have completed the consent forms that allow your sperm to be used in fertility treatments. Please contact us if you are not sure, your samples cannot be used without these!

If you decide you would like to use your frozen samples in fertility treatment, your first port of call is usually your (or your partner’s) GP. They will probably arrange for you to be seen at a fertility clinic, along with your partner, where a series of tests can be carried out to help determine what type of fertility treatment is likely to give you the best chance of a pregnancy.

As well as the investigations that look at your partner’s fertility, before we freeze your sperm sample, we analyse it to give an idea of the quality we can expect when it is thawed out for use. Everyone will have variable sperm quality to a degree, and people who have been ill can have lower results in their sperm analysis because of this. The analysis of your sperm sample, along with the results of your partner’s investigations, will determine the types of fertility treatment recommended for you, and the likelihood of successful fertility treatment although no fertility treatment can be guaranteed to give you a baby.

Although we do perform fertility treatments here at UCLH, it may be that you receive your fertility treatment at another clinic. The transportation of samples between clinics can be straightforward, but does require an exchange of paperwork, so please bear this in mind, and contact us early on in order to start arranging this for you.

Fertility treatments are sometimes paid for by the NHS, but there are some circumstances that will mean that you would need to pay for fertility treatments yourself. These include having children already, or if your partner is over the age of 40. The rules about who can have NHS-funded treatment will be different depending on where you live, so if you are thinking of using your stored samples, you should see your GP first of all to find out what you are entitled to.

The main steps:

1. Contact us in the Fertility Laboratory to request transport and get the ball rolling.
2. When you receive the transport form, talk to your embryologist to find out how many straws/vials you’d like to move.
3. Send the completed transport form back to the laboratory. Please note that we require the form to be hand-signed.
4. Ask your clinic to contact us if you haven’t already done so. Alternatively, provide us with an email address for your clinic so that we can contact them.
5. We will not release samples for transport unless your treating clinic has confirmed they are happy to accept them.

Before your samples can be transported, the paperwork that you completed will need to be verified to ensure that the information you provided is still valid. This is why we encourage you to respond to the ‘Keeping In Touch’ letters that we send out and to attend the lab for an annual check-up if this is relevant for you. You may need to attend the laboratory to bring photo identification and update your paperwork.

We require written confirmation that you wish to transfer your samples and will ask you to complete a consent form. We may ask for your permission to send your paperwork and information to your clinic if we have not yet received your consent form.

You will be asked how many of your stored straws/vials you wish to have sent to your clinic. Please discuss with your embryologist how many straws/vials are required for your treatment and consider how many cycles of treatment you want to plan for. Your clinic may charge you for the storage of any samples that you did not use in your fertility treatment, so we advise transporting only what you need.

Once we are in contact with your clinic, we will exchange paperwork. Your clinic will then confirm with us when they are happy to accept your samples.

If you decide to use a fertility clinic abroad, we must be sure that it is accredited, designated, authorised, or licensed in line with the laws of the country. We are not allowed to transport samples to another clinic if they cannot show they meet the standards required by the Human Fertilisation and Embryology Authority (our regulators). Certain paperwork is required to authorise transfer of samples, if we don’t receive the correct paperwork your request to transfer abroad will be declined.

The process of moving samples abroad can be very time consuming and may not always be possible.

Please allow plenty of time and do not start any treatment until your samples have reached your clinic.

If your partner is unable to carry a pregnancy, for example if they have a medical condition or you are in a same-sex relationship, please let us know so that we can discuss future options with you. We may suggest that you undergo additional infection testing so that your samples could be used in a wider range of fertility treatment scenarios, and some alternative consent forms may be more appropriate for your wishes.

You can withdraw your consent to storage and request the disposal of your stored sperm samples at any time. Please contact the laboratory for a discussion, and details of the forms required.

It can be a very difficult subject, but by law, we need to know what to do with your samples in the event of something happening to you. There are sections on your consent forms which enable you to specify what you would like us to do with your stored samples if you are to die or become mentally incapacitated. We will honour your preferences indicated in your consent forms – this is why it is extremely important that your forms are kept updated.

It is also extremely important that your close ones know to contact us, and if you have consented for your partner to use your samples, that they know where to find us. While it is important that you have these conversations with your close ones, the topics can be difficult to broach.

Please speak to us if you are finding this hard and we can arrange an appointment with our counsellor if helpful.

We will maintain the storage of your samples, in accordance with your consent forms, for the time specified in your consent forms, and while we have funding to do so. Because circumstances do change, it is vital that these forms are kept updated, and that we don’t lose contact with you.

We will write every couple of years with a “keeping in touch” letter, but you may contact us at any time using the details on the back page of this leaflet to inform us of any changes, with any questions, or to discuss your options.

By law, we cannot store beyond the time specified in your forms, and if we cannot make contact with you to discuss the possibility of extending your storage, your samples will need to be discarded. We will write to you around 13 months before your consent forms expire to explain your options and remind you that counselling is available if you would find that helpful to make a decision about your storage. We will tell you the date that you need to respond to us by and if we do not receive your renewal consent forms by that date, your samples will need to be removed from storage and discarded in accordance with the law.

If you have frozen your samples before starting treatment that could harm your fertility (e.g. chemotherapy), we also invite you to come back to our clinic for a sperm test to assess the effects of your treatment on your fertility. As well as assessing the quality of your sample following treatment, it also provides an opportunity to review your paperwork, updating your forms as necessary. We recommend annual check-ups, the first one at least a year following the completion of your treatment. A proportion of people will regain fertility, sometimes within months and sometimes after years, and it may be that continued storage of the semen samples is no longer required.

We will need an up to date assessment of your fertility if/when you renew your storage consent forms to see if we can still store your sperm on the NHS. If your stored sperm samples do not give you an advantage over using a fresh semen sample in fertility treatment, the NHS will not continue to fund the storage.

You can still choose to keep your sperm samples but you will need to self-fund this.