Advances in cryopreservation: we are not frozen in time.

Life is like riding a bicycle, to keep your balance you must keep moving. -Albert Einstein.

Sperm cryopreservation in adolescents and young adults with cancer: results of the French national sperm banking network (CECOS).

OBJECTIVE: To determine the feasibility of fertility preservation in adolescent males with cancer. DESIGN: Large multicenter retrospective study of male patients ≤20 years from 23 centers of a national network of sperm banks over a 34-year period. SETTING: Sperm banks. PATIENT(S): A total of 4,345 boys and young men aged 11 to 20 years. INTERVENTION(S): Age, cancer diagnosis, feasibility of sperm banking, and sperm parameters. MAIN OUTCOME MEASURE(S): Description of patients, and success of their fertility preservation. RESULT(S): We observed a mean yearly increase in referred patients of 9.5% (95% confidence interval, 9.1%-9.8%) between 1973 and 2007. Over the study period, the percentage of younger cancer patients who banked their sperm increased, especially in the 11-14 year age group, rising from 1% in 1986 to 9% in 2006. We found that 4,314 patients attempted to produce a semen sample, 4,004 succeeded, and sperm was banked for 3,616. The mean total sperm count was 61.75 × 10(6) for the 11-14 year age group, and 138.81 × 10(6) for the 18-20 year age group. It was noteworthy that intercenter variations in practices involving young patients seeking to preserve their fertility before cancer therapy were observed within this national network. CONCLUSION(S): Our results emphasize the need for decisive changes in public health policy to facilitate the access to reproductive health-care for young cancer patients.

Trends and usage in a London National Health Service Sperm Bank for cancer patients.

Sperm cryopreservation is the only method currently available that offers men with cancer insurance against sterilising iatrogenic treatments. We carried out two cohort and cross-sectional audits to identify trends with sperm cryopreservation referral rates and sample usage rates for men diagnosed with cancer and who banked sperm at The Andrology Laboratory, Hammersmith Hospital, Imperial College NHS Trust. These retrospective audits revealed that a total of 4362 men with cancer successfully banked sperm between 1976 and 2013. Truncating the dataset to 2009 to allow for lag times between storage and use, the overall sample usage rate for cancer patients was 6.0% with 75 live births. Increased median age at referral influences the cancer profile of men seen at the bank, which is highlighted by a disproportionate rise in the number of men with prostate cancer. Among men who use banked sperm, a large rise in the use of intracytoplasmic sperm injection has occurred over time. The number of patients requiring the service is sharply increasing year on year as are the number of patients who go on to use their sample in assisted conception. The historical use rates of frozen sperm are likely to be significant underestimations of future use.

[Artificial insemination with donor sperm in the Netherlands: future-proof?]. / Kunstmatige inseminatie met donorsperma in Nederland: toekomstbestendig?

In recent years much has changed in care for artificial insemination with donor sperm (AID). Since new laws and regulations were implemented, a large number of sperm banks have closed and the total number of sperm donors and their availability have decreased. Long waiting times and the use of sperm donors recruited by foreign commercial sperm banks can indicate a shortage of sperm donors. The fact that the internet offers women the possibility of ordering donor sperm and starting treatment without the intervention of a sperm bank means that future donor-conceived children may be prevented from obtaining the identity of their sperm donor as stipulated in the Dutch law on donor information in the context of artificial insemination. In order to comply with this law, an active recruitment policy is needed for Dutch sperm donors, to prevent waiting lists and treatments outside Dutch sperm banks. Only then can current AID care be guaranteed in the Netherlands in the future.

Danish sperm donors across three decades: motivations and attitudes.

OBJECTIVE: To study the motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women among Danish sperm donors in 2012 compared with the two preceding decades. DESIGN: Anonymous survey. SETTING: Danish sperm bank. PATIENT(S): Sperm donors active in 2012 (n = 97), 2002 (n = 62), and 1992 (n = 41). INTERVENTION(S): All donors who donated sperm in the study period were asked to participate. The results were compared with those of previous surveys from the same sperm bank. MAIN OUTCOME MEASURE(S): Motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women. RESULT(S): In 2012, the most frequently stated factor was altruism, motivating 90% of the sperm donors, which was not significantly different from the previous surveys. If economic compensations were removed, only 14% would continue to donate. The proportion of anonymous donors who would stop their donations if anonymity was abolished was 51%, 56%, and 67% in 1992, 2002, and 2012, respectively. A significantly increasing proportion of donors felt positive about donation to lesbian couples. CONCLUSION(S): The motivation for sperm donation is multifaceted and primarily based on economic compensation and altruism. Most Danish donors would stop their donations if economic compensation or anonymity were abolished.

The sperm donor programme over 11 years at Newcastle Fertility Centre.

The UK national sperm donor shortage is well known. We aimed to analyse the trends in various aspects of the sperm donor programme at Newcastle Fertility Centre (NFC) between 2000 and 2010. A retrospective review of the assisted conception treatments with donor sperm was performed. A decline in the numbers of donors recruited alongside a declining trend in the number of patients treated with donor sperm and donor insemination (DI) treatment cycles carried out was apparent. There was an accompanying rising trend in donor IVF cycles and in same-sex couples and single women coming for treatment. The transfer of sperm to local peripheral centres ceased during this time and an increasing number of patients imported sperm from overseas commercial sperm banks. A waiting list for treatment was set up in 2007 with a gradual increase in waiting time to 18 months in 2010. Overall, there was a significant change in the sperm donor programme at NFC with fewer donors recruited, fewer patients receiving treatment, increasing sperm import and longer waiting times for treatment over the study period.

Gamete donation in France: the future of the anonymity doctrine.

In France, since the approval of the first bioethics laws in 1994, the principle of the anonymity of sperm donors has prevailed. This choice is regularly challenged, namely by children who have been conceived under these conditions and have now reached adulthood. In this paper, we will briefly describe the reasons that led practitioners of assisted reproduction to endorse the anonymity principle in 1994. Secondly, we will elaborate on the reasons why this principle is becoming so controversial today. Finally, we shall examine two possible outcomes of the debate, highlighting their respective legitimacy as well as their consequences, as far as the rights of children, the notion of the family, and medical practice are concerned.

Designing deaf babies and the question of disability.

This article explores the recent controversy surrounding a Deaf lesbian couple's deliberate attempt at finding a Deaf donor to increase their chances of having a d/Deaf baby. Many have criticized the Deaf couple for harming their child; Deaf advocates have responded that the couple's decision reflects a natural cultural desire. This article seeks to explore how the medical model of disability implicitly used on both sides of the debate has obscured important points. Once this controversy takes into consideration the social construction of disability, the ethical defense of seeking a deaf child gains further support. This leads to the ironic claim that seeking a deaf child could actually mitigate the conditions of disability within the family.

Current and future concepts and practices in human sperm cryobanking.

This article focuses on a range of issues that are of current concern to those working in human sperm cryobanking and considers them within a general framework of risk analysis and management, taking into account the available evidence and perceptions of 'best practice' from both the medical and legal perspectives. In particular, issues arising from concerns over the risk of cross-contamination between samples during storage immersed in liquid nitrogen have been analysed in detail. Even though such an occurrence has never been reported for spermatozoa or embryos, and the risk is generally accepted to be vanishingly small, it does represent a finite risk and all reasonable measures should be taken to reduce the chance of its occurring. It is concluded that all methods used to collect, cryopreserve, store, thaw and use cryobanked human spermatozoa must address the risk of contamination from any source throughout the entire process. To assist workers in this area, a series of recommendations as to current best practice are made, based upon conclusions from risk analyses using currently available information.

Current status of semen banking in the USA.

Anonymous donor sperm banking has been a fundamental aspect of reproductive medicine for several decades. In 1987, >170,000 women in the USA were treated for infertility using artificial insemination. Current estimates suggest that the number of women seeking treatment for infertility has increased markedly since that time; however, there are no accurate, updated data to indicate the magnitude of that increase. Most anonymous donor sperm banks in the USA can be categorized as one of three types based upon administrative structure: (i) physician practice based; (ii) hospital/clinic based; or (iii) commercial corporations. Of these it is estimated that the most common structures are the physician office and hospital/clinic based banks. However, the largest (i.e. those processing the most units) are the for-profit corporate banks. A survey conducted in 1989 found that there were at least 135 sperm banks operating in the USA. More recent information indicates the number of banks to be somewhere between 50 and 150. Guidelines for anonymous donor sperm banking practices have been established by the American Society for Reproductive Medicine and standards have been established by the American Association of Tissue Banks (AATB). The AATB has recently established an inspection and accreditation programme and six anonymous donor banks have been accredited in the last few years. It is anticipated that mandatory registration of all donor banks will be required by the FDA in the near future with mandatory inspection and accreditation to follow shortly thereafter.

Donor insemination--a look to the future.

In this article we have reviewed many aspects of donor insemination. The deficiencies in the screening of semen donors especially for sexually-transmitted diseases has been discussed and importance of a rational protocol for recruitment and screening of potential donors has been emphasized. Factors influencing the success and outcome of donor insemination have been reviewed with particular emphasis on providing prognostic guidelines to potential donor insemination couples as to the success and outcome of the treatment. The importance of accurate timing of inseminations in determining the success of donor insemination has also been discussed. However, as has been highlighted throughout this review, there is a lack of specific prospective controlled trials, which are clearly necessary to answer specific important questions. Also emphasized has been the need of these trials to answer such basic questions as the influence of accurate timing on conception rates in specific groups of insemination recipients.

[The Munich cryopreserved sperm bank--intermediate 1974-1986 evaluation]. / Kryospermabank München--Zwischenbilanz 1974-1986.

The storage of spermatozoa from tumour patients in sperm banks is an important medical task. As a result of improved treatment strategies the survival rate, particularly in patients with testicular tumours and Hodgkin's disease, is excellent if the diagnosis is made early. However, the necessary therapeutic measures often lead to the mutilation of reproductive function. At the Department of Dermatology at the University of Munich a sperm bank has been in existence since 1974; most of the patients who consult the sperm bank are men with testicular tumours. A synopsis of the last 12 years provides information about the patients, indications for storage, the method of preservation used and the fate of the cryopreserved samples used for insemination. To guarantee that optimal results are achieved, cryopreserved sperm samples should only be used by gynaecologists who are particularly experienced in the treatment of sterility.