Many benign and malignant conditions are treated with fertility-threatening medical or surgical therapies. Fertility preservation is a recourse critical to discuss prior to initiation of these therapies. This chapter describes contemporary and future fertility preservation approaches while also exploring barriers in access to their use as well as key decision-making strategies helpful for clinicians caring for patients with a range of medical conditions.

You have accessJournal of UrologyCME1 Apr 2023MP01-18 DECLINE IN SPERM FREEZE-THAW RECOVERY RATE WITH DELAYED CRYOPRESERVATION Andre Belarmino, Daniel Colin, Stacey Kenfield, Stanton Honig, James Dupree, Mary Samplaski, Dolores Lamb, Jerrine Morris, and James Smith Andre BelarminoAndre Belarmino More articles by this author , Daniel ColinDaniel Colin More articles by this author , Stacey KenfieldStacey Kenfield More articles by this author , Stanton HonigStanton Honig More articles by this author , James DupreeJames Dupree More articles by this author , Mary SamplaskiMary Samplaski More articles by this author , Dolores LambDolores Lamb More articles by this author , Jerrine MorrisJerrine Morris More articles by this author , and James SmithJames Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003212.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sperm cryopreservation requires in-person visits to produce an ejaculate and immediately freeze the sample. Recently, companies began offering services for mail-in semen analysis (SA) testing and cryopreservation. However, the effects of delayed cryopreservation associated with shipping times were generally understudied. Our laboratory has continued to optimize our cryopreservation technique. This study aims to define the effect of delayed cryopreservation on the recovered total motile count (TMC) compared to standard immediate cryopreservation, using our improved methods. METHODS: Fresh semen samples were provided from healthy volunteers. Samples were diluted with 5 mL of a proprietary preservation solution, mixed, and allowed to liquify for 30 minutes. Samples were then analyzed per World Health Organization (WHO) guidelines V5 and those with abnormal concentration, volume, or motility were excluded. Samples were then divided into 3 aliquots. Aliquot #1, T0 was immediately frozen with equal part cryoprotectant. Aliquot #2, T24 was left at room temperature for 24hrs, analyzed on the SQA (sperm quality analyzer) and then frozen with cryoprotectant. Aliquot #3, T48 was left at room temperature for 48hrs, analyzed on the SQA, and then frozen with cryoprotectant. 24hrs after the third aliquot was frozen, all aliquots were thawed in an incubator at 37C for 10 minutes and analyzed on the SQA. RESULTS: Eight adult men provided a total of 26 semen samples. Baseline SA values were: volume 3.4 ml±1.2, concentration 128.2±48.7 × 106, motility 49%±7%; TMC 211±109 million. A decline in % motility was observed after specimens sat at room temperature, as well as after freeze-thaw in most individuals. The average loss from freeze/thaw in TMC at T0 was 44.0%, at T24 was 47% relative to T24 pre-freeze, and at T48 was 65% relative to T48 pre-freeze (p=0.046) (Figure 1). CONCLUSIONS: This analysis reveals a superior freeze-thaw protocol compared to our prior methods, as we continue to refine our process, and follow best practice guidelines of experts in the field. Further investigation is needed to improve the methods needed for shipping with the goal of improving the freeze-thaw recovery rate with delayed cryopreservation. Source of Funding: Fellow Health Inc. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e9 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Andre Belarmino More articles by this author Daniel Colin More articles by this author Stacey Kenfield More articles by this author Stanton Honig More articles by this author James Dupree More articles by this author Mary Samplaski More articles by this author Dolores Lamb More articles by this author Jerrine Morris More articles by this author James Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

1525 Background: Over 90% of oncologists agree that sperm banking should be offered to all men at risk of subfertility associated with cancer treatment, but fewer than 50% bring up the topic. Barriers cited include lack of time for the discussion, perceived high cost, and lack of convenient facilities. The advent of mail-in semen analysis (SA) testing and cryopreservation may improve access to this service via lower patient cost, decreased required oncologist logistical support, and home rather than local lab collection. That said, average sperm recovery rate after sample thaw is ~50% with immediate banking, and sperm recovery rate after delayed cryopreservation with a mail-in approach remains unknown. Methods: This is a prospective preliminary study assessing freeze-thaw total motile count at 3 time points of cryopreservation: upon receipt of sample, at 24 hours, and at 48 hours post collection. We collected 39 fresh semen samples from 13 healthy adult volunteers. Samples were diluted with 5mL of Fellow Health preservation solution and analyzed (World Health Organization guidelines V5). Samples were divided into 3 aliquots: Aliquot #1, T0 was immediately frozen with equal part cryoprotectant. Aliquot #2, T24 and aliquot #3, T48 were left at room temperature for 24 and 48 hrs respectively, analyzed, and then frozen. Aliquots were then thawed on a heat block at 37C for 10 minutes and analyzed. Results: Baseline SA values were: volume 3.3ml +/- 1.3, concentration 138.3 +/-57.4 x 10 6 , motility 49% +/-6%; Total Motile Count (TMC) 213 +/- 110 million. TMC was the primary endpoint as measured by baseline semen volume, concentration, and motility at 3 time points (T0, T24, T48). The average loss from freeze/thaw in TMC at T0 was 45%, at T24 was 55% relative to T24 pre-freeze, and at T48 was 59% relative to T48 pre-freeze (p = 0.013). On average, samples with starting TMC between 50-100 million had enough motile sperm for six intrauterine insemination (IUI) cycles when frozen and thawed at T0, two at T24, and two at T48. Samples with starting TMC between 100-200 million had enough motile sperm for 16 IUI cycles when frozen and thawed at T0, eight at T24, and four at T48. Samples with starting TMC > 200 million had enough motile sperm for 42 IUI cycles when frozen and thawed at T0, 21 at T24, and nine at T48. All samples had ample viable cells ( > 50,000) at all three time points for in vitro fertilization (IVF). Conclusions: Mail-in cryopreservation using our improved methodology may increase access to this service for oncological patients while still facilitating reasonable assisted reproductive technology care relative to in-person cryopreservation.