Male fertility is a subject that has been very much under the microscope of the global scientific community
A man’s contribution to a healthy pregnancy is all too important and cryopreservation of sperm may help with male fertility in some cases, and statistics show that the number of men that may benefit from this practice is on the rise.
Frequently, the scientific approach is somehow cold and faceless and many of us believe that it does not directly relate to us. However, the story of Orpheas, could be any one of us, presenting the subject from a different perspective
Orpheas was born with cryptorchidism, he was in other words among the 3-4% of babies born with undescended testes
Experts stress that with cryptorchidism, if the testes have not dropped within the first year of the child’s life, then the best option is to correct the problem through an operation, which is best done at about 12 months.
If this isn’t carried out at this point, then there is the fear that the testes will be irreparably damaged or that later cancer will develop in the displaced testes,. The reasoning behind this is that cryptorchidism increases the likelihood of cancer developing by 20 to 30 times in the cryptorchidic testes.
Orchiectomy is necessary after puberty when the testes are confirmed to not be functioning properly. Indeed, in some cases orchiectomy is recommended before puberty, when it concerns microorchidism, that is, manifestly atrophic.
Orpheas’s parents realised this situation early on and so the young boy underwent restorative surgery at the age of one
The operation was a success, the testes were fully restored and young Orpheas reached manhood normally just like all the other boys of his age.
At 22 it was discovered that there was a hardening of the testis, and so he consulted a urologist for more extensive tests. The tests were reassuring but due to his history and the fact that this testis was atrophic it was decided to remove it.
Orpheas went immediately to a specialist fertility centre for advice, the necessary tests and information on the legal framework in Greece. Unfortunately, it was not possible to predict to what extent Orpheas’s fertility would be affected after the operation. Consequently, the fertility centre and the urologist suggested that he should cryopreserve (freeze) sperm samples, and this is what he eventually did prior to the operation.
Some years passed, Orpheas grew up and met his life partner
They then decided to have their own family, though they were aware the road ahead might be rocky because of his history. The couple consulted the same assisted reproduction centre where he had his cryopreserved sperm, and there, with the guidance of a coordinated team of specialist scientists, the couple began their efforts.
The road was going to be long, but thanks to the expert coordination, service and care they received, they managed in a short time to start their treatment and to complete it with embryo transfer, having made use of Orpheas’s frozen sperm sample for the fertilization of the oocyte.
Orpheas’s story is just one of thousands of men with low fertility who fight daily to have a child and who with the help of science, can succeed.
So who are likely candidates for cryopreservation of sperm?
There are two basic categories:
Men who are to undergo imminent cancer treatment (chemotherapy, radiation). It is common knowledge that all treatments which are toxic for cells, can have serious consequences for spermatogenesis and therefore also for the man’s future fertility.
Incipient operation on the testes. Beyond the removal of one or both testes, as already mentioned, a man might undergo another kind of surgery in the area (varicocele, inguinal hernia, hydrocele, vasectomy etc.). For these men, sperm cryopreservation is recommended if the urologist deems that the outcome of an operation may be unpredictable.
Testicular biopsy. When the sperm test indicates azoospermia absence of spermatozoa in the seminal fluid, then the removal of a sample of testicular tissue (done surgically) will show whether the testes produce spermatozoa and in what concentration. If the testes produce spermatozoa, cryopreservation of the testicular tissue from the cryobiology lab will enable those men to make use of their own sperm in any imminent IVF treatment.
Men with serious oligoasthenozoospermia or a progressive drop in sperm parameters. Abuse (smoking, alcohol, sedentary lifestyle and obesity) as well as exposure to radiation, chemical or toxic factors at work or in a hobby have been proven to affect sperm. As long as the parameters remain useable, specialists recommend sperm cryopreservation.
In recent years, we hear more and more about another sperm parameter, of a genetic nature, which appears to be affected by the factors mentioned above. This concerns DNA Fragmentation Index or DFI in the sperm. Research shows that when this factor is at non-physiological levels it is associated with failed embryo implantations as well as with miscarriages. The reassuring thing is that the DFI seems to be dynamic, a fact that means that when the conditions and the man’s way of life improves, this factor also improves in many cases. And in these men, specialists recommend sperm cryopreservation as long as the DFI is within normal ranges.
Last, but not least, are men, who have difficulty, for psychological reasons, to give sperm. It is not uncommon for a man to feel uncomfortable with the procedure of giving sperm, and because of his or various ethical inhibitions he cannot manage to give a sample on the day of treatment (oocyte collection or sperm injection). With these men, and on condition that they will notify promptly the attending doctors, sperm cryopreservation for future use in treatment is recommended.
Sperm cryopreservation is recommended also for non-medical reasons, such as, for example, if a partner will be absent on the day of the treatment (oocyte collection or sperm injection) for professional reasons. There are various categories of professions, which are associated with long-term absences, whether that be days or months and can benefit from cryopreservation (e.g. drivers, sailors or military personnel).
Another category are those men who have delayed fatherhood for later in life for various reasons, mainly professional, which seems to have become a modern trend. The need for preserving fertility has become all the more pressing since the most recent research coming from the Standford Medical school which indicates that the older the father, the greater the risk is of a child being born with a disorder.
In the lab, cryopreservation is a straightforward procedure, safe and of low cost
Sperm is provided by the patient which is then followed by the use of a microscopic to check the sample. After this, the sample is pre-prepared using the suitable materials, which aim to protect the spermatozoa during the process of freezing. In rare instances, the taking of sperm is performed through intervention methods when there is an inability to or difficulty with ejaculation.
Having prepared the sample appropriately, it is then transferred onto a small phial, and the temperature is gradually reduced and controlled from room temperature to -196C which is then placed in containers for long-term storage.
The sperm may remain cryopreserved theoretically indefinitely, on condition that the cryobiology lab carries out continuous checks to ensure the safeguarding of the samples in the right conditions.
Before the procedure of freezing the sperm or testicular tissue, an immunology check must take place for any infectious diseases of the interested party (for hepatitis B, C, AIDS virus and syphilis).
The legal restrictions for retaining samples amounts to ten years in total
If there is a medical reason for keeping the sample for more than this, then an application for an extension must be made to the National Authority of medically assisted reproduction by the interested parties.
Cryopreservation of sperm has been applied for decades now with success, with tens of thousands of successful births of healthy children
Literature refers to pregnancy and the birth of children using frozen sperm for up to 40 years. Also, most studies have shown that the percentage of children with chromosomal or other abnormalities from cryopreserved sperm does not differ from those from fresh sperm.
Just like the Orpheas in our story, many men will face low fertility in various forms
In many of the above cases, cryobiology can retain and preserve fertility for several years and provide healthy pregnancies.
The preservation of fertility and fatherhood is a biological right for all men and as a way to help safeguard fertility should be an obligation towards the generations to come.
Dr Moysidou is a biologist, clinical embryologist and deputy head of the laboratory at Embryolab, in Greece