Cryopreservation of Client Depositor Semen

Abstract

The primary purpose of the Andrology Center and Reproductive Tissue Bank is to provide quality sperm cryopreservation service to those patients who have been diagnosed with cancer and will undergo chemotherapy or radiation therapy. This service is also provided to pre-vasectomy patients, patients undergoing vasectomy reversals, as well as those needing sperm for IVF backup or general fertility preservation purposes.

Chemotherapy and radiation therapy may cause a patient to become temporarily or permanently sterile. Cryopreservation of sperm prior to treatment will allow these patients the opportunity to father their own children in the future. Future pregnancies would be achieved by insemination or other assisted reproductive techniques available at the time of use.

Therapeutic bank patients, referred to as “client depositors,” can address the risks of infertility inevitable in certain medical treatments and surgeries by taking advantage of the controlled practice of cryopreservation.

Appendices

Addendum

1.1 Cryopreservation of the “Traveling Husband” Specimen

1.1.1 Introduction

A client depositor identified by the Gynecology Department as a “traveling husband” can make use of the time delay factor in the cryopreservation procedures, i.e., when the wife ovulates the husband may of necessity be out of town. Due to the fact that the husband is not present when the specimen is used for insemination, three forms must be signed and filled out with the other paperwork to allow for future use of the specimen.

1.1.2 Procedure

Note: Follow the procedure steps as detailed in the “Cryopreservation of Client Depositor Semen” protocol along with the steps below:

• A. The traveling husband (client depositor) must also fill out the “thawed specimen ID” form (Appendix 10). He should print his name and clinic number on the top line of the form. He should sign his name on the line after “Client Depositor” and put the date of cryopreservation of the specimen after “Date.” The wife’s signature and lower portion of the form will be filled out on the date of specimen use.

• B. Also, at the time of cryopreservation, the “Authorization to Transport Semen Specimens” form should be filled out on page 2 (Appendix 11). The client depositor should sign the form on the top line after the “Client Depositor” signature, as should his partner. Then he should print his name, address, telephone number, and date on the indicated lines. The technologist processing the specimen for cryopreservation should then sign after the “Witness Signature” and provide the date of processing.

• C. Complete the “Release of Positive Blood/Semen Test Notification” (Appendix 9).

Appendix 1: Sperm Bank Patient List

Bank number	Color of marker	Letter code	Index card color
1st	Red	A	Red
2nd	Blue	B	Blue
3rd	Green	C	Green
4th	Black	D	Yellow
5th	Red	E	Orange
6th	Blue	F	White
7th	Green	G	White
8th	Black	H	White
9th	Start rotation from top

Appendix 2

Appendix 3: Sperm Bank Questionnaire

Appendix 4: Authorization to Cryopreserve Specimens

Appendix 5: Cryopreservation Worksheet

Appendix 6

Appendix 7: Cryopreservation Report

Name:	Clinic number	Bank ID number
Specimen Type: Semen
	Specimen A	Specimen B
Pre-cryopreservation
Date:
Time (24 h):
Length of abstinence (days):
Semen volume (mL):
Viscositya:
pHa:
Colora:
Round cells (106/mL)a:
Motility (%):
Velocity (μ/s):
Linearity (%):
ALH (μ):
Concentration (106/mL):
Total count (106):
Morphology (% normal sperm forms by Kruger method)a:
Endtz (106/mL)a:
Comments:
Post-cryopreservation
Motility (%):
Velocity (μ/s):
Linearity (%):
ALH (μ):
Total motile sperm (106):
Motile sperm/vial (106):
No. of vials:
No. of possible insemination (IUI) attempts:
No. of possible IVF attempts:
Volume/vial (mL):
Comments:

1. ^aData Entered for Specimen A Only

Appendix 8: Release of Reproductive Cells and/or Tissues Not Tested for Infectious Diseases

Appendix 9: Release of Reproductive Cells and/or Tissues Positive Test Notification

Appendix 10: Thawed Specimen ID Form

Appendix 11: Authorization to Transport Semen Specimens

Appendix 12: Positive Blood Test Notification