Fertility Preservation

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Freezing and Storage of Sperm for Fertility Preservation Leaflet

Freezing and Storage of Sperm for Fertility Preservation

The leaflet is detailed below, or you can download the 'Freezing and Storage of Sperm for Fertility Preservation' leaflet in PDF.

Why is sperm stored?

Some forms of chemotherapy, radiotherapy, surgery, and hormone therapy can lead to

infertility which may be temporary or permanent. Therefore, fertility preservation is particularly important for patients undergoing cancer treatment. Before any of these procedures are carried out, it is possible to store sperm using a freezing process known as cryopreservation.

Frozen sperm samples can be thawed if/when required and used in procedures such as artificial insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

How does cancer treatment affect fertility?

Cancer treatments are important for your future health, but they may harm the reproductive organs and glands that control fertility. These changes to your fertility may be temporary or permanent. It is difficult to predict if the cancer treatment will affect your fertility. Whether or not your fertility is affected depends on factors such as:

Baseline fertility
Age at the time of treatment
Type of cancer and type treatment you receive
Other personal health factors

Your doctor will be able to talk with you about whether your cancer treatment is likely to lower your fertility or cause permanent infertility. Your doctor can then refer you to the Andrology Team at The Hewitt Fertility Centre to have your sperm stored.

I would like to store my sperm for future use, what happens next?

Once referred, The Andrology Team at The Hewitt Fertility Centre will telephone you to arrange an appointment date and time to visit the centre and store your sperm. The appointment(s) made will be before your cancer treatment is due to begin.

On your sperm freeze appointment date, you will first have a consultation with a Reproductive Scientist to discuss the implications of storing your sperm and complete the relevant consent forms. It may be useful before your appointment to consider, if you have a partner, whether you would like them to be able to use your stored samples. You will be asked questions with regards to the storage and use of stored samples. At this appointment, you will have the opportunity to ask any questions you might have.

Next, you will be asked to produce a semen sample through masturbation. The centre has private, specially designed production rooms available for you produce your sample in. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within 50 minutes of production.

Finally, you will first have a blood test where you are screened for HIV, Hepatitis B & Hepatitis C. This is for sperm storage purposes as there is a theoretical risk of viral cross-contamination between samples.

If it has been established that a surrogate might be required to carry a pregnancy in the future, then further extended screening will be required. This will involve urine testing, a physical examination and further blood testing.

What happens to my sperm once I’ve produced a sample?

Once you have produced your sample, a diagnostic semen analysis test will be performed to assess the quality of the sample. Your sample will then have cryoprotectant added (a liquid media that prevents damage to sperm cells during freezing) before being transferred into a number of units which are also known as ‘straws’. The straws are gradually cooled to -196°C. Once cooled, your sample will be placed into special containers called dewars, where they will be kept in liquid nitrogen or liquid nitrogen vapour until you potentially require them for fertility treatment.

Have I produced enough sperm and what is its quality like?

The Andrology Team at The Hewitt Fertility Centre will ensure that enough of your sperm will be frozen for future fertility treatment(s). This may involve attending the centre for more appointments. We will know whether further appointments will be needed after you have produced your first sample and will arrange this with you. This is of course dependent upon when your treatment is due to start. If your sample is unsuitable for storage, you can discuss your options and next steps with your clinician. You are welcome to use our counselling service if you wish to do so.

How successful is the use of frozen sperm?

Success does depend on the quality of the sperm stored. Frozen samples with reduced numbers of sperm or high rates of sperm abnormality are less likely to be successful in treatment. There is always a reduction in sperm quality due to the freeze-thaw process. We cannot guarantee any samples frozen will achieve a pregnancy.

What are the legal implications for storing sperm?

All fertility centres are under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

Storage of your sperm and the length to which it is stored for
The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family with named on your form)
Your decision over any embryos created using your sperm
What happens to your frozen sperm in the event of your death or incapacitation
What will happen if your sperm is not used

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born because of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

How long can sperm be stored?

The legal period for storing sperm is 55 years according to the HFEA. However, crucially, for storage to lawfully continue you will need to renew your consent every 10 years. Stored sperm can only be used by the person providing the sperm, or together with their partner, it cannot be donated to treat others. It is unlawful to store sperm beyond the period to which you consent, and The Hewitt Fertility Centre has a legal obligation to dispose of your sample once consent has expired.

Can I test my fertility once my cancer treatment has finished?

Twelve months after your cancer treatment has ended, you can contact the centre to arrange a semen analysis test along with a follow-up consultation to see a fertility specialist.

Here, we will discuss whether your sperm function has returned and your available fertility options in the future. There is currently no evidence that children conceived naturally of a parent who has had cancer treatment will have an increased risk of abnormalities.

Do I have to pay for freezing & storing my sperm?

If you will be undergoing cancer treatment where there is a possibility of it affecting your fertility, funding for the freezing and storage of sperm is typically provided by the NHS for 10 years. This is dependent upon which NHS Integrated Care Board you fall under and what specific criteria they have set for funding sperm storage.

When NHS funding for storage ends, you will be contacted by The Hewitt Fertility Centre to ask whether you wish to continue storage. Continued storage after this period, will incur an annual fee.

Will future fertility treatment be available on the NHS?

After your cancer treatment, if you require fertility treatment to achieve a pregnancy, your GP will have to refer you to a fertility centre.

Your Integrated Care Board will then make an assessment as to whether you and your partner meet the eligibility criteria they have set for NHS funding. If you do not meet these criteria, fertility treatment will have to be self-funded.

Safety & Quality

We promise to look after your sperm as carefully as possible but we cannot be held responsible for its safety or the risk of the loss of sperm due to equipment failure. In addition, we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licensed centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

I am under 16 years old, can I have my sperm stored?

If you are under 16, you will be assessed for Gillick competence to ensure that you have capacity to understand and consent to having your sample stored. You would produce your sample through masturbation. Counselling is available to help support you and your family during this time.

How can I contact the unit?

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net if you require any further information about fertility preservation.

You must keep us informed of any change in your circumstances e.g. change of address. This is because we will contact you every three years to see if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

This leaflet can be made available in different formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at pals@lwh.nhs.uk

Document Code: P-INFO-FP-3	Version No:
Document Title: Freezing and Storage of Sperm for Fertility Preservation
Date of issue: 19.04.2024	Date of review: 19.04.2027
Owner: P Mallanaphy	Author: A Allan

Freezing and Storage of Sperm Prior to Fertility Treatment Leaflet

Freezing and Storage of Sperm Prior to Fertility Treatment

The leaflet is detailed below, or you can download the 'Freezing and Storage of Sperm Prior to Fertility Treatment' leaflet in PDF.

Why is my sperm sample being frozen?

Sperm freezing, also known as sperm cryopreservation, is typically offered for the following reasons;

Retrograde ejaculation, where the sperm is passed into the bladder instead of passing out through the urethra.
If you have difficulty with or concerns about producing a sperm sample on the day of treatment.
If the quality of your sperm sample is such that we have concerns that there may not be an adequate number of sperm to perform your ICSI treatment on the day of egg collection.
Social reasons. For instance, not being available when your semen sample will be required during fertility treatment.

Sperm freezing will ensure that there is sperm available to use when fertility treatment starts. Frozen sperm samples can be thawed when required and used in procedures such as artificial insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

I’ve been asked to freeze my sperm, what happens next?

If your doctor has recommended sperm freezing, you will first have a blood test where you are screened for HIV, Hepatitis B & Hepatitis C. This is for sperm storage purposes as there is a theoretical risk of viral cross-contamination between samples.

On your sperm freeze appointment date, you will first have a consultation with a Reproductive Scientist to discuss the implications of storing your sperm and complete the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. At this appointment, you will have the opportunity to ask any questions you might have.

Next, you will be asked to produce a semen sample through masturbation. The centre has private, specially designed, production rooms available for you produce your sample in. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within 50 minutes of production.

What happens to my sperm once I’ve produced a sample?

Have I produced enough sperm and what is its quality like?

The Andrology Team at The Hewitt Fertility Centre will ensure that enough of your sperm will be frozen for future fertility treatment(s). This may involve attending the centre for more appointments. We will know whether further appointments will be needed after you have produced your first sample and will arrange this with you. If your sample is unsuitable for storage, you can discuss your options and next steps with your clinician. You are welcome to use our counselling service if you wish to do so.

What are the legal implications for storing sperm?

Storage of your sperm and the length of time it can be stored for
The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family with named on your form)
Your decision over any embryos created using your sperm
What happens to your frozen sperm in the event of your death or mental incapacitation

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born because of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from the partner that you listed at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

How long can sperm be stored?

The legal period for storing sperm is 55 years according to the HFEA. However, for storage to lawfully continue you will need to renew your consent every 10 years. It is unlawful to store sperm beyond the period to which you consent, and the Hewitt Fertility Centre has a legal obligation to dispose of your sample once your consent has expired.

Do I have to pay for freezing & storing my sperm?

This is dependent upon which NHS Integrated Care Board you fall under and what specific criteria they have set for funding sperm storage. This will be assessed before you freeze sperm. If you qualify for NHS funding, sperm storage is typically funded by the NHS for a period of between 1 and 10 years and the terms may vary if your treatment is successful.

When your NHS funding for storage ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage up until the length that you have legally consented for. Continued storage after this period will incur an annual fee.

If you do not qualify for NHS funding, sperm freezing and the ongoing storage of your sperm incurs a fee.

How successful is the use of frozen sperm?

We would expect around 50% of your frozen sperm sample to survive the thawing procedure. This might mean that your treatment type may vary from that if you were having treatment using your fresh sperm. Treatment using frozen sperm has a similar success rate to treatment using fresh sperm. Please note, success rates are partly dependent on sperm quality.

Safety & Quality

We promise to look after your sperm as carefully as possible but we cannot be held responsible for its safety or the risk of the loss of sperm due to equipment failure. In addition we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

Contact with the unit

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net if you require any further information about fertility preservation.

You must keep us informed of any change in your circumstances e.g. change of address. This is because we will contact you to see if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

Document Code: P-INFO-FP-2	Version No: 7
Document Title: Freezing and Storage of Sperm Prior to Fertility Treatment
Date of issue: 19.04.2024	Date of review: 19.04.2027
Owner: P Mallanaphy	Author: P Mallanaphy

Egg Freezing for Transgender Patients

Transgender & Non-Binary Fertility Preservation - Egg Freezing

The leaflet is detailed below, or you can download the 'Transgender & Non-Binary Fertility Preservation - Egg Freezing' leaflet in PDF.

Why should I think about fertility preservation?

Future fertility may be something you are thinking about as a transgender or non-binary person. Understandably, some transgender and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you realise later that it is not possible, or more difficult, to have a biological family. Thinking through all these issues now and understanding your options will help you to make an informed decision.

Some medical treatments for gender dysphoria, including hormone therapy and surgery, can have a temporary or permanent impact on your fertility. If you are considering starting treatment to physically alter your body, or you have already started, you can contact us to discuss possible options for preserving your fertility.

Having genital reconstructive surgery can prevent you from having biological children without the use of a surrogate or interventional fertility treatments. Genital surgery that may be considered includes salpingo-oophorectomy (removal of the fallopian tubes and ovaries) and/or hysterectomy (removal of the womb). How you decide to preserve your fertility would be dependent on your particular situation. You may wish to preserve your fertility by having your eggs frozen or by creating and freezing embryos. If you are interested in embryo freezing, please find more information on this process in our leaflet titled ‘Embryo Freezing and Thawing Patient Information’

How are eggs collected and stored?

You will be assessed by a clinician before undergoing fertility preservation treatment, most likely by way of an ultrasound examination. If you are concerned about being examined, please contact the clinic to discuss how we can make this more comfortable for you. You will also need to have blood tests to determine your hormone levels in addition to viral screening (minimum requirement: Hepatitis B, Hepatitis C and HIV).

In the future, you may decide to have IVF treatment using a surrogate and your frozen eggs. For this reason, the clinical team may recommend that you undergo extended screening tests prior to freezing your eggs. If you decide to go ahead with IVF treatment using a surrogate, you may then be required to undergo further extended screening tests at that time; these tests may incur a further cost.

Fertility drugs are given to stimulate the ovaries to produce several follicles that contain eggs (please see the leaflet “Ovarian Stimulation”). The development of follicles is monitored by vaginal ultrasound scans. When the follicles have reached the right size, the eggs are collected by a practitioner using a needle at the end of the ultrasound probe under direct vision, to remove the fluid within the follicles. The fluid is assessed under a microscope; any eggs present are identified by the embryologist and placed into an incubator until they are frozen. It is important to note that not all the eggs may be suitable for freezing; only mature eggs will be frozen. Regarding the egg freezing process, mature eggs are mixed with cryoprotectant (a solution that protects the eggs from very cold temperatures) and placed on straws before submersion in liquid nitrogen. Egg freezing is a technique that allows long-term egg storage in very cold conditions (-196°C).

How long can eggs be stored?

Eggs can be stored for up to 55 years; however the storage period will be renewed every 10 years. You are free to withdraw or vary the terms of your consent at any time.

I’ve already started my transitioning medication, what are my options?

If you have already started hormone therapy or you are taking puberty suppressing medication, you will need to discuss your future options with a clinician. They may recommend that you stop taking your medication to increase your chance of having a family through assisted reproduction treatment. We understand that it can be distressing to come off their hormone therapy, so there will be no pressure from the clinic to do this.

Some transgender and non-binary people may also consider other options for having a family, such as the use of donated eggs, sperm or embryos in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family. If you’re interested, please ask The Hewitt Fertility Centre for further advice and the relevant patient information leaflets.

What happens when I want to use my frozen eggs?

The use of your frozen eggs is dependent on your individual situation; this may involve your partner, using a surrogate, using donor sperm or of you have not had your uterus removed, the option of carrying the pregnancy yourself may exist.

Once you are ready to proceed with treatment, the eggs are removed from storage and thawed. Not all eggs survive the freezing/thawing process. Current data from the Hewitt Fertility Centre shows that 77% of eggs survive the process (this data was collected from patients of all ages between the years 2013 - 2018).

Suitable eggs are inseminated with sperm using a technique known as Intracytoplasmic Sperm Injection (ICSI). ICSI is required because frozen-thawed eggs no longer have their protective outer cell coating. Conventional IVF cannot be performed, as for this method, the outer cell coating is necessary for sperm to achieve fertilisation.

What are the success rates?

Until recently, pregnancy rates from egg freezing procedures were very poor, but scientific advances have now made egg freezing a viable option. However, the data is still limited and as with all fertility treatments, there is no guarantee this procedure will result in a successful pregnancy. It is also important to remember that some cycles may be cancelled prior to embryo transfer due to poor egg survival, failed fertilisation or poor embryo development.

Are there any risks associated with egg freezing?

Although current data indicate that there are no increases in birth defects or chromosomal abnormalities in children born from frozen eggs, we still need to monitor this carefully as we collect more data. It is important to note that many healthy babies have been born following egg freezing/thawing; but as this is still a relatively new procedure, there may be some yet unrecognised risks.

Do I have to pay for freezing & storing my eggs?

Funding for egg freezing for gender reassignment prior to future IVF/ICSI treatment is dependent upon the NHS clinical commissioning group that you fall under and your specific circumstances. You will need to contact your GP to investigate your funding options. If you are eligible for NHS funded storage, it is important to note that when this is due to end, you will be contacted by The Hewitt Fertility Centre to ask whether you wish to continue storage. Continued storage after this period, will incur an annual fee (approximately £180 per year).

If you are not pursuing NHS funding for any aspect of your treatment, you can contact the clinic directly for more information on treatment costs.

Safety & Quality

We promise to look after your eggs as carefully as possible, but we cannot be held responsible for egg safety or the risk of the loss of eggs due to accident or equipment failure. In addition, we cannot guarantee that your eggs will survive the warming process or that a successful pregnancy will result from their use.

Contact with the unit

You must keep us informed of any change in your circumstances e.g. change of address. This is because, we will contact you in the future to see if you still want your eggs to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on egg storage, please contact the unit and ask to speak to a member of the Embryology team.

Document Code: P-INFO-EF-2

Version: 2

Document Title: Transgender & Non-Binary Egg Freezing

Date of issue: 26/07/22

Date of review: 26.07.2024

Owner: R Gregoire

Author: M McGrane

Sperm Freezing for Transgender & Non Binary Patients

Transgender & Non-Binary Fertility Preservation - Sperm Freezing

The leaflet is detailed below, or you can download the 'Transgender & Non-Binary Fertility Preservation - Sperm Freezing' leaflet in PDF.

Why is it a good idea to freeze sperm?

Future fertility may be something you are thinking about as a transgender or non-binary person. Understandably, some transgender and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you realise later that it is not possible, or more difficult, to have a biological family. Thinking through all these issues now and understanding your options will help you to make an informed decision. Before any of these procedures are carried out, it is possible to store sperm using a freezing process known as cryopreservation.

Some medical treatments for gender dysphoria or incongruence, including hormone therapy and surgery, can have a temporary or permanent impact on your fertility. If you are considering starting treatment to physically alter your body, or you have already started, you can contact us to discuss possible options for preserving your fertility.

What happens at my first appointment?

Once referred, The Hewitt Fertility Centre will telephone you to arrange an appointment to visit the centre. If possible, this appointment should be made before the gender reassignment treatment is due to begin.

During your first appointment, you will have a consultation with a member of staff to discuss the implications of storing your sperm and discuss the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. It may be useful (before your appointment) to consider, if you have a partner, whether you would like them to be able to use your stored samples in the future. At this appointment, you will also have the opportunity to ask any questions.

In order to store your sperm, you will require a blood test to screen for HIV, Hepatitis B & Hepatitis C, this is a legal requirement due to the theoretical risk of viral cross-contamination between samples. You will also be asked whether you would like to have extended screening which will allow your samples to be used in a wider variety of circumstances in the future, should you so wish. Extended screening involves further blood tests, a urine test and a physical examination of your penis to rule out infections.

What is the procedure for freezing sperm?

Once the results of the blood tests become available, The Andrology Team at The Hewitt Fertility Centre will phone you to arrange an appointment date and time to visit the centre and store your sperm. During this second visit you will be asked to produce a semen sample. The centre has private, specially designed production rooms available in which you can produce your sample. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within 50 minutes of production.

What happens to my sperm once I’ve produced a sample?

If your sample is unsuitable for storage, additional tests may be required to understand why; if this occurs you can discuss your next steps and future options with your clinician.

How many samples will I need to produce?

On average, the cryopreservation of three samples will be sufficient, however, the clinic will guide you on whether you need to produce more or less.

What are the legal implications for storing sperm?

All fertility centres fall under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

Storage of your sperm and the length to which it is stored for
The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family named on your form)
Your decision over any embryos created using your sperm
What happens to your frozen sperm in the event of your death or incapacitation
What will happen if your sperm is not used

You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born as a result of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately. This is because we will contact you to ask if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

I’ve already started my transitioning medication, what are my options?

If you have already started hormone therapy or you are taking puberty suppressing medication, you will need to discuss your future options with a clinician. They may recommend that you stop taking your medication to increase your chance of having a family through assisted reproduction treatment. We understand that it can be distressing to come off their hormone therapy, so there will be no pressure from the clinic to do this.

Some transgender and non-binary people may also consider other options for having a family, such as the use of donated eggs, sperm or embryos in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family. If you’re interested, please ask The Hewitt Fertility Centre for further advice and the relevant patient information leaflets.

How long can sperm be stored?

Sperm can be stored for up to 55 years; however, the storage period will be renewed every 10 years. You are free to withdraw or vary the terms of your consent at any time.

Do I have to pay for freezing & storage of my sperm?

Sperm freezing funding for gender reassignment is dependent upon the NHS clinical commissioning group that you fall under and your specific circumstances.

If NHS funding is available for you, when your funded storage period ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage. Continued storage after this period may incur an annual fee.

In the future, you may decide to have IVF treatment using a surrogate and your frozen sperm. For this reason, the clinical team may recommend that you undergo extended screening tests prior to freezing your sperm. In the future, if you decide to go ahead with this IVF treatment, you may then be required to undergo further extended screening tests at that time; these tests may incur a further cost.

If you are not pursuing NHS funding for any aspect of your treatment, you can contact the clinic directly for more information on treatment costs.

What are the risks of sperm freezing?

It is well established that a number of sperm can either be damaged or do not survive the freezing process. It is also clear that success depends on the quality of the initial sperm sample; frozen samples with reduced numbers of sperm or high rates of sperm abnormalities are less likely to be successful in treatment. However, it must be noted that treatment with frozen sperm is currently just as successful as treatment using fresh sperm (HFEA, 2021).

Safety & Quality

We promise to look after your sperm as carefully as possible, but we cannot be held responsible for its safety or the risk of the loss of sperm due to accident or equipment failure. In addition, we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licenced centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

Contact with the unit

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net if you require any further information about fertility preservation.

References:

HFEA (2021). Sperm freezing, Fertility Preservation. https://www.hfea.gov.uk/treatments/fertility-preservation/sperm-freezing.

Document Code: P-INFO-FP-2	Version No: 5
Document Title: Freezing and Storage of Sperm Prior to Fertility Treatment
Date of issue: 19.04.2024	Date of review: 19.04.2027
Owner: R Gregoire	Author: P Mallanaphy

Egg Freezing

The leaflet is detailed below, or you can download the 'Egg Freezing' leaflet in PDF.

What is egg freezing?

Egg freezing is a technique that allows long-term egg storage in very cold conditions (-196°C).

Who can have egg freezing?

Patients facing medical treatment that may affect their fertility, such as chemotherapy, radiotherapy or surgical removal of the ovaries, may benefit from egg freezing. Also, patients at risk of premature ovarian failure or suffering from endometriosis, cysts and pelvic infections could preserve their fertility by storing their eggs for future use. Egg freezing could also allow individuals to delay having a baby, due to career demands, the lack of partner, or other medical reasons.

I am under 16 years old, can I have my eggs collected?

Eggs are not routinely collected and stored for minors unless there is an urgent care need. If you are under 16, you will be assessed to ensure that you have capacity to understand and consent to this procedure. Counselling is available to help support you and your family during this time.

How are the eggs collected?

Fertility drugs are given to stimulate the ovaries to produce several follicles; sacs of fluid that hopefully contain eggs (see the leaflet “Ovarian Stimulation”). The development of follicles is monitored by vaginal ultrasound scans. When the follicles have reached the right size, the eggs are collected by a clinician using a needle to remove the fluid within the follicles. This is done with sedation under ultrasound guidance. The fluid is looked at under a microscope and any eggs present are identified by the embryologist and placed in an incubator until they are frozen. Not all eggs are suitable for freezing. Only mature eggs will be frozen.

How long are eggs stored for?

Eggs can, in theory, be stored for decades and still be viable after thawing. The maximum legal period for storing eggs is 55 years according to the Human Fertilisation & Embryology Authority (HFEA). The HFEA is our governing body responsible for upholding fertility law. Initially, eggs can be stored for 10 years. For storage to lawfully continue after this, you will need to renew your consent every 10 years. A written consent form is required for storing eggs before treatment starts. Consent can be changed or withdrawn at any time before the eggs are used in treatment. Eggs can be donated for training or research purposes if they are no longer wanted for patient treatment. Eggs can only be used for training or research purposes if this option has been selected on the HFEA consent form. Please note, it is unlawful to store eggs beyond the period of consent, and The Hewitt Fertility Centre (HFC) has a legal obligation to dispose of them once consent has expired.

What happens when I want to use my frozen eggs?

Frozen eggs can be used in a natural or stimulated frozen embryo transfer cycle. Once you are ready to proceed with treatment, the eggs are removed from storage and thawed. Not all eggs survive the freezing/thawing process. Current data from 2021-2022 at HFC show that 80% of eggs survive the freezing/thawing process for patients of all ages.

Suitable eggs are inseminated with sperm using a technique known as Intracytoplasmic Sperm Injection (ICSI). ICSI is required to inseminate frozen-thawed eggs because the outer shell (zona-pellucida) surrounding the egg hardens after freezing making sperm entry difficult. ICSI is the only practical way of ensuring a sperm will enter the egg; this is because the injection procedure bypasses the hardened shell. ICSI is also required because frozen-thawed eggs no longer have their protective outer cell coating. Conventional IVF cannot be performed as the outer cell coating is necessary for sperm to achieve fertilisation.

What are the success rates?

Until recently, pregnancy rates from egg freezing procedures were very poor, but scientific advances have now made egg freezing a viable option. However, the data is still limited and with all fertility treatments, no clinic can guarantee this procedure will result in a successful pregnancy. The number of people who have used their frozen thawed eggs in treatment at HFC is small which means the dataset cannot be used to give a realistic chance of success. The HFEA reported the live birth rate for people using their own frozen thawed eggs to be 18%. In addition, the live birth rate for people using frozen donor eggs was reported to be 30% (HFEA, 2018).

Are there any risks associated with egg freezing?

Frozen eggs are stored in liquid nitrogen, and this presents a theoretical risk of potential cross-contamination between samples in storage. To reduce this theoretical risk, all patients are screened for viral diseases (Hepatitis B, Hepatitis C and HIV) and stored appropriately according to viral status. Current data indicate that there is no increase in birth defects or chromosomal abnormalities in children born from frozen eggs, but we need to monitor this carefully (HFEA, 2016). Many healthy babies have been born following egg freezing/thawing; however, this is a relatively new procedure and may yet involve unrecognised risks. We will look after your eggs as carefully as possible, but we cannot be held responsible for loss or damage of eggs due to equipment failure.

Any other questions?

If you have any other questions about egg freezing, please speak to a member of the scientific staff.

References

HFEA (2016) https://www.hfea.gov.uk/media/2656/egg-freezing-in-fertility-treatment-trends-and-figures-2010-2016-final.pdf

HFEA (2018) https://www.hfea.gov.uk/about-us/news-and-press-releases/2018/press-release-age-is-the-key-factor-for-egg-freezing-success-says-new-hfea-report-as-overall-treatment-numbers-remain-low/

Document Code: P-INFO-EF-1	Version No: 11	Document Title: Egg Freezing Information
Date of issue: 27.02.2024	Date of review: 27.02.2027	Owner: R Lunt	Author: R Byrne

Sperm Banking for Young People

The leaflet is detailed below, or you can download the 'Sperm Banking ' leaflet in PDF.

Sperm Banking for Young People

Reproduction

Reproduction is the process where a baby is created. To make a baby, the sex cells (called gametes) of a male and a female must fuse together. The sex cells are the sperm and eggs. The sperm fertilises the egg, and an embryo develops to become a baby.

When a boy goes through puberty their reproductive system matures and the testes, found inside the scrotum, produce and store millions of tiny sperm and continue to do so throughout adulthood. These sperm cells travel from the testes through the system and mix with a white-ish fluid called semen, and this is what is released from the penis during ejaculation.

Sperm Banking

Sperm banking is the process of freezing and storing some of your sperm. In the future, this stored sperm can be thawed and used in fertility treatment in the hopes of creating a baby. Your doctor has referred you to us as you are due to start treatment that may affect your ability to produce sperm (spermatogenesis). Your treatment might affect your sperm production temporarily or permanently, so it may be difficult to have a baby naturally. Storing sperm for this reason is called Fertility Preservation. Having sperm stored means you have more options when you are ready to try for a baby.

Human Fertilisation and Embryology Authority (HFEA) – Regulatory Body

The HFEA monitor all treatment relating to fertility including sperm banking. You will be required to complete HFEA consent forms to allow us to store your sperm. The forms may seem overwhelming with a lot of information, but you will be guided through these and the Andrologist is there to help with any questions.

The Process

Referral
• Your doctor sends our team a referral describing your diagnosis, treatment, and when they would like you to start this, so we know how much time we have for your appointments.

Booking In
• A member of the Andrology team will contact you or your parent/guardian to discuss the process and to book your appointments.

Consultation
• You will attend the Andrology laboratory.
• You will have a consultation with an Andrologist where you will sign consent forms relating to the storage and use of your sperm.

Sample production
• You will need to produce a sample by masturbation • We have private rooms specifically made for sample production (you may be able to produce your sample at home, if you would prefer).

Blood test
• If these tests have not been done already, you will be taken to our nursing team for a blood test. This is for storage purposes; we will store your samples with other samples with the same blood test result.

Further samples
• Further appointments may be required to ensure we have a good number of samples stored for future use. We will discuss this with you when you attend.

Summation letter
• After banking, you will be sent a letter summarising what you have in storage and what sort of treatment it can be used for in the future.

Post-treatment
• At least 12 months after you have finished your treatment, you can contact the lab and book in for a semen analysis.
• You will then be booked in for a chat with one of our Doctors or Lead Scientists who will be able to talk with you about your post treatment fertility and your options for using your stored sperm

Freezing

You will need to provide a semen sample by masturbation and collect your entire sample in a pot that will be provided to you. A basic semen analysis is performed to assess the number of sperm in your sample, their shape and size, and how well they are moving.

A solution called cryoprotectant is added to your sample. This works to protect the sperm during the temperature changes of the freezing and thawing. Your sample is split into small thin straws (called cryostraws) labelled with your details and then sealed. The cryostraws are slowly cooled to -196 degrees Celsius by vapour of liquid nitrogen, and finally dunked into liquid nitrogen to complete the freeze process.

Storage and use

These straws are then stored in large tanks that are filled with the liquid nitrogen vapour to keep them frozen for as long as you have consented to on your HFEA GS consent form. The temperature of these tanks is continuously monitored to ensure the safety of your samples.

When you are ready to use your stored sperm, there are several methods currently used. Your doctor will let you know which options you can use based on what we have stored:

- Your samples could be inseminated directly into your partner.

- Your partner’s eggs could be collected and inseminated in a dish in the lab, this is called in vitro fertilisation (IVF).

- If there is a chance you may require surrogacy in the future (where a woman carries a baby for another person or couple), further screening will be required, and this can be discussed at your consultation.

Common Questions

Do I have to do this?
You do not have to decide to bank your sperm if you do not wish to, and we will support you in whatever decision you make. Although you may not be thinking about having children now, banking your sperm allows you the choice when you are older.

Do I have to do this now?
It is important to freeze your sperm before any treatment starts, as this could significantly decrease your sperm production or damage the DNA within it.

How long can I store my sperm?
The law allows you to store your sperm for up to 55 years, however you must renew your consent every 10 years, so it is really important that you keep us updated with changes to address or contact details by calling or email the Andrology laboratory team. You are also able to change or withdraw your consent to store at any time by contacting our team.

Where will I produce my sample?
We have private rooms in the hospital for you to produce your sample.

There is a possibility that you will be able to produce your sample at home, and this will be discussed further when we contact you to book in.

If you are an in-patient at your hospital and need to stay, a member of staff will be able to visit you at the hospital to take your consents and deliver your sample to our lab. Any further samples needed can be delivered to us by a family member.

How many samples do I need?
We aim to store enough samples for 10 treatment cycles, in accordance with the World Health Organisation (WHO). Depending on your initial sample quality and volume, you may only need to produce one sample, but you may require one or two more, we will let you know as the process goes on. This is just to ensure we have enough in storage for multiple treatment cycles, and optimise chances of a pregnancy, should you need to use this sperm in the future.

Fertility preservation sperm banking is available to everyone regardless of sexuality or gender identity. Options for using your sperm may include using donated eggs or surrogacy and will be discussed with you at your follow up consultation.

If you are experiencing gender incongruence, please refer to the patient information leaflet ‘Transgender & Non-Binary Fertility Preservation - Sperm Freezing’.

Useful Resources

Teenage Cancer Trust website: www.teenagecancertrust.org/information-about- cancer/how-does-sperm-banking-work

HFEA website: https://www.hfea.gov.uk/treatments/fertility- preservation/

References

McAteer, M. (2023) Andrology Production Room

World Health Organisation (2021) WHO laboratory manual for the examination and processing of human semen. 6th edn. World Health Organization, Department of Reproductive Health and Research. Geneva, Switzerland. WHO Press. 2021

Document Code: P-INFO-FP-5	Version No: 1	Document Title: Sperm Banking for Young People
Date of issue: 29/07/2024	Date of review: 29/07/2025	Owner: A Allan	Author: M McAteer

Document Code: P-INFO-EF-2	Version: 2	Document Title: Transgender & Non-Binary Egg Freezing
Date of issue: 26/07/22	Date of review: 26.07.2024	Owner: R Gregoire	Author: M McGrane

Fertility Preservation

Freezing and Storage of Sperm for Fertility Preservation

Freezing and Storage of Sperm Prior to Fertility Treatment

Transgender & Non-Binary Fertility Preservation - Egg Freezing

Why should I think about fertility preservation?

How are eggs collected and stored?

How long can eggs be stored?

I’ve already started my transitioning medication, what are my options?

What happens when I want to use my frozen eggs?

What are the success rates?

Are there any risks associated with egg freezing?

Do I have to pay for freezing & storing my eggs?

Safety & Quality

Contact with the unit

Transgender & Non-Binary Fertility Preservation - Sperm Freezing

Why is it a good idea to freeze sperm?

Egg Freezing

Sperm Banking for Young People