CRYOPRESERVATION (SPERM BANKING) http://www.infertility-male.com/treatment/cryo.

htm

CRYOPRESERVATION (SPERM BANKING)

There are many myths and misconceptions regarding cryopreservation or sperm banking. Hopefully, this reading
material will clarify some of those issues and help you to better understand the concept of freezing sperm, or
"banking."

Many patients who have malignant tumors will have a decrease in the ability of the testicle to produce sperm. That is,
often when a patient has a tumor, the testicle will not produce sperm as well as it does normally. This tumor may be
Hodgkin's disease, lymphoma, sarcoma, a testicular malignancy, or a variety of other malignancies. Therefore, it is
important to recognize that at the time you present to our clinic for sperm banking, your testicles may not be working
as well as they might normally. Although this decreased function is not directly related to the stage of your tumor, it
appears that the better you feel at the time you present to our clinic, the better the results of your semen specimen
may be.

Many patients who have developed tumors such as Hodgkin's disease and testicular cancer have already fathered
children. This shows us that, in general, their testicles have the potential to work quite well. If you are in this group,
we would expect that your semen analysis would be quite good. Again, however, it does depend somewhat on how
you are feeling at the time you come to see us, since this may reflect how the malignancy has affected your general
health.

Most chemotherapeutic drugs will damage the testicle at least temporarily. Some will have permanent effects on the
testicle. The testicle performs two functions, the first of which is to produce male hormone. None of the
chemotherapeutic drugs seem to impair the testicle's ability to manufacture testosterone (the male hormone) either
while you are receiving or after you have finished your chemotherapy. The second function of the testicle is to
produce sperm. Almost all chemotherapeutic drugs will shut down the production of sperm to some degree while you
are receiving the drugs. Certain chemotherapeutic medications damage the machinery of sperm production to such an
extent that the testicle will never recover and will never again produce sperm.

In general, extended treatment for Hodgkin's disease will permanently damage the testicleís ability to make sperm in
approximately 80%-90% of patients. It is important to remember that although this is a significant side effect of the
therapy for Hodgkin's disease, the cure rates for Hodgkin's disease have been improving over the last several years,
and your doctors want to make sure that you are cured of your disease.

If you have a testicular tumor, you should know that the chemotherapeutic medications that are used to treat these
specific types of tumors may not permanently damage the testicle as much as the ones that are used in a prolonged
fashion to treat Hodgkin's disease. Approximately 30%-40% of patients who are treated for lymphoma or leukemia
will regain normal sperm counts by 2 years after the chemotherapy ends. Approximately 50%-70% of patients who

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are treated with the standard chemotherapeutic medications for testicular cancer will regain some sperm production
2-3 years following their chemotherapy.

It is important that you understand that sperm banking before you receive chemotherapy is like an insurance policy. If
you are one of the lucky patients who regains normal sperm counts after chemotherapy, then you should consider
yourself fortunate that you do not need the services of the sperm bank. However, if you are one of the patients who
does not regain normal sperm counts after chemotherapy, then to put sperm in the sperm bank before your
chemotherapy was a very intelligent decision.

Cryopreservation (Sperm Banking)

For patients with testicular cancer, some of you may not have good function in your remaining testicle even before
chemotherapy. This is simply due to non-malignant changes in the testis itself. Therefore, before and after
chemotherapy, the remaining testicle simply may not work as well as it should.

Sperm banking is performed by first analyzing your semen to determine the sperm count and also looking at the
movement of the sperm. Depending on these factors as well as the volume or amount of the sample that you have
provided us, we then place the semen sample in individual plastic vials for the freezing process. The number of vials
that we are able to obtain is dependent upon the sperm count, sperm movement, and volume of your ejaculate. We
generally recommend that 2-3 samples obtained for sperm banking. The more sperm that you are able to leave in the
sperm bank, the better your chances are to have children in the future if you are one of those patients who does not
regain normal sperm counts after the chemotherapy. Your physician may be anxious to start chemotherapy as soon
as possible. In this case, we will simply have to get as many samples as we can; however, you must remember that
your chemotherapy and your ultimate good health are our top priorities!

After you have given us your samples, we will let you know how many vials we were able to obtain. The sperm will be
frozen for 5 years. At the end of that 5-year time period, we will contact you to see if you would like us to store the
sperm for another 5 years. If you have regained normal sperm counts and are doing well, then at that time you may
make the decision to discard your stored sperm. If you have not regained normal sperm counts, then we will continue
the storage for another 5 years.

If at any time you would like your spouse to become pregnant and you have not regained an adequate sperm count,
then we can use your frozen sperm in association with one of the modern assisted reproductive techniques.
These include intrauterine insemination (IUI), in vitro fertilization (IVF), and micromanipulation (placing one sperm
microscopically into each egg). The quality and quantity of cryopreserved semen determines which options in assisted
reproduction are available to you. Patients with several vials of good-quality semen may attempt IUI, whereas
patients with smaller amounts of cryopreserved semen, or semen of poor quality, may opt for routine IVF, or IVF with
micromanipulation. Pregnancies have been achieved with all of these methods utilizing cryopreserved semen. If

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necessary, cryopreserved samples may also be Federal Expressed to physicians elsewhere.

It is crucial to understand that any sperm that fertilize the egg and produce an embryo are likely to be normal. That is,
any sperm that are produced by your testicles, even after chemotherapy or after x-ray therapy, as long as you have
waited 1 year, or any sperm that are frozen and then thawed and used for insemination, will not have a higher
likelihood of producing a deformed child. Your chances of having a normal baby are as high as that of the general
population.

In summary, the key points to remember are:

1. Before your chemotherapy or radiotherapy, your sperm counts may or may not be as good as they normally were.

2. Depending upon the type of disease that you have, the chemotherapy may or may not render you permanently
sterile.

3. If you do regain normal sperm counts after your chemotherapy, then please contact us, and we will discard your
sperm.

4. If you do not regain normal sperm counts after chemotherapy, please contact us any time you would like to use
your sperm in order to achieve a pregnancy. We will work closely with your gynecologist.

5. Any child who is conceived after either chemotherapy or radiotherapy is completed and a "rest" period passed, or
any child conceived with sperm from the sperm bank, will have as much chance to be normal as a child born to
normal parents.

If you would like some more specific, detailed, and comprehensive literature on the subject, please ask Dr. Lipshultz
to provide you with a copy of the chapter entitled "Fertility and Testicular Function in Patients After Chemotherapy and
Radiotherapy." If we can be of service at any time, please let us know.

SPERM BANKING
Sperm banking may be helpful in establishing future pregnancies for men who face potential sterilization following
chemotherapy for a variety of malignancies such as testicular tumors, Hodgkinís disease, non-Hodgkinís lymphoma,
or any other disease that requires chemotherapy or radiation. In addition, since surgical ablation of the bladder neck
(TURP; Y-V plasty) may cause retrograde ejaculation, patients undergoing these procedures sometimes profit by
preoperative sperm preservation. Those men considering a vasectomy as a means of birth control after they have
completed their families may now have an option for future fertility without undergoing vasectomy reversal surgery.

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When a specimen is processed for cryopreservation:

1. A semen analysis is performed on each ejaculate. This includes a complete seminal fluid analysis quantitating
sperm motility, forward progression, sperm density, and morphology.
2. All specimens are stored in liquid nitrogen storage tanks (-196_C).
3. There does not appear to be any increased risk of birth defects using frozen semen.
4. There is no guarantee that any given specimen will necessarily produce a pregnancy; however, recent studies
indicate that the overall success rate following the use of cryopreserved semen is from 40%-50%.

COSTS:
The cost of analyzing and freezing one ejaculate is $150.00. At the time of freezing, an advance 5-year storage fee of
$250.00 per specimen ($50.00/year) is likewise paid. Each specimen is stored in a series of plastic vials; each vial
holds approximately 1.0 ml. Two vials are usually recommended for each insemination. Therefore, the total cost for
analyzing, freezing, and storing one specimen (a total ejaculate) for 5 years is:

Analyzing & Freezing $150.00

5-Year Storage $250.00

PROCEDURE:

It is recommended that a minimum of three specimens be stored. Two to three days of sexual abstinence is
suggested between ejaculates. Thus, approximately 9 days are needed to complete the collection and storage of three
specimens. The freezing of additional specimens does provide extra semen for future inseminations.

***************************** IMPORTANT *********************************

Due to the complicated and lengthy procedure involved in freezing sperm, freezes will be performed by appointment
only from 9:00 a.m. to 1:00 P.M. Monday through Friday. For scheduling, please call our appointment desk at (713)
798-4550.

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