Best practices for sperm cryopreservation prior to gonadotoxic treatment: recommendations from leaders in fertility preservation

To characterize the recommended number of semen samples to cryopreserve for fertility preservation. ASRM Fertility Preservation Special Interest Group and Society for Male Reproduction and Urology members were surveyed on counseling patterns on sperm cryopreservation prior to gonadotoxic therapy. We collected demographic information including profession, length of time in practice, and practice affiliation. We investigated number of ejaculates and aliquots to cryopreserve as a function of total motile count (TMC). Fertility preservation clinical vignettes were presented to examine variations in recommended number of samples and aliquots to cryopreserve. Respondents (n=93) identified professionally as REIs (41%), Reproductive Urologists (30%), and Other (29%). The majority had 10 or more years in practice (67.4%) and in academic practice (54.8%). Most clinicians recommended increasing the number of ejaculates cryopreserved to 3+ if total motile count (TMC) was 25 million (M) or fewer with an inverse increase as TMC was lower [TMC 1mil (90.8%), TMC 5mil (86.8%), TMC 10 mil (69.7%), TMC 25 mil (50.7%), TMC 100 (34.6%)]. Based on TMC, providers were asked to provide recommendations regarding number of vials to cryopreserve. If TMC was 1M, there was lack of consensus, with 42.9% and 44.3% recommending aliquoting the sample into 1 vial and 3+ vials, respectively. However, for a TMC of 5M or more, more than half of respondents recommended aliquoting the sample into at least 3 vials. As insurance coverage increased and predicted treatment was considered more gonadotoxic, respondents more frequently recommended increasing the number of ejaculates cryopreserved (table 1). In this study, providers who counsel patients on sperm cryopreservation prior to gonadotoxic therapy, were more likely to recommend at least 3 ejaculates if TMC was 25M or fewer. Recommendations were heavily influenced by insurance status and suspected treatment gonadotoxicity. Due to variations in coverage for cryopreservation, further research is necessary to determine if access is correlated with number of ejaculates cryopreserved.