 Preserving Your Ability
to Have Children - The Westwood Cryobank |
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The Tyler Medical Clinic established an in-office bank for freezing and storing sperm
more than forty-five years ago, less than ten years after the world's first successful
pregnancy using frozen sperm was reported. We were one of the first such banks in the
southwestern United States, and now we are among the first in the world to store not
only sperm but also human eggs, embryos, and testicular and ovarian tissue.
The Tyler Medical Clinic was opened more than 50 years ago and
is still at the same location across the corner from UCLA School of Medicine.
To our knowledge, it is the oldest institution specializing in the diagnosis
and treatment of infertility in the southwest part of the country.
The founder, E. T. Tyler, M.D. pioneered many tests and procedures in this field.
In 1947, he described his technique of insemination, in 1956, he reported results
of successful pregnancies from frozen sperm. For many years, the cryobank at the
Tyler Medical Clinic was the only one in this part of the country.
For many years, the cryobank at the Tyler Medical Clinic was
the only one in this part of the country. Later, other cryobanks were opened.
The personnel of the Tyler Medical Clinic were helpful in establishing many
new cryobanks banks in Southern California and we were particular in passing
high standards in donor selection and screening, in the technique of cryopreservation
and record-keeping to these new cryobanks.
The Westwood Cryobank is doing a truly excellent job. Recently,
we were successful in establishing a pregnancy using sperm cryopreserved in our
bank for almost twenty years.
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| - Successful Pregnancy 20 Years After Cryopreservation - |
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Recently, the Tyler Medical Clinic and Westwood Cryobank
achieved the first successful pregnancy
using sperm that was cryopreserved for approximately 20 years.
In 1978, a 32-year-old man came to the Tyler Medical Clinic to deposit
sperm for cryopreservation. In mid-1997 he informed us that he had relocated
out of state and that he and his wife were thinking about the
possibility of starting a family.
Because of prolonged storage and the limited number of vials, a decision was made
to proceed with GIFT or IVF/ICSI. The wife was given a schedule of medication and
was instructed to return to California on day 11 of her menstrual cycle. Her response
was satisfactory, and the GIFT procedure was performed on day 13. The semen, after
thawing, showed 24% active motility. Five oocytes
(three mature and two slightly immature) were retrieved and transferred, with the
husband's sperm, into the fallopian tube.
The patient returned to the East Coast two days after the procedure.
A pregnancy test was positive on day 25. Ultrasound at six weeks confirmed a twin
intrauterine pregnancy. The course of gestation was uneventful, and female twins
were delivered at 39 weeks without complications.
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Testicular Tissue Cryopreservation and Ovarian Tissue Cryopreservation
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When sperm and eggs are not easily retrieved,
testicular and ovarian tissue may be collected and stored.
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Testicular Tissue Cryopreservation -
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Obtaining the tissue sample
Testicular biopsy is performed. Retrieved tissue is cut into small pieces.
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Separating the sperm
Seminiferous tubules are isolated and incubated in collagenase for 1 hour.
The tubules are then rinsed in fresh medium and stripped of sperm using
needles and fine tweezers.
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Cryopreservation
Tissue and sperm are mixed with cryoprotectant solution (glycerol)
and deposited in cryo-vials. The cryo-vials are placed into liquid nitrogen vapor for
3 hours and then plunged into liquid nitrogen. The sample is preserved in
liquid nitrogen at temperatures of -196°C until needed IUI/IVF/ICSI.
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Ovarian Tissue Cryopreservation -
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Ovarian tissue have been found to survive well using improved cryoprotectant
solutions and techniques. These new developments offer
the hope of preserving fertility for a large number of patients.
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Ovarian Tissue Retrieval
Ovarian tissue is removed through a laparoscopic procedure.
A portion of the ovary is sectioned into thin tissue slices.
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Treatment with cryoprotectant
Ovarian tissue must be treated with a cryoprotectant before they can be frozen.
A cryoprotectant such as ethylene glycol (EG) is added to a physiological saline in 0.5 M
increments every 5 minutes until the desired concentration (1.5 M EG) is reached.
The sample, processed at ambient temperature, is now ready for freezing.
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Ovarian tissue freezing and storage
The temperature of the sample is reduced from 20° to -7°C
(the temperature of ice nucleation) at 2°C/minute, then held for 10 minutes.
Cooling is then resumed at a rate of -0.5°C/minute to -30°C.
The frozen tissue is then plunged into liquid nitrogen for storage.
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Sperm Cryopreservation
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Reproductive tissues can be cryopreserved for many years.
Insemination using previously deposited frozen sperm has a greater chance of
success than current techniques such as the reconnection of the vas after vasectomy
or operative retrievals of sperm directly from the testicle by aspiration or biopsy.
These latter procedures are used in association with In Vitro Fertilization (IVF) and
Intracytoplasmic Sperm Injection (ICSI), which may not be necessary if an adequate
number of stored sperm is available. The Tyler Medical Clinic was successful in
producing a pregnancy using sperm cryopreserved at our bank for almost
20 years.
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Sperm Freezing (Cryopreservation) -
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There are situations in life when the depositing of sperm in a
long-term storage bank offers options for future preservation and peace of mind.
The two primary reasons for sperm freezing are long-term preservation for later use by
depositors and availability of sperm for donor insemination. |
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There are a number of reasons why men should consider sperm cryopreservation:
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Before undergoing cancer therapies.
Cancer therapies such as surgery, chemotherapy and radiation can cause permanent
sterility and infertility.
Having their sperm frozen can preserve future fertility.
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Before having prostate or testicular surgery.
Testicular surgery, prostatectomy and similar surgeries can cause sterility, or
redirect the flow of semen into the urinary bladder. Sperm cryopreservation can ensure that men who have these surgeries can
preserve their reproductive capabilities.
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If considering a vasectomy.
Sperm cryopreservation can preserve fertility and prevent
the need for reversal surgery if personal circumstances change.
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When involved with Assisted Reproductive Technologies.
Sperm can be stored for use
with IUI, IVF, ICSI, GIFT, and other similar procedures so that
it is available at a critical time. Sperm that is obtained through sperm aspiration,
vibratory stimulation, or through surgery
can be stored to prevent the need for additional procedures.
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High-risk occupations.
High risk professions with exposure to chemicals,
radiation, extreme heat, etc.
can cause sterility in men.
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Low sperm counts or low-quality sperm.
Higher-quality sperm samples can be frozen for later use with IVF and ICSI.
Specimens can be pooled to increase the likelihood of achieving pregnancy.
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Ejaculatory dysfunction.
It is thought that sperm number and quality decreases over time when ejaculation doesn't
occur. Therefore, in cases where men can't ejaculate, such as with spinal cord injury,
preserving sperm as early as possible may increase their fertility chances.
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When men are going to be absent.
Sperm freezing enables the female partner to
continue with her reproductive schedule even if the male partner can't be there,
due to a busy schedule, unforeseen events, etc.
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Sperm Cryopreservation Procedure -
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Obtaining the semen sample.
Semen samples are collected
in a sterile container. It is recommended that patients abstain for at least
three days, but not more than ten days. In patients who cannot ejaculate
on their own, samples can be collected using vibratory stimulation or testicular
sperm aspiration. |
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Semen Analysis.
Once collected, semen samples are analyzed
for volume, viscosity and pH levels, and microscopically evaluated to
determine motility, sperm count, morphology and other important factors.
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Semen Cryopreservation.
Cryoprotectant is added to the semen to control sperm damage caused by freezing.
The specimen is then divided into individual cryo-vials, placed into liquid
nitrogen vapor for 3 hours, and then plunged into liquid nitrogen. At a
temperature of -196°C all metabolic activity is halted. Semen can thus
be preserved for many years. |
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Egg Cryopreservation for Women
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Although, more difficult than freezing sperm, eggs have been recently found to
survive well using improved cryoprotectant solutions and techniques. These
new developments offer the hope of preserving fertility for a large number of cancer
patients and for women wishing to
delay family building by storing their eggs at a younger age.
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Options available for women to preserve fertility:
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Freezing of eggs through a multi-step laboratory procedure to preserve viability.
Eggs can later
be thawed and fertilized, and embryos implanted to achieve pregnancy.
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Removal of ovarian tissue from the ovarian cortex
and freezing for re-implantation into the body at a later date.
The cryopreserved tissue can be transplanted after chemotherapy to provide
both gametes and hormonal production. Ovarian tissue storage can provide a backup
to egg freezing for additional fertility insurance. Thousands of eggs may potentially
be recovered from ovarian tissue,
improving the opportunity for childbearing dramatically.
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Who does egg and ovarian tissue freezing benefit?
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Professional, career-minded women or women without a partner
who wish to have children at a later
date, when career demands and pressures are less.
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Women confronted with the decision to undergo radiation or chemotherapy
due to the onset of cancer at
an early age, or faced with the possibility of having their ovaries removed.
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| Preserving Life |
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Although not clinically available yet, preliminary research suggests that
eggs and ovarian tissue may be one of the best, if not only, source of compatible
stem cells if the egg donor develops cancer or another devastating disease later in life. Eggs and tissue not used
for fertility can be kept
in storage for possible therapeutic use as the woman’s life progresses.
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Egg Freezing Process -
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Eggs and ovarian tissue have been found to survive well using improved cryoprotectant
solutions and techniques. These new developments offer
the hope of preserving fertility for a large number of patients.
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Egg Retrieval.
Using fertility drugs, the ovaries are stimulated to produce
several high quality eggs for retrieval. When the follicles are ready for
egg retrieval, a needle is inserted into the ovaries using ultrasound guidance
to locate each follicle. Fluid from the follicles is drawn into a test tube to
retrieve the eggs. The patient is given pain medication and the procedure lasts about 15 minutes.
The eggs are identified with a microscope and collected for freezing.
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Treatment with cryoprotectant.
The eggs must be treated with a cryoprotectant
before they can be frozen. A cryoprotectant such as ethylene glycol (EG) is added
to a physiological saline in 0.5 M increments every 5 minutes until the desired
concentration (1.5 M EG) is reached.
The sample, processed at ambient temperature, is now ready for freezing.
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Egg freezing and storage.
The temperature of the sample is reduced from 20° to -7°C
(the temperature of ice nucleation) at 2°C/minute, and then held for 10 minutes.
Cooling is then resumed at a rate of -0.5°C/minute to 30°C.
The frozen eggs are then plunged into liquid nitrogen for storage.
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Egg Fertilization.
When ready to have children, one or more of the eggs is thawed.
After thawing, surviving eggs are fertilized through the ICSI method. The fertilized eggs
usually develop into multi-celled embryos. Using a catheter, one or more embryos are
then simply placed in the uterus, hopefully establishing a pregnancy.
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