Autologous sperm cryostorage is used by men risking infertility due to gonadotoxic treatments. While this original fertility preservation procedure is a key component of comprehensive care for cancer and similar diseases, few sperm banks are available leaving unmet needs for young men still to complete their families. As realistic expectation of autologous sperm cryostorage programs are not well understood, we aimed to describe the natural history of autologous sperm cryostorage from a single centre program operating with the same clinical and laboratory team and policies for over 4 decades featuring no out-of-pocket costs to men storing sperm.
This survival analysis describes outcomes for men (n=3923, mean age 30 years) who sought sperm cryostorage for a wide range of cancers (90%) and other diseases requiring gonadotoxic treatments. Men provided a median of 3 semen samples comprising those with no (473, 12%), one (364, 9%), two (891, 23%), three (1805, 46%) and more than three (390, 10%) semen samples producing an average 25 ± 0.3 straws for storage. The men’s marital status was single (n=1905, 52%), married (1713, 47%) or divorced (61, 2%) with most having no children at cryostorage (2611, 72%) and residing mainly in the Sydney metropolitan area (3034, 77%). The median time to transfer for use (n=371 men, 10%) was 2.4 years (quartiles 1.0, 6.0), time to death (n= 553, 14%) was 1.7 (0.9, 3.3) years and time to discard (n=1790, 46%) was 7.7 (1.7, 11.1) years. In multivariate Cox model regression, underlying disease, number of storage visits and follow-up visits and sperm seen at follow-up visits were significant predictors of times to outcomes.
This provides the first large scale estimates of the key operational features of autologous sperm cryostorage from a program free from financial, insurance or other access limitations.