Treatment Spotlight:

• Sperm freezing is a safe and relatively quick fertility preservation method available to males or those assigned male at birth (AMAB).
• It involves taking a fresh semen sample, mixing it with a 'cryoprotectant', and then freezing it in liquid nitrogen.
• New rules mean sperm samples can be stored for up to 55 years, with consent renewals every 10 years.
• In certain cases, the NHS may cover sperm freezing - such as when undergoing cancer treatment or gender reassignment.
• The rules and process for sperm freezing and sperm donation are different: donation requires more intensive genetic and viral screening steps.

Sperm freezing - sometimes called semen freezing - is the most successful way to preserve your fertility if you're male, or AMAB.

The process involves taking a fresh sample of semen and mixing it with a 'cryoprotectant' - a special fluid that protects the sperm during freezing. The sample is divided across multiple 'straws' (this means not all the semen needs to be defrosted at once), and then frozen using liquid nitrogen.

Sperm freezing is a popular fertility preservation method for many reasons. It's particularly useful when:

• Getting older. Age affects both male and female fertility, so preserving sperm can be a good way to keep your options open as you get older.

• Planning for future flexibility. If you're thinking of having a vasectomy, preserving a sperm sample might be a good idea in case you change your mind. Or, if you are currently planning fertility treatment with a partner, you may choose to freeze sperm beforehand, rather than produce a sample the morning of the treatment.

• Sperm quality is deteriorating. If your sperm count is low, or the quality of your sperm is declining, then preserving your sperm can be a good option.

• Facing cancer or other medical conditions. Certain treatments can negatively impact fertility, including most therapies for cancer. If you are due to undergo any treatment that can impact your fertility in the future, your doctor may recommend sperm freezing, and, based on local eligibility criteria, the NHS may cover this.

• Planning gender reassignment. The process of hormonal treatment and gender reassignment can significantly impact fertility, making sperm freezing a useful option if considering children in the future.

• Considering career and lifestyle choices. Sperm freezing offers flexibility and reassurance for those who may not want children currently, or whose job is high risk - such as armed service personnel.

• Consent matters. Before treatment starts, you'll be asked questions like how long you want sperm stored for, what should happen to your sperm if you die, what to do with sperm left over from treatment, and whether your sperm is only for your use, or if it can be donated to others. You can change these preferences at any time.

• Sperm can be stored for up to 55 years. Since July 2022, sperm can now be stored for up to 55 years. But you'll need to renew your consent every 10 years - so it's important to keep contact details up to date. If you don't renew consent for any reason, the clinic is legally required to dispose of your sperm sample.

• Frozen sperm is as good as fresh. Regardless of how long you decide to freeze your sperm, the evidence currently suggests that the use of fresh or frozen sperm makes no difference to success rates [1]. However, be aware that not all sperm survive the thawing process.

• Lifestyle can affect sperm quality. Many factors can affect sperm quality, including diet, smoking, stress and alcohol - your doctor may recommend you make some lifestyle changes first. Sperm regenerates every 3 months, so even if your initial sample is low quality, the outcome of future freezing cycles may be better.

• Hold fire before submitting your sample. Depending on your clinic's requirements, you may need to abstain from ejaculating for up to 2-7 days before submitting your sample. This is to ensure your sample is of the highest possible quality.

• Surgery may be required. If there is no sperm in the sample, or you have problems ejaculating, surgical retrieval from the testicles is also possible.

Time: 1-2 hours

Location: Clinic

In the initial consultation, you'll go over the procedure with your doctor. You'll also need to complete your personal contact details, and complete legal consent forms that set out what should happen to your sperm in different situations.

You'll also take a blood test to screen for various diseases, like HIV or hepatitis. If you test positive for a disease, it doesn't mean you can't freeze your sperm - your samples will be stored separately to prevent them contaminating other samples.

Your clinician might also recommend lifestyle and nutrition changes to ensure your sperm is the healthiest it can be, or you might be recommended further pre-treatment tests (sometimes called a Fertility MOT) before freezing your sperm to better understand your current fertility health.

Time: 2-5 days

Location: Home

You might be asked to abstain from ejaculating for 2-5 days before submitting your sample. This is to ensure your sample is as high quality as possible

Time: Variable

Location: Clinic (sometimes home)

A fresh sperm sample needs to be frozen within an hour of being produced, and maintained at body temperature. That's why most clinics require you to produce a sperm sample on the premises. If that's not possible or preferable, make sure you discuss this with your doctor in the initial consultation.

It's also worth knowing that many clinics require the sample to be produced via masturbation without the use of lubricants, condoms or sex. Always check with your clinic what their requirements are.

Time: Up to 55 years

Location: Clinic

Once produced, sperm is mixed with a special fluid - a 'cryoprotectant' - in the lab. This helps protect it during freezing. Your sample is divided across smaller containers, called 'straws'. This means not all your sample needs to be defrosted for use in one go. The sample is then frozen in liquid nitrogen.

At this point, the lab may test a small part of the same by thawing it. This allows them to check sperm quality and its response to thawing. If the sample isn't viable for future use, you may need to submit and store another sample.

In the future, if you undertake fertility treatment with a different clinic, your sperm sample can be transported there.

Typical timeline: 2 weeks

This is based on one sample, from initial consultation to sample testing and freezing.

Sperm freezing, from initial appointment to sample testing, varies based on individual circumstances and the clinic. Overall, the process is relatively quick - and can take as little as two weeks. However, your clinic should provide a timeline personal to you after the initial consultation.

If you've been advised to make lifestyle changes before submitting your sample, this can take a few months to implement and before any effects are seen in semen analysis. This can introduce both extra time and cost to the process, as analysis tests will need to be repeated.

Two key factors affect sperm freezing success rates:

1. The quality of the sperm when frozen
2. The survival rate of the sperm once thawed

According to recent research, the length of time sperm has been frozen doesn't significantly impact success rates, or the survival rate of sperm.

Thawing, however, can cause sperm to die or impact how well sperm can move (referred to as 'motility'). Research suggests 50-66% of sperm in a sample may not survive the thawing process - but the ones that do are as effective when used in treatment, such as IVF.

Freezing your sperm is a big deal, with lots to think about - including whether you want to restrict the use of your sperm to your own fertility treatment in the future, or donate it for others to use. Your clinic should support you throughout your journey, putting you in touch with a counsellor if needed.

If you decide to freeze your sperm, make sure your clinic provides clear steps - including what needs to be done if you change your mind. Sperm freezing is completely reversible: if you do change your mind, the clinic can discard your sample.

Remember that for each year you store your sample, an annual charge applies - and you'll need to provide consent every ten years to keep it in storage.

Sperm freezing is safe. There are no known risks, and the process is not invasive (unless sperm retrieval surgery is required). However, not all sperm will survive the freezing and thawing process.

There are only certain situations in which the NHS will fund sperm freezing. One example is when undergoing treatment for a medical condition - like cancer - that could negatively impact fertility.

However, funding might not be available for the full length of time you wish to store your sperm sample - so always double check the length of time funding will cover.

Sperm freezing is widely available across the UK. The advertised cost of sperm freezing is £410 on average. However, this price doesn't usually include the initial tests that your clinic may need to carry out - including screening for blood borne viruses (on average, £181) and semen analysis (on average, £164).

You'll pay, on average, an additional £357 per annum for each year of storage.

If you're male or AMAB, then sperm freezing is a highly effective, easy way to preserve your fertility - whether your reasons are medical, age-related or simply to give yourself options in the future.

While options for sperm freezing on the NHS are limited, private treatment is widely available, and compared to egg freezing, it's relatively cost effective. However, always check what's involved in your clinic's pricing package, and be prepared to pay extra for screening tests. You'll also need to budget for the annual storage cost.

Another important aspect to remember is your consent, and how you want your sperm to be used. You can change your preferences at any time, but remember you'll need to renew your consent every 10 years - or run the risk of your sample being disposed of.