What to do when the (sperm) bank is overcrowded and underused

Since licensed sperm banks store their precious stockpiles in vials that resemble drinking straws to freeze them in liquid nitrogen, one would think that space would not be a problem. 

In fact, due to indecision and inaction by the Health Ministry in Jerusalem on how long to keep them, sperm banks throughout Israel are desperate to clear the freezers from samples that will never be used for years and even decades.

The problem reportedly affects such medical facilities in countries around the world.

The muddle results not only from lack of room but also from the fact that large numbers of men who supplied the sperm and families whose loved ones are no longer alive are not paying annual storage fees. 

Since public hospitals have to maintain equipment, the financial burden is onerous.

The dilemma was recently dissected in depth by researchers at the Shamir (Assaf Harofeh) Medical Center in Tzrifin, Bar-Ilan University (BIU) in Ramat Gan, and the Tel Aviv University (TAU) Medical Faculty. 

It appeared in the Israel Medical Association Journal (IMAJ) under the title “Long-term Sperm Preservation: Exploring the Clinical, Economic, and Ethical Dimension.” The authors were Dr. Roy Bitan, Tal Suissa, and Dr. Itai Gat.

Persevered for many decades 

Incredibly, frozen sperm can be viable for many decades, and a recent study reported that semen from rams in a farm remained usable even after 35 years. 

Another article, published in 2022 in the Springer-Nature group’s journal Cureus, reported that human twins were born from sperm stored for four decades.

Short-term preservation of semen in dry ice resulted in the first human live birth using cryopreserved sperm in 1953. 

A decade later, long-term sperm cryopreservation using liquid nitrogen was demonstrated, and this advance paved the way for sperm freezing to become known all over the world. 

No differences in the quality of sperm and the health of infants born from them were found.

Cryopreservation of sperm is a relatively straightforward procedure without medical complications. 

Contents are used when the male suffers from infertility, has to undergo treatments for cancer or other systemic diseases, or transfers sperm between locations when a partner is unavailable.

The special case of Israel 

Israel is a special case in which sperm banks are vital because of the high demand for having offspring, such as in when there are deaths of men in battle and terror attacks, and the problem of unmarried religious Jewish women who want to have children or any single women who have no male partner and want a family.

The sperm are washed to remove seminal fluid, cryoprotective agents are gradually added, and gametes are then frozen. 

After testing of quality, the sperm sample is divided into straws, with each meant for a single fertility treatment – fertilization in the uterus or egg fertilization after retrieval via in-vitro fertilization (IVF). 

If the quality is high, several straws can be used. Many who want sperm storage regard it as “fertility insurance for a rainy day,” the authors argued.

THE ACCUMULATION of frozen sperm samples for years leads to financial costs that are not entirely or at all covered by patients, their families, the head funds, private insurance, or regulatory bodies.

In Israel, the Health Ministry set the annual storage fee at only $90 to $120. In the US, men with testicular cancer were charged $358 as a one-time fee plus an annual preservation fee of $243. 

The US Food and Drug Administration set down requirements for sperm freezing and regulations that sperm banks must meet. 

In some states, including California and New York, insurance companies are found to cover the costs for insured men who may be at risk of losing their fertility due to a variety of medical conditions. 

In China, the costs range from prohibitive fees of $100 to $200 annually, while in Australia, such a service is provided free.

In Israel, the public health funds cover storage fees for their members who have had certain diseases for just five years.

Countries from Australia and Canada to the UK report that samples are destroyed after several years, only in a minority of cases. A Canadian study found that just a third of cancer patients who didn’t eventually use their sperm chose to destroy them after completing their oncology treatment.

In Israel, a retrospective study of 1,500 patients found that usage rates were lower than 40% over a span of nearly 18 years.

Jewish culture and the need for IVF units

With large sectors – ultra-Orthodox Jews and Arabs – in Israel that are very conservative, starting a family nevertheless holds great importance in the culture. 

As a result, Israel holds the highest birth rate among Western countries – and this country has IVF units in nearly every general hospital. 

Fertility physicians have established the country as a global leader in the number of pregnancies achieved via IVF, and this is boosted by the fact that the public purse covers many treatment cycles for women up to the age of 45 and until the birth of a second child.

The huge death toll of soldiers and terror victims since the barbarous onslaught of Hamas terrorists on October 7, 2023, has led to families requesting the extraction of sperm after the men died and their cryopreservation eventually to produce a baby. 

Soldiers, including reservists, who are facing military service, are also requesting sperm cryopreservation.

Frozen sperm samples are usually reserved for five years in Israel unless the patient specifically asks in writing for the storage period to be extended. 

The samples are supposed to be disposed of after the patient’s death unless, within a year, his partner explicitly asked for preservation. 

The authors write that neither the ministry nor the public health funds give clear guidance on the disposal after five years, and sperm banks usually keep the samples after the limit has passed, even when no one is paying or storage.

The authors conclude that while cryopreservation can be clinically beneficial in addressing male infertility, the utilization rate, as well as the rate of sperm disposal, tends to be low, especially for long-term storage. “The disposal of unused sperm after extended periods can reduce financial costs and mitigate significant ethical concerns since preserved sperm may represent the only potential for biological paternity.”

Since healthcare in this country is mostly funded publicly with health taxes and government budgets, comprehensive legislation and regulation are urgently needed to prevent waste, and standardization of criteria of the quality of samples and the duration in all the sperm banks is necessary when no imminent clinical need is apparent, they conclude.