CIVF - Information and consent for patients freezing sperm

This information has been compiled to summarise the service we offer and give you the information you need to consider how the service can best work for you. It is important that you have read and understood our patient information prior to your freeze consent appointment. If you have any further questions, please do not hesitate to ask, a member of our specialist team will be happy to answer them for you.

1. Storage of gametes (sperm and eggs) is an activity regulated by the Human Fertilisation and Embryology Authority (HFEA), who license and regularly inspect centres storing gametes to ensure that the highest standards of quality and practice are met.
2. All people storing gametes are required to be tested for HIV, Hepatitis B and Hepatitis C. The tests may be funded by the NHS or in some cases you may have to pay for them. The cost for the tests in such circumstances is available in the Cambridge IVF schedule of fees. Additional tests may be performed depending on your personal circumstances and you will be informed if we plan to carry out further testing during your appointment. If any of the test results return indicating an infection we will notify you and arrange an appointment for you to see a medical practitioner. In such cases it may not be possible for us to store your samples.
3. Storage of your gametes will probably involve at least one visit to Cambridge IVF, which will be arranged as soon as possible after the decision to freeze a semen sample has been made. During each visit, you will be required to produce a semen sample by masturbation in a comfortable private room. If you are unable to travel, you should contact us so that we can ensure that alternative arrangements can be made to collect a sample locally from you if possible.
4. Please make sure you carry a photographic ID document when attending for your first appointment, as we will need to save a scanned copy onto our records. In the event you have legally changed your name, we will also need a scanned copy of your Deed Poll.
5. Before you produce this sample, where possible, you should abstain from sex or masturbation for between 2 days (48 hours) and 5 days. This serves to optimise the sample quality.
6. We will inform you, and with your consent, your doctor, about the quality of each semen sample you provide. As long as there are some sperm present in the sample we will be able to attempt to freeze it and store it in our liquid nitrogen cryostore. Liquid nitrogen is very cold, much colder than a normal electric freezer, and enables your samples to remain preserved for very long periods of time, without the sample perishing. In some cases, there may be no sperm in the semen sample you provide (azoospermia). If this is the case then you will be invited back to Cambridge IVF for a second semen analysis to confirm the diagnosis of azoospermia.
7. Some of the sperm in your sample will die during the freezing process. This is normal and unavoidable, and means that the number of living sperm in the sample after freezing will be lower than in the fresh sample. To determine the quality of your sperm following the freezing/thawing process, a small amount of your sample will be thawed and tested, and you will be informed of the results. This will not be performed in cases where there is a very low volume of semen sample, as we cannot afford to use some of your sample for this test.
8. There is no evidence to suggest that those babies born using frozen sperm have an increased rate of abnormalities at birth, or subsequent problems later in life.
9. There is a wide variability not only between individuals but also between semen samples from the same person when we compare sperm survival after freezing. This means that one sample may freeze better than another from the same person. The cause of this variability is unknown, thus we cannot predict how well a sample will freeze prior to the procedure.
10. In general, the better the quality of a fresh sample, the more likely is to freeze well. Samples from very young patients tend to freeze less successfully than those from people who are fully sexually mature.
11. We will attempt to freeze samples even if there are only very small numbers of sperm in them. Advances in fertility treatment technology make it possible for us to create an embryo in the laboratory using a single healthy living sperm. You should be aware that the availability of fertility treatment on the NHS varies regionally and is limited, and you may have to pay for specialist treatment to create embryos from your frozen sperm, should you wish to in the future.
12. Samples can be damaged or destroyed by circumstances outside of our control. Damage to the nitrogen tanks storing gametes, due to a fire or other catastrophic event could result in the total loss of your samples. Although we do everything we can to ensure that the equipment we use is maintained to the highest standards, there is no guarantee that the equipment will never fail. In the event of your samples being damaged or destroyed, we will contact you to explain exactly what has happened.
13. Current law permits the storage of semen samples for up to 55 years. The statutory storage period for which your gametes can be frozen is up to 10 years. (You can of course decide to freeze for a shorter time period). Renewal of consents must occur every 10 years to continue the lawful storage of your samples. You can change and amend your desired storage period at any time, and withdraw your consent to storage of your sample.
14. Although difficult, you must address what you wish to happen to your samples in the event of your death, or mental incapacitation. It is possible to consent to the use of your gametes in such a situation, by naming your partner on the consent form. You should however think carefully as to whether you feel this is appropriate, and how you feel about the use of your gametes posthumously. Your consent can be added or changed at any time, therefore you do not have to rush into a decision you do not feel comfortable with.
15. The samples you produce will not be used for any purpose other than to treat the partner you name on the consent forms.
16. For oncology storage, samples will only be accepted from patients prior to the onset of treatment, as samples after treatment tend to be of poor quality and may have been affected by the treatment you have already received. In exceptional circumstances we may consider accepting a semen sample after starting chemotherapy; this decision will be made on a case by case basis.
17. If you have been referred to us for sperm freezing because you are undergoing oncology treatment that may compromise your fertility (eg. chemotherapy, radiotherapy, surgery, ..) you will be invited to attend Cambridge IVF for a semen analysis at 12 and / or 24 months post treatment. The semen analysis will assess whether your fertility has been affected by your treatment by comparing your last analysis to the analysis that was performed at the time of sperm freezing. The results of this analysis do not have an impact on your eligibility for funding of samples stored. The NHS (Cambridgeshire and Peterborough CCG) will continue to fund the storage of your semen samples for up to 10 years. However, if your fertility remains unaffected you may wish to discard your samples. If you wish to and are eligible to extend your storage period beyond the ten years point then you will be asked to renew your consent.
18. The fee for self-funded storage of sperm for the first sample including the first year of storage can be found on the price list on our website. A further 2 samples can be frozen within 3 months of the first sample at a reduced cost, which can also be found on our website. NHS funded patients will not be billed for freezing of up to 3 samples where this is indicated.
19. If you are self-funding storage, there is an annual storage fee. The cost of this can be found on the price list on our website. This storage fee will be subject to annual review. We will write to you on an annual basis to confirm you wish to continue with sample storage and request this payment.
20. Unfortunately a small number of patients fail to pay for the storage fees incurred. In such cases we reserve the right to transfer your data to a third-party debt collection agency and if this is necessary, the costs of the agency will be added to the amount being recovered.
21. You are free to move your samples at any time to any other licensed centre in the UK or overseas. If you wish to do this, you should contact us and we will advise you how to proceed and assist you in the process. You should be aware that we reserve the right to charge an administration fee to cover our costs for the part we play in facilitating the movement of your samples.
22. It is essential that you keep us up to date with any changes in your relationship status and in your personal details such as your address, telephone number and email address. If you fail to do this and we cannot contact you, your samples will be removed from storage and destroyed at the end of the permitted storage period, in accordance with current UK legislation.
    It is your responsibility to keep us informed of your current contact details.
23. Before offering you fertility treatment with a partner at Cambridge IVF you and your partner will require a full assessment for suitability for treatment using your stored gametes. The act of storing gametes at Cambridge IVF does not guarantee that we will be able to offer you fertility treatment in the future.
24. Achieving a pregnancy is dependent upon the fertility of both partners, and you should be aware that we can never guarantee a pregnancy even if the quality of the frozen sample is excellent.

Declaration by patient

I have read and understood this information. I have been offered the opportunity to ask any questions and am happy to proceed with sperm banking.

Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . / . . . . / . . . . .

Print Name: . . . . . . . . . . . . . . . . . . . . . . . . . . Date of Birth: . . . . / . . . . / . . . .

Declaration by representative

I declare that the person named above is present at the time of signing this form and I am signing in accordance with their direction.

Relationship with patient: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . / . . . . / . . . .

Print Name: . . . . . . . . . . . . . . . . . . . . . . . . . . Date of Birth: . . . . / . . . . / . . . .

On behalf of Cambridge IVF

Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . / . . . . / . . . .

Print Name: . . . . . . . . . . . . . . . . . . . . . . . . . .