**5.2 Anonymous donors**

Semen donors can be classified into two specific groups, anonymous and non-anonymous (known). Currently, with the establishment of many commercial sperm banks and the ability to safely transport samples even between continents, anonymous sperm donation is the method of choice for most recipients. The anonymity of the donor is maintained through the process. This is an important issue to both the recipient and the donor (Ernst et al., 2007). For fully anonymous sperm donation, the recipients would not be known to the donor and the donor offspring would have no future contact with the donor. The sperm donor gives up all legal rights over the biological children conceived from his samples donated to sperm bank. Anonymous donation allows parents, if they wish, to conceal the issue of infertility, or the fact of non-genetic parenting from the offspring. The motivation to hide this information most commonly is driven by pressure from other family members; fear of being rejected by the child or to protect children from the complicated psychosocial matters related to sperm donation. In many Western countries disclosure is encouraged by many counsellors, and if open disclosure is chosen by the parents, it is usually advised to disclose the method of conception to their children at an early age. Non-disclosure by parents of the biological origin of their children is viewed by some as misleading the child and could potentially affect trust between parents and their children, if their origin eventually becomes known to the child (Patrizio et al., 2001). However, it is ultimately the decision of the parents to disclose or not as in adoption cases.

Cryopreservation of Human Spermatozoa

**patients, adolescent and young adults** 

permanent infertility (Magelssen et al., 2006).

(Rivkees & Crawford, 1988).

by Vitrification *vs.* Slow Freezing: Canadian Experience 93

government or professional organizations, they may also be influenced by religious

When an individual is diagnosed with cancer almost every aspect of their physical and psychosocial well-being is altered. Quite often in clinical practice, the long term effects of cancer therapy on a patients' ability to have children in the future is not adequately addressed (Thaler-DeMers, et al., 2001). While the priority is to eliminate the cancer and save their life, fertility preservation especially among adolescent or young adults to ensure the potential of procreation with their own gametes after treatment, needs to be considered. Impaired spermatogenesis has been demonstrated before treatment in some patients with malignancies, depending on their location (eg. testicular cancer) or type (eg.Hodgkin's lymphoma) (Rueffer et al., 2001). Current treatment options such as surgery, chemotherapy and/or radiation can impair spermatogenesis and sexual function and lead to temporary or

The scale of negative effects of cancer treatment on spermatogenesis depend on the specific gonadotoxicity of administered chemotherapeutic agents, number of chemotherapy treatment cycles, radiotherapy field location and dosage, type and stage of the cancer, and age of the patient. Considering combination cancer therapy, uncertainty in individual response to treatment and the large number of confounding variables, it becomes very challenging to assess the risk of iatrogenic infertility in many patients. The ability of cancer survivors to have their own biological offspring is very important for many oncology patients, especially at younger ages (Schover et al., 1999). Advances in early diagnostic investigation and treatments have led to increasing numbers of young cancer survivors. Unfortunately up to 30% of childhood cancer survivors are permanently sterile following cancer treatment (Tournaye et al., 2004). In Canada and the United States, cancer in patients 15 to 29 years of age who can benefit from sperm banking is nearly three times more common than in patients younger than 14 years (Bleyer et al., 2006). Early germ cells, (spermatogonia) are very sensitive to radiation and chemotherapy. Even low doses or a single dose treatment can potentially cause functional impairment of spermatogenesis. With increase in dosage or duration of the treatment, initially spermatocytes get damaged and as treatment progresses spermatids also become damaged. Radiation doses of less than 0.8 Gy can result in oligospermia and doses between 0.8 and 3 Gy can result in azoospermia

Cryopreservation of semen has changed the reproductive prospects for young patients diagnosed with cancer. Unfortunately, banking services continue to be underutilized since cancer patients and their families are not always informed about the potential fertility risks associated with cancer treatments, or the availability of banking. According to some surveys, less than 20% of patients undergoing chemotherapy or radiation treatment are informed about the adverse effects of such treatment on spermatogenesis or are offered sperm banking for fertility preservation. Cancer patients are usually under huge physiological and time pressure to make cryopreservation decisions while dealing with a life threatening situation. To complicate matters, some young patients are unable to produce semen samples by masturbation. In such cases, PVS or electro-ejaculation under general anaesthetic might be required. Surgical retrieval of testicular tissue may be an option for

**6. Social importance and psychological aspects around banking oncology** 

institutions and they vary widely from country to country (Gong, 2009).

There is some consensus that there should be limits on the number of offspring allowed from a given sperm donor. This is driven by possibility of accidental consanguinity between children from the same sperm donor. For example ASRM recommends a limit of 25 children per population of 800 000 for a single donor, but there are no federal or state laws limiting the number of sperm donation by a donor. In UK the number is limited to 10 different families, but does not apply if a genetically related sibling for an existing child is desired. Some countries limit the number of children to 4 in New Zealand; 5 in China; and 5 to 10 in Australia depending on the region; 25 in the Netherlands (Gong et al., 2009).

Recently, open-identity sperm donors have become available through many sperm banks. These donors have agreed to at least a single contact with any children born through use of their sperm, usually when the child reaches the age of consent (18 years old in most jurisdictions), for those individuals who wish to contact them (Gottlieb et al., 2000; Frith et al., 2007). In some cases audio interviews and pictures are available from these donors.

Two types of anonymous donor samples are usually available through sperm banks, prewashed or unwashed: Prewashed samples are obtained by processing the ejaculate by density gradient centrifugation for seminal fluid removal prior to freezing and can be directly inseminated into the uterine cavity after thawing (Larson et al. 1997). These samples are favoured by doctors' offices without access to an Andrology laboratory for post thaw processing. For processing unwashed samples, density gradient isolation is required to remove contaminants and CPAs after thawing the specimen prior to intrauterine insemination or for IVF. The removal of CPAs has to be performed step-by-step and gradually to minimize osmotic stress on spermatozoa. Drop-wise dilution of the sample with 1:10 sample to sperm wash medium ratio is recommended (Mortimer, 2004).
