Objective: To analyze the causes of failure in autologous sperm cryopreservation (ASCP) in the human sperm bank and propose some countermeasures to improve the success rate of ASCP and promote it in human sperm banks.
Methods: We retrospectively analyzed the reasons for and causes of failure in ASCP 1 156 males undergoing ASCP in the Human Sperm Bank of Guangdong Province from January 1, 2016 to December 31, 2019.
Results: Of the 1 156 cases of ASCP, 857 (74.1%) succeeded and 299 (25.9%) failed, with a failure rate of 56.1% (96/171) in the microdissection testicular sperm extraction (micro-TESE) group, 29.9% (67/224) in the reproduction insurance group, 21.2% (27/100) in the non-tumor disease group and 17.2% (109/525) in the tumor group, with statistically significant difference between the four groups (χ2 = 109.926, P < 0.01). The causes of failed ASCP included failure to extract semen (14.0% ［42/299］), failure to meet the standard of sperm cryopreservation (67.6% ［202/299］), giving up ASCP for low semen quality (7.4% ［22/299］), and giving up ASCP for some other reasons (11.0% ［33/299］), including worry about the reliability of cryopreservation technology (6.0% ［18/299］), suspicion about the complexity of the ASCP procedures (3.0% ［9/299］) and expectation for fertility recovery after chemotherapy withdrawal (2.0% ［6/299］).
Conclusions: In view of different causes of failure in ASCP, human sperm banks can provide individualized cryopreservation schemes, including guidance with masturbation or the use of sperm extraction instrument in sperm extraction, strengthening sperm preservation-related education and the awareness of reproduction protection and earlier sperm preservation among cancer patients, promoting the cryopreservation of microsamples of motile sperm by microsample or single sperm freezing, and development of testis tissue cryopreservation to preserve the fertility of children with cancer.
Keywords: causes of failure; countermeasures; semen quality; autologous sperm cryopreservation.