An excerpt from "Sperm Banking: A Reproductive Resource" by Sonia Fader.

SPERM BANKING: A HISTORICAL PERSPECTIVE

When the California Cryobank opened its doors in 1977, the technology for preserving or "banking" human sperm by cryogenic methods, while nearly a quarter century old, was still in its infancy.

The prefix "cryo" comes from the Greek word "kryos," meaning cold or frost. The science of cryogenics deals with the effects of extremely cold temperatures on matter. Applying this technology to preservation of sperm was a natural outgrowth of the development of artificial insemination.

ARTIFICIAL INSEMINATION: AN OLD TECHNOLOGY

Although we tend to think of artificial insemination as a modern technology, it has a history dating back to 1779. That was the year an Italian priest and physiologist named Lazaro Spallanzani performed a laboratory experiment that revolutionized scientific thinking.

Until that time, our understanding of reproduction was based on our understanding of how plants grow. It was believed that the embryo was the "product of male seed, nurtured in the soil of the female." Spallanzani's experiment established for the first time that for an embryo to develop there must be actual physical contact between the egg and the sperm.

Armed with this new understanding, Spallanzani successfully inseminated frogs, fish and dogs. But while the artificial insemination of animals was quickly propelled into an industry, the application of this technology to "growing" of human babies proceeded cautiously.

THE HUMAN APPLICATION

The first successful artificial insemination of a woman was recorded just eleven years after Spallanzani's experiment. In 1790, the renowned Scottish anatomist and surgeon, Dr. John Hunter, reported that he had successfully inseminated the wife of a linen draper, using her husband's sperm.

For over a century nothing more was heard on the subject. Then, in 1909, a letter appeared in the American journal, Medical World, spotlighting another aspect of the little known procedure. In the letter, the author, Addison Davis Hard, claimed that the first human donor insemination had been performed at the Jefferson Medical College in Philadelphia in 1884—twenty-five years earlier.

According to Hard's letter, the mother, a patient of Dr. William Pancoast, was the Quaker wife of a local merchant, fifteen years her senior. The couple had come to the doctor seeking advice about her inability to have children. Extensive examinations of the woman revealed no abnormality. Finally, the husband was examined. It was discovered that he was azoospermic, or sterile.

According to Hard's letter, when Dr. Pancoast discussed the case with his medical students, including Hard, someone in the group suggested that semen should be collected from the "best looking" member of the class, and used to inseminate the woman. Dr. Pancoast agreed to the experiment. Without informing either the woman or her husband of his intentions, he called the merchants wife back under the pretense of doing another examination.

The woman was anesthetized, and the procedure was carried out. It wasn't until it became evident that the woman had actually conceived that her husband was informed. Fortunately, he was pleased. At his request, his wife was never told how she became pregnant. Hard's letter went on to say that, as a result of this medical school experiment, the merchant's wife gave birth to a son, who became the first known child by donor insemination (DI).

DONOR INSEMINATION - THE LONG ROAD TO ACCEPTANCE

The idea of applying artificial insemination to human propagation was difficult enough for turn-of-the-century society to accept: to use the sperm of a man other than the woman's husband was scandalous. Hard's letter triggered heated debate among lawyers, moralists, theologians and medical practitioners.

However, after a year of debates, the controversy, as the practice itself, appears to have faded into oblivion. If any doctors were treating infertility through DI, they were doing it with the utmost discretion. DI remained virtually unknown to the public until 1954. That was the year the first comprehensive account of the process was published in The British Medical Journal.

As it had before, donor insemination provoked heated public debate. The Archbishop of Canterbury established the first in a long procession of commissions that, over the years, inquired into the development of the practice.

The first commission produced a report strongly critical of DI, and recommended that the practice be made a criminal offense. A Parliamentary Commission agreed. In Italy, the Pope declared DI a sin, and proposed that anyone using the procedure be sent to prison.

In that same year (1954), on this side of the ocean, the Supreme Court of Cook County ruled that regardless of a husband's consent, DI was "contrary to public policy and good morals, and considered adultery on the mother's part." The ruling went on to say that, "A child so conceived, was born out of wedlock and therefore illegitimate. As such, it is the child of the mother, and the father has no rights or interest in said child."

This perspective was maintained as late as 1963, when a court in the United States held that a DI child was illegitimate because the sperm donor was not married to the child's mother. Regardless of her husband's consent, the court stated, the woman's insemination constituted adultery.

But a year later, there were signs that attitudes were changing. In 1964 Georgia became the first state to pass a statute legitimizing children conceived by DI, on the condition that both the husband and wife consented in writing.

In 1973 the Commissioners on Uniform State Laws, and a year later, the American Bar Association, approved the Uniform Parentage Act. This act provides that if a wife is artificially inseminated with donor semen under a physician's supervision, and with her husband's consent, the law treats the husband as if he were the natural father of the DI child. The laws most states have enacted pertaining to DI have been based on this act. In every case, the statute makes it clear that the donor who provides the doctor or sperm bank with sperm is not the legal father of any child conceived by that sperm.

One court ruling in particular is relevant: the 1968 People V. Sorensen. While an earlier (1945) oral opinion in an Illinois case held that donor insemination was neither adultery nor grounds for divorce; it was not until the Sorensen case that a court ruled the DI child was legitimate.

In the Sorensen case, the California Supreme Court upheld the criminal conviction of a man for not supporting a DI child conceived with his consent during marriage. Sorensen claimed the child was not his; therefore he had no obligation to support it. The court ruled that the sperm donor had no more responsibility for the use of his sperm than a blood donor had for his blood. The court noted, "Since there is no 'natural father', we can only look for a lawful father." And that was Sorensen.

THE APPLICATION OF CRYOGENICS TO HUMAN SPERM

The father of artificial insemination marked up another first in reproductive biology. It is believed that Spallanzani was the first to report the effects of cooling on human sperm when he noted, in 1776, that sperm cooled by snow became motionless. But efforts to actually freeze sperm did not begin until the mid 1800s.

In 1866 a man by the name of Montegazza was the first to envision banks for frozen human sperm. He suggested that "a man dying on a battlefield may beget a legal heir with his semen frozen and stored at home." While it took some 150 years, during the Gulf war crises in 1992, Montegazza's vision became a reality. Service men were able, and indeed some opted to freeze and store specimens of their sperm before leaving for battle.

Between the years 1938 and 1945, a number of scientists observed that sperm could survive freezing and storage temperatures as low as minus 321 degrees Fahrenheit. But surviving is one thing; being able to successfully function in the conception process is another.

The first major breakthrough in that area came in 1949 when A.S. Parkes and two British scientists developed a method of using a syrupy substance known as glycerol to protect semen from injury during freezing. The process was further refined in 1953 by Dr. Jerome K. Sherman, an American pioneer in sperm freezing.

Sherman introduced a simple method of preserving human sperm using glycerol, but he combined this with a slow cooling of sperm, and storage with solid carbon dioxide as a refrigerant. Sherman also demonstrated for the first time that frozen sperm, when thawed, were able to fertilize an egg and induce its normal development.

As a result of this research, the first successful human pregnancy with frozen spermatozoa was reported in 1953. (Shortly before the Cook County Supreme Court ruled DI was "contrary to public policy and good morals.") Considering the hostile climate for DI at the time, it is not surprising that nearly a decade passed before the first public announcement of a successful birth from frozen sperm.

The announcement, made the 11th International Congress of Genetics in 1963, triggered interest in the possibility of sperm banks. Approximately a decade later, in the early 70s, the first commercial sperm bank opened.

SPERM BANKING FINDS A FOCUS

When doctors Cappy Rothman and Charles Sims established the California Cryobank in 1977, they had a specific vision for their new undertaking. Rothman, a male fertility specialist and urologist, and Sims, a pathologist, saw this new reproductive potential as a practical, viable solution to a painful dilemma both had witnessed in the practice of their professions: the often traumatic effect of sterilization on men.

Their observations concurred with the findings of Dr. Patricia Schreiner-Engle of the Mt. Sinai School of Medicine. According to Dr. Schreiner-Engle, the loss of a man's ability to father children often has a shattering impact on his self-esteem. It doesn't matter whether the sterilization is the result of a voluntary vasectomy, or of cancer or some other disease which requires surgery, chemotherapy or radiation. Whatever the reason, a man's loss of his ability to perpetuate his family name often triggers crisis in identity—a sense of diminished masculinity.

Through their cryobank, Rothman and Sims saw a way to lessen the impact of sterilization by providing these men with an option to retain their ability to father children. The plan was simple. Before the sterilization procedure was performed, the men would deposit specimens of their sperm at the Cryobank to be frozen and stored. At some later date, if they decided they wanted to become fathers, they could redeem their frozen semen and father a child or children through artificial insemination.

Although the population for such a service was small, freezing and storing sperm for men requiring or desiring sterilization was the main focus of most early sperm banks. But in the late seventies, a survey published by a group of researchers and clinicians at the University of Wisconsin dramatically changed that focus.

Infertility is still perceived by many to be a female problem. However, for nearly half of the 3.5 million infertile couples in the United States, the problem stems from the infertility of the male. The University of Wisconsin survey, which was sent out to doctors throughout the United States who were treating problems of infertility, revealed that a surprising number of those doctors were quietly treating infertility with donor insemination. The physicians performing the procedure were using fresh semen, and usually selected the donors themselves, most often medical students, residents of other hospital personnel. Most of these doctors reported an effort to select donors who matched the husband in such things as height, hair, skin and eye color, blood type, religious or ethnic background and educational level. Donor screening for genetic diseases was usually limited to a medical history. Few of the doctors performed any biochemical tests on the donors.

The publishing of the University of Wisconsin survey generated an increased demand for anonymous donor insemination. Sperm banks across the country responded. By the beginning of the eighties, meeting this need had become their main focus.

FROZEN SPERM BECOMES THE STANDARD

At first some doctors resisted the use of frozen sperm for donor insemination. The job of a fertility specialist is to help a woman get pregnant. Research at the time suggested the chances were slightly better with fresh sperm than with frozen sperm.

Over the years, expanded demand for DI, convenience, and the number and variety of donor prospects offered by sperm banks slowly eroded this resistance. Then in 1985, something happened that dramatically hastened the transition to the predominate use of frozen sperm for DI: the identification of a devastating newly recognized sexually transmitted disease—AIDS.

A year later, in response to this new threat, the American Association of Tissue Banks began discouraging the use of fresh semen among its member sperm banks. In February 1988, the American Fertility Society (now, the American Society for Reproductive Medicine), the Food and Drug Administration, and the Center for Disease Control all recommended that only frozen semen be used for DI, in conjunction with a minimum 6 month quarantine period.

It became clear to the scientific community that the best way to ensure semen was not infected with HIV, hepatitis or other sexually transmitted diseases was to freeze and quarantine the specimen for 6 months, at which time the donor is retested. This reduces the possibility that the donor had the virus at the time the specimen was collected and frozen. Today, the majority of sperm used for DI is frozen; clearly giving sperm banks a critical role in reproductive biology.

We have come a long way since the days when the only viable alternative an infertile couple had to become parents was adoption. The ability to freeze and store sperm has contributed greatly to this process. It has played an integral part in the development of today's more effective reproductive technologies.

SPERM BANKS TODAY: A REPRODUCTIVE RESOURCE

In the United States, primary and reproductive care physicians treat approximately 1.2 million people every year for infertility problems. Nearly half are men.

Fortunately, male factor infertility no longer means a couple must forgo the experience of pregnancy and childbirth. Thanks to modern reproductive technology and sperm banks, many of these couples have the option of becoming parents by using artificial insemination. According to a national survey commissioned by the United States Office of Technology Assessment (OTA), in 1987, 11,000 physicians around the country provided artificial insemination services to approximately 172,000 women. Eight out of ten requests for artificial insemination were prompted by male infertility. Three percent were due to impotence; another three percent to genetic disorders.

A little under 4% of the women sought artificial insemination because they were single. This translates to approximately 5,000 requests from single women.

FREEZING AND STORING SPERM FOR THE FUTURE

While couples and individuals requiring sperm for artificial insemination make up most of the people who use today's sperm banks, these institutions also provide help for other individuals with reproductive problems; among them, men facing voluntary sterilization, or sterilization resulting from medical conditions or treatments.

There is a medical and legal consensus today that men facing the possibility of sterilization, reduction in fertility potential or exposure to reproductive hazards should be fully informed of the option of semen storage. This practice is frequently followed by physicians treating men who are facing vasectomy, orchiectomy, chemotherapy, radiation therapy, or high risk occupational exposure to radiation or toxic substances.

There are no figures on how many men, nationwide, are availing themselves of this service, but in 1988 Dr. J.K. Sherman, writing for the American Association of Tissue Banks/Reproductive Council, reported 500 pregnancies using thawed sperm frozen prior to sterilization.

Our current environmental crisis has also generated a need for sperm bank services. Men who work in industries where there is the danger of exposure to radiation, toxins or other genetically threatening environmental pollutants are using sperm banks to preserve their sperm as insurance against possible accidents that could leave them infertile, impotent, or genetically damaged.

In addition to these typical uses for sperm bank services, California Cryobank has responded to some unique requests. Dr. Cappy Rothman—at the behest of a young victim's family—has successfully harvested and frozen sperm from a man who sustained brain death in an accident. The California Cryobank's records also reveal instances of fathers donating sperm for infertile sons and brothers donating sperm for infertile brothers.

Recently a single woman used the California Cryobank to solve an unusual reproductive problem. Deciding she wanted to have a child, she arranged for a friend to father her child. But the man lived some three hundred miles away. The couple had trouble coordinating their schedules so they could be together when she was ovulating. To solve the problem, the gentlemen deposited some sperm specimens at the California Cryobank. The woman's doctor was then able to artificially inseminate her with the stored sperm at the proper time in her reproductive cycle.

WHAT A SPERM BANK CAN AND CANNOT DO FOR YOU

If you are a couple with a male factor reproductive problem, or a single woman who has chosen to become a mother, you may be considering using the services of a sperm bank. Your first step should be to discuss the possibility with your doctor. His or her knowledge of your physical condition and your doctor's experience in reproductive medicine can provide you with insight into whether a sperm bank can help you meet your specific reproductive goals or needs.

Ultimately, however, only you can make that decision. It will depend as much on whom you are and your feelings and beliefs about what you are doing, as it will on what you are seeking to accomplish. But before you can make that decision, you need to understand precisely what a sperm bank can and cannot do for you:

A sperm bank can freeze and store sperm for a man facing voluntary or medically induced sterilization. Sperm that can be thawed at a later date and used for artificial insemination.

A sperm bank can freeze and store the sperm of a man whose vocation places him at risk for an environmental accident that could leave him infertile, impotent, or genetically damaged.

A sperm bank can store a husband's sperm for AIH or other modern reproductive technologies that require sperm for use during ovulation.

A sperm bank can provide safe, disease-tested sperm for artificial insemination from a wide selection of carefully screened and tested anonymous donors.

A sperm bank can provide recipients seeking sperm from an anonymous donor with accurate and comprehensive information about their prospective donors, so that the recipients can select the donor best suited to meet their specific requirements.

In other words, a sperm bank can test, freeze, store and provide safe, disease-screened sperm for use in various reproductive technologies.

A sperm bank cannot guarantee successful conception.

A sperm bank cannot guarantee a healthy pregnancy or child.

A sperm bank cannot genetically determine or in any way manipulate the intelligence, talents or physical characteristics of any child conceived from the sperm it supplies.

Legend has it that the world renowned dancer, Isadora Duncan once wrote to George Bernard Shaw, "You have the greatest brain in the world, and I have the most beautiful body, so we ought to produce the most perfect child." To which Shaw is alleged to have answered, "My dear woman, what if the child inherits my body and your brains?"

Shaw fully understood the element of chance involved in procreation; the innumerable possibilities that come into play with the union of sperm and egg. The laws of nature that dictate those possibilities remain intact whether the conception is the result of normal sexual intercourse or reproductive intervention.

SOME COMMON CONCERNS ABOUT SPERM BANKS