Sperm: Fresh vs. Frozen

I have a fertility app on my phone called iPeriod. Before we found out Mr.E had zero sperm I was using it to track LH surges, morning basal body temperature, pregnancy tests, etc. Now I mostly just use it to track my period.

Anyway, I was looking at it several weeks ago and realized that Mr.E’s mTESE is scheduled for exactly 6 weeks after my next period is supposed to start. Six weeks is exactly the minimum for how long it takes to do an egg retrieval cycle. So I thought, “Is this a sign? Should we try to do a fresh-fresh cycle?”

What do I mean by “fresh-fresh”? I mean fresh (not frozen-then-thawed) eggs and fresh (not frozen-then-thawed) sperm. What difference does it make?

First we have to define what “success” means. For most, if not all, infertility patients, success would be considered taking home a healthy baby while success in the laboratory might be considered making lots of grade A embryos or simply surviving the freeze-thaw procedure. For this post, “success” means taking home a baby.

I think all studies agree that fresh eggs are always better than frozen eggs. So if possible, you always want to use fresh eggs.

Some studies show that fresh sperm is better than frozen sperm. Other studies show that fresh and frozen sperm have the same chance of success. I think there’s even one that shows frozen is better than fresh (think survival of the fittest).

For us, I think fresh-fresh is going to be the best option. Why?

– not 100% guaranteed that all/any sperm will survive the freeze-thaw
– only 80% of subsequent mTESE procedures are successful (meaning sperm found on the 2nd mTESE)

By doing fresh-fresh, we’ll have the same number of sperm frozen (minus the 8-12 used to fertilize any eggs retrieved), plus we get to do the fresh-fresh. It’s like a two-for-one deal.

And if no sperm are retrieved, we will have more eggs frozen for use in the future should anything change in the realm of azoospermia treatments.

Our clinic prefers to do fresh-frozen because they don’t want to put the wife through stimulation and egg retrieval if they don’t have to. In fact I kind of had to talk them into doing my first egg retrieval. But I felt really strongly about preserving my fertility and I just kept talking until they agreed to do it 🙂

Not all clinics will do fresh-fresh when mTESE is the sperm retrieval method, so be sure to talk to your clinic about it! And don’t be afraid to ask to speak with the director of your lab to get their opinion on all of it.

3 thoughts on “Sperm: Fresh vs. Frozen

  1. Sorry, you now have 4 comments from me, please forgive me! I’ve been wanting to ask you this…Dr. Hotaling recommended that we what to start the IVF process after the microTESE to see if they find any sperm. I know it’s kind of a debate about the whole frozen vs. fresh. What do you think about starting IVF after the microTESE? I would just love to hear your thoughts.

    • I kind of giggled imagining Dr. Hotaling’s response if he heard my answer. I definitely think fresh eggs are best with fresh sperm. And that’s what we went for. He won’t be mad if that’s what you want to do, but it does go outside their normal procedure, so be prepared to have good reasons for doing it when you talk to your IVF doctor. I think my first egg retrieval had to be approved by some/all of the IVF doctors.

      If you’re short on cash you might not want to spend the money talking with Dr. Carrell, director of the Andrology Lab, but he definitely will see you for a consultation if you do want to spend the money. You can share your fears and concerns with him, and he will give you honest answers.

      There are pros and cons for each way. If you do them separately then you can focus 100% on your husband after his mTESE while he recovers. It is very unlikely that none of the sperm retrieved would survive the freeze-thaw, but it is possible. The other pro about waiting is that if they don’t find sperm, you’ll have $10k you didn’t spend on IVF that you can spend on your own Plan C.

      We went for fresh-fresh because we couldn’t imagine living with regrets if the worst happened and we lost all the sperm. And because I feel strongly about preserving my fertility should a stem cell miracle happen in the next 5-10 years. I’m considering doing another egg retrieval again one day, too. 21 eggs sounds like a lot, but if only 15 of them survive the thaw and only half of those make decent embryos, that’s only 7-8! And not all of those will survive the embryo freeze-thaw, so we might wind up with only 5-6 embryos to be transferred. Throw in a miscarriage or two (we assume I’m fertile, but who knows?) and a couple of BFNs and we’ll be lucky to get 1 baby!

      I’m a worry wart.

      And I tend to assume the glass is half empty. But I do that so that I’m prepared with contingency plans so that I won’t have regrets. We only live once and I want to get it right!

      21 eggs to other women would probably sound like a pot of gold. But I think since I’ve been on this road for so long and we’ve beaten the odds too many times (in the wrong way), that having lots of eggs stored up makes it so I can think about other things and relax a little. Chances are we’ll never use them. But I’ll never regret having them. Peace of mind is priceless.

      Keep us updated on what you decide!

    • A few more thoughts:

      I don’t think there’s any real medical reason to keep you from doing IVF. It won’t make you go into menopause sooner or anything crazy like that.

      There are some logistical benefits to doing them separately, but if you feel strongly about retrieving eggs, the doctors will work with you to make that happen. Obviously if you read my blog you know I’ve asked them to do several out of the ordinary things. As long as I back up my suggestions/thoughts with good logic, they accommodated me. And when my logic was flawed they pointed it out 🙂

      Some of the logistical benefits to doing them separately are:

      – having a set date/time for the surgery (no weekends or holidays), which is good for Dr. Hotaling and the operating room staff, which in the long run is good for you, too.
      – no chance of you guys being in separate facilities for your procedures, which is what would happen if your egg retrieval fell on a week day
      – the lab can be prepared for 1 scenario instead of 2 scenarios (just sperm freezing instead of both egg freezing and embryo making)

      As I mentioned, Dr. Hotaling will do it whatever way you want. Think about it. Pray about it. Study it out. When it feels right in your mind AND in your heart, you’ll know it’s the right thing to do.

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