Sperm banking, or male fertility preservation, is widely used prior to medical, surgical, and nonmedical procedures that might affect a male’s fertility. Both federal and state regulations have been instituted to regulate the sperm banking industry, requiring rigorous screening and testing of sperm donors and detailed records of the donors and clients that choose to store their own sperm. Cryopreservation consents are detailed and cover long-term storage, use of the specimens, and disposition of the specimens in case of incapacitation or death of the sperm banker or lack of need for the frozen specimens. Sperm cryopreservation is relatively simple in the laboratory, but does require trained staff working with cryopreservatives and liquid nitrogen. With the increased use of ART, cryopreservation of even the poorest specimens with only a few sperm has become routine. Sperm can be retrieved with testicular biopsy or epididymal aspiration even in the case of purported azoospermia. Use of fresh or frozen specimens have been shown to yield comparable results. The future of sperm cryopreservation is promising as we look to storage of testicular tissue for future autotransplantation as well as prepubertal spermatogonial stem cell storage for future in vitro maturation, or transplantation and growth of testicular tissue and sperm production.

Many benign and malignant conditions are treated with fertility-threatening medical or surgical therapies. Fertility preservation is a recourse critical to discuss prior to initiation of these therapies. This chapter describes contemporary and future fertility preservation approaches while also exploring barriers in access to their use as well as key decision-making strategies helpful for clinicians caring for patients with a range of medical conditions.

This chapter provides an overview of the hormonal and surgical interventions available to transgender and nonbinary (TNB) people, what is known about how these interventions affect fertility, fertility preservation options at different stages of pubertal development, TNB individuals’ attitudes toward family building and experiences with fertility counseling and fertility preservation, barriers to fertility counseling, and recommendations for best practice for fertility counseling for TNB people based on the known literature to date.

Human sperm cryopreservation is a highly desirable technique for preserving fertility potential and future use in couples desiring to have a biological child. Slow cryopreservation of sperm has been the mainstay technique. The drawback of this technique is the inability to freeze extremely small numbers of sperm as in the case of surgical retrieval of testicular sperm. These sperm are extremely few in number and it is difficult to retrieve motile, viable sperm post-thaw. In the past decade, sperm vitrification has been introduced along with both biological and non-biological carriers to freeze extremely low numbers of sperm. Vitrification also allows the ability to freeze single spermatozoa. These techniques are in many ways more efficient and better than the older techniques. This chapter aims to provide a detailed introduction to various approaches used for preserving spermatozoa. It also discusses indications of sperm cryopreservation based on semen quality and summarizes the advantages and shortcomings of these techniques.