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.