The CECOS, or Center for Studies and Conservation of Eggs and Human Sperm, cannot be reduced to a simple sperm bank. And for good reason: they are key players in medically assisted reproduction with donors, gamete donation and fertility preservation. Back to these essential structures in the French medical landscape.

Better known by the acronym CECOS, the Centers for the Study and Conservation of Human Eggs and Sperm are the only establishments authorized to collect and store donated gametes in France. If we sometimes tend to assimilate them to simple sperm banks, the CECOS actually have a much larger role to play in medically assisted procreation (MAP or MAP) with donation. If you wish to donate sperm or oocytes (or even an embryo in the event of prior IVF), if you are in a situation of infertility and are considering AMP with donation, if your state of health justifies preserving your fertility, the CECOS teams will be among your interlocutors.

The first sperm banks appeared in France in the early 1970s in two large Parisian health establishments. At the time, reproductive medicine and the management of infertility were in their infancy, so the two structures functioned in radically different ways:

Paid sperm donation

The first was created at Necker Hospital, by gynecologist Albert Netter, and operates on the basis of paid sperm donation. The objective: to promote donation among young men in order to allow optimal quality. This model, still common in many countries of the European Union in particular, has since been abandoned in France.

Preservation of semen for research

The second is deployed at the Bicêtre hospital by Professor George David. Its purpose: “the study of normal and pathological sperm as well as the conservation of sperm intended for research and therapeutic purposes.” If the wording is intentionally vague, it is because relations between the project leaders and the supervisory authorities (including the Ministry of Health) are strained. At the heart of their dissensions: the IAD (artificial insemination with donor), at the time very controversial because of the ethical questions it raises in particular in terms of filiation.

To legitimize the ADI and finally promote the management of male infertility, it was decided that the donation, framed by this structure, would be based on three main principles that are still in place today: free, anonymity and volunteering. At the same time, negotiations with the Ministry of Health are progressing under the leadership of Simone Veil, who sets the conditions for opening the CECOS in Bicêtre.

As it happens :

• the establishment must constitute itself in association (statute of law 1901), in order to release the responsibility of the hospital administration,
• its management must respond to a board of directors and scientific whose composition is multidisciplinary (representation of supervisory authorities, the order of physicians, specialists …) and representative of different scientific points of view (at the time the supporters and opponents of the IAD),
• This administrative and scientific board must be chaired by a medical personality providing personal support for the practices of the establishment (Robert Debré in the case of the CECOS of the CHU de Bicêtre).

This is how the first CECOS was officially born on February 9, 1973 (date of its publication in the Official Journal). In the years that followed, around twenty new Centers for the Study and Conservation of Human Eggs and Sperm were created on the same model. Today there are 31 of these centers in France. In 2006, it was estimated that CECOS had participated in nearly 50 births.

CECOS have a dual vocation:

Ptake charge of infertility

Whether feminine, masculine or linked to the specificities of the couple, when it requires the donation of a third party.

Preserve patient fertility

In this area, the Cecos intervene first to allow the cryopreservation (freezing) of the gametes of patients suffering from pathologies whose treatment could affect their fertility (such as people with cancer who need to undergo chemotherapy). But their role is also to optimize the chances of subsequent pregnancy for patients who have already had recourse to medically assisted procreation. Thus, couples benefiting from supernumerary embryos following IVF may be offered to keep them at CECOS pending subsequent gestation or embryo donation.

The different missions of CECOS

To work in this direction, the CECOS have several missions:

• provide medical and technical assistance to infertile couples in need of a donation,
• supervise and organize the donation of gametes (sperm donation, oocyte donation) and embryo donation,
• support patients, before gamete donation, during the process, but also afterwards. It is sometimes less known, but CECOS staff can be contacted if the parents or the person born from a donation wish, during childhood or adulthood.
• allow the self-preservation of gametes in the event of illness and sensitize patients and stakeholders (doctors, patient associations, etc.) to this end,
• allow cryopreservation of supernumerary embryos resulting from IVF,
• participate in research in the field of procreation, bring their expertise to reflection on technological and societal developments that may influence it.
• take part in campaigns to promote gamete donation organized by the Biomedicine Agency.

In order to guarantee both the preservation of fertility and the management of infertility, each CECOS is located in a university hospital center and consists of:

• a multidisciplinary medical team (doctors, biologists, psychologists and psychiatrists, geneticists, technicians, etc.)
• a cryobiology platform allowing the conservation of gametes. Since 1981, the CECOS have also been united in a federation, in order to harmonize practices in matters of procreation with donation, to promote patient care and exchanges between centers. To this end, the federation is organized into commissions (genetics, psychological and psychiatric, ethics, scientific and technical) which meet at least twice a year.

The Cecos, which are now part of the public hospital service, are unique structures that have enabled significant advances in the area of ​​reproductive reproduction for 50 years. We find among their successes:

• The positive development of gamete donation in France. Thus, under the leadership of CECOS and the Biomedicine Agency, gamete donors are increasingly numerous (404 sperm donors in 2017 against 268 in 2013, 756 oocyte donations in 2017 against 454 in 2013) . In 2017, 1282 births were also possible thanks to a donation.
• Support for patients in preserving their fertility, which involved 7474 people in France in 2017
• Improvement of the legal framework of the MPA in France. Indeed, it is partly thanks to the ethical rules and the evaluation procedures put in place by the CECOS that the legislator was able to formalize and update the bioethics laws.

The Cecos are distributed throughout France in order to facilitate access to patients. Do not hesitate to consult the directory of centers.

Note however:

• If you are already followed in an ART or oncology department (adult or child), the healthcare professional who follows you will put you in touch with CECOS practitioners.
• If you wish to donate gametes, do not hesitate to contact the dedicated service in the CECOS closest to you directly.