Far from the popular image rocked by films and medical news items involving sometimes unscrupulous establishments, sperm banks in France are truly the subject of national specificity. And for good reason: in France, only the CECOS, the Centers for the Study and Conservation of Human Eggs and Sperm are authorized to take charge of sperm donations, within a strict legal framework. Explanations.

In France, sperm banks appeared in the 1970s. At that time, reproductive medicine was still in its infancy. With the appearance of ADI, artificial insemination with a donor, then very controversial, a question arises: where to find donors and how to formalize the practice of donation? It is in this context that the sperm bank created by Dr. Albert Netter at Necker Hospital in Paris was born. Its specificity: it works on the basis of a paid sperm donation. Thus, until 1976, men who donate their gametes were reimbursed, as is still the case today in certain countries (United States, Belgium, etc.) The objective: to meet demand, obviously, but also to promote donation among young men and thus the quality of the samples taken.

A model that questions

But this model raises questions on the ethical and medical levels. Indeed, in the absence of a legal framework, how to avoid the appearance of “serial” donors, which could ultimately promote possible consanguineous relations? After all, the more gametes you donate, the more likely you are to meet someone who was also born from a donation from the same person, as many high-profile failures later evidenced. If at the Necker hospital sperm bank donations from the same man are limited to six, then nothing prevents these same patients from going to other establishments, or even gynecology offices where the Insemination by fresh sperm (a man donates his gametes in an office which are directly inseminated in a patient) has long been practiced.

CECOS

It is therefore finally another type of sperm bank which is generalized in France: the CECOS. The first Center for the Study and Conservation of Human Eggs and Sperm was set up by Professor George David at the Parisian hospital of Bicêtre in 1973. No remuneration here: the donation of gametes is voluntary, anonymous and free. Originally associative structure, this “sperm bank”  sees its practice more supervised (its management must answer to a multidisciplinary and representative board of directors and scientific, be endorsed by a medical personality) and contributes over the years to define the good practices that will serve as the basis for the bioethics law of 1994. This same law has since regulated sperm donation, limiting to ten children born from the same donor.

There are currently 31 centers in France that have received authorization from the supervising Regional Health Agency and therefore qualified to be CECOS. Grouped together in a federation since 1981, the CECOS are much more than sperm banks. Of course, sperm donation is organized there, but the prerogatives of these centers are much broader. They are therefore intended to:

• allow the management of infertility when it requires a donation. The latter can certainly be a sperm donation, but also an oocyte donation or an embryo donation.
• Promote the preservation of fertility.  The role of CECOS in this framework is twofold. On the one hand, a patient whose treatment could lead to a loss of fertility (like chemotherapy) can be taken care of in a CECOS in order to allow the conservation of his gametes for subsequent procreation. This is called self-preservation (of spermatozoa or oocytes). On the other hand, it is the CECOS who are responsible for preserving the supernumerary embryos resulting from IVF to allow couples, treated for infertility, to consider a subsequent pregnancy.

What are sperm banks made of?

In order to implement these missions, these French-style “sperm banks” have:

• of a team multidisciplinary medical
• bya cryobiology platform where are frozen and preserved the gametes and embryos collected.

Still, a good part of the activity of the CECOS relates to the donation of sperm, from its collection to its attribution, including its conservation. And far from being a “formality” as one might sometimes think, the collection of sperm donations in the CECOS is strictly supervised and particularly long. It is thus broken down into several stages during which the donor goes to the center and exchanges with the various health professionals on site (medical biologist, psychologist, etc.)

More precisely…

• After a first contact, the potential donor is invited to an information consultation aimed in particular at verifying that it fulfills all the conditions for the donation.
• He then participates in a medical consultation. The objective: to sign the consents to the donation (and in particular to certify that he will not make donations in other centers), to assess the genetic risks, to determine the phenotypic characteristics that will be useful for the matching (eye colors, ethnicity). , etc.)
• A first collection of sperm is then carried out in order to evaluate the spermatic characteristics (sperm volume, count, sperm mobility, etc.)
• Serologies (HIV, Cytomegalovirus, hepatitis), a karyotype and a sperm culture are then carried out.
• The donor must then realize a consultation with the psychologist or psychiatrist service

It is only after all these preliminary steps that 4 to 5 collections are carried out by masturbation, in a dedicated area of ​​the center (no collection at home is authorized).

A final check-up appointment is made 6 months after the donation to check the serologies. Its objective: to allow the Cecos team to ensure that there is not a new infection that would contraindicate the use of the sperm collected. It is only after this last consultation that the sperm resulting from the donation can be allocated to a recipient couple.

À note: a donor who has not yet had a child can request to keep part of his donation for future procreation if it were to require medically assisted procreation.

Once the semen is collected, it goes through various stages of processing to ensure its conservation.

• After being analyzed, the semen is diluted in a solution that prevents the formation of ice crystals during the freezing process, like glycerol.
• The sperm is then packaged in thin tubes (the straws) and  numbered in order to preserve the anonymity of the donor and to ensure the follow-up of the donation.
• Finally, it is frozen at -196 ° C and stored in a liquid nitrogen container until its  use.

The allocation of straws from a donor to a recipient couple is based on two main factors:

Risk assessment

Risk assessment cumulative effects between the genetic heritage of the donor and the recipient.

Pairing

Pairing which consists, for the CECOS team in taking into account as much as possible the simple physical characteristics of the donor and the recipients (skin or eye color, type of hair) to allow the future child to have a maximum of features close to his parents. Unfortunately, the lack of donors (especially of certain ethnic origins) often makes the matching procedure very long, if not impossible.

In France, only CECOS are authorized to collect and allocate a sperm donation. Faced with the delays in obtaining the latter, some recipient couples are sometimes tempted to turn to foreign sperm banks. In fact, today there are establishments based abroad which allow sperm straws to be ordered online and delivered to France so that recipients can practice traditional insemination.

The problem: the importation of semen, which participates in this practice, not only poses health risks, but is also illegal in France, any handling of semen outside a CECOS being prohibited under the article. L1244-3 of the Public Health Code. The risk involved: a fine of 30 euros and two years in prison.

However, there are alternatives, although these are limited:

be followed in an IVF center abroad to benefit from donor IVF: this process is legal if the waiting period in France is not compatible with the patient’s medical needs. Partial coverage of costs by Social Security may even be considered if the couple concerned falls within the French legal framework.

— Importing semen from abroad may exceptionally be authorized in very specific cases and under certain very strict conditions, only after the agreement of the Biomedicine Agency. If you are eligible, the team that ensures your follow-up at CECOS will support you in this process.