Jade, who lives in Macon, Georgia and identifies as transfeminine, had been considering sperm banking since 2013. She wanted to preserve her genetic material knowing that hormone replacement therapy could affect her fertility — but she wasn’t able to afford going through with traditional methods, which totaled over $1,000 at the sperm bank closest to where she lives. At her mother’s urging, and after a partner lost a viable pregnancy, Jade recommitted herself to preserving her fertility and keeping biological children as an option in the future.
She found Dadi, a new company that offers a mail-in sperm analysis kit and storage subscription, while searching online last year, and used the company in their beta phase. Now she pays $9.99 a month, the equivalent to a Netflix subscription, to store her genetic material.
Only a sliver of the estimated 1.4 million U.S. adults who identify as transgender preserve their genetic material. Dr. Joshua Safer, the Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, says that research in transgender medicine is limited but conjectures that rates are “less than 10%”. A 2017 study of transgender adolescents initiating hormone therapy showed that just over 12% chose to see a fertility specialist and only 5% underwent gamete preservation as part of their transition. The barrier to do so, historically, are high costs.
Traditional sperm banks often charge over $1,000 for semen analysis, freezing, and a year of storage, with subsequent years of storage costing in the hundreds per year. Some banks, like California Cryobank, offer discounts to demographics who need their services the most. Although not listed on their pricing webpage, a public relations representative at California Cryobank confirmed they offer a discount of 50% off fertility preservation and storage services for transgender and non-binary clients, reducing their cost to just over $500 for the analysis, freezing, and year of storage.
At $199, Dadi can cut that cost in half, although they charge a $299.99 withdrawal fee. Legacy, Dadi’s closest competitor, lowers it to $340 inclusive of the withdrawal.
Both companies send customers a kit that includes a cup with preservative that will protect the deposit throughout the shipping process until it reaches a lab. Dadi offers one kit that includes semen analysis and the first year of cryogenic storage for 3 vials, with following years for $99. Legacy offers three packages, the lowest offering clinical semen analysis and optional storage for up to 6 vials at an additional $145 a year.
Tom Smith, co-founder and CEO of Dadi, began working on the company after a friend received a cancer diagnosis. Since launching in January 2019, they’ve already supported thousands of customers, with a focus on improving the customer experience, adding convenience, and minimizing the discomfort of providing a sperm sample over traditional fertility preservation methods. Dadi entered the market a year after Legacy, which was founded in January 2018. Similarly, Legacy’s CEO and co-founder, Khaled Kteily, began working on the company after his own medical emergency. While Legacy’s starting package begins at a higher rate than Dadi’s $199 offering, there is no additional cost to ultimately withdraw the sample from storage and use it, which could ultimately make it a more cost effective option.
Legacy and Dadi market themselves as an “insurance policy” for those who can afford the services, although experts maintain that sperm banking for all may be considered overkill. Instead, sperm banking is most often recommended for those in the armed forces, cancer patients who may be receiving medications or surgery that impact fertility, and transmasculine patients before starting gender-affirming hormones.
Recognizing that Dadi’s affordable prices and accessible product means it is, as Tom Smith says, “tailor-made” to support transgender and non-binary community, Dadi has partnered with Planned Parenthood of Pasadena and San Gabriel Valley to expand their TransCare program as a phased approach that they plan to expand to other cities. Those who seek care through Planned Parenthood Pasadena and San Gabriel Valley will receive a $50 discount to use Dadi’s services. Unfortunately the discount cannot be applied retroactively to someone already storing with the company, like Jade.
Despite discounted rates, fertility experts are wary of how little is known about the impact of the preservative used to enable shipping the sample back in the mail. Dr. Bobby Najari, a urologist at NYU Langone, is concerned with the lack of long-term data. Given that both Dadi and Legacy have only been around for a couple of years, experts warn of their novelty and prefer referring patients to traditional sperm banks with years of results. It has been proven, for decades, that providing a sample on-the-spot at a sperm bank does not have a negative impact on the chances of getting pregnant with that sperm. The use of preservative to ship the sample to a lab, however, is a far newer practice.
Legacy’s CEO, Khaled Kteily, says they are open with their clients about the fact that there will be “a small reduction in motility when using the buffering medium, which is not particularly meaningful.” In using the preservative, they work closely with Dr. Gail Prins’ lab, who championed the research into the buffering medium. If concerned, clients that prefer to have their sample taken directly to the clinic for testing and freezing without use of the medium can use Legacy’s offered same-day courier service that is available in select cities. Dadi also cites an insignificant impact to sperm motility when using the preservative, and in a year of operating, can confirm one viable pregnancy as a result of their service.
While it has been proven that frozen sperm is as effective as fresh for in vitro fertilization (IVF) treatments, it is important to note that the live birth IVF success rate is generally between 40 and 50% for those who start the cycle before 35. Frozen sperm can also be used for intrauterine insemination (IUI), which has success rates that range from 5 to 20% per IUI based on different factors.
Yet new mail-in kits can offer exactly what sperm banks cannot: privacy. Experts see this as the primary benefit that they allow — fertility preservation in the comfort of your own home — especially for those who may experience dysphoria in providing a sample. While Dr. Najari preferentially refers his patients to traditional sperm banks, he would much rather a patient use any service to preserve fertility than not. “I'm always disheartened by how few transgender individuals have banked their sperm prior to starting therapy and so I think anything that we can do to raise those number is of a huge benefit,” he said.
These services are part of an industry-wide shift towards more accessible and affordable means of fertility preservation. Doctors note that the public consciousness of what is able to be done to preserve genetic material is rising significantly, options across the country are expanding, and costs should continue to lower.
For trans masculine patients, egg freezing remains an inherently more invasive procedure than freezing sperm that requires blood work, medications, an outpatient procedure, and an even higher price tag. Similar to Dadi and Legacy, start-ups like Kindbody and Extend Fertility have emerged with lowered prices — $6,500 for egg freezing not inclusive of blood work and medications but down from numbers like $10,000 — and increased accessibility.
Kindbody’s Chief Medical Officer, Dr. Lynn Marie Westphal, reinforced that the company is actively treating trans masculine patients and are committed to further reducing the barriers to fertility preservation. While the start-up has brick and mortar locations in New York, San Francisco, and Los Angeles, they have plans for other centers across the U.S. in the next 12 to 36 months. In the meantime, they offer an online portal through which they can shepard patients through the process and connect them with partner clinics across the country, which in many cases will honor their reduced pricing. Kindbody’s CEO, Gina Bartasi, is focused on offering as much at-home care as possible in the coming years, in part to better accommodate patients who experience dysphoria and discomfort in clinical settings.
Fertility experts will always be cautious of services without established results. Reproductive endocrinologist Dr. Brooke Hodes-Wertz said, “the thing that is important regardless of where you’re freezing your eggs is being really aware and having realistic expectations about what’s going to happen on the other end.” She explained that it’s important that all services be “very transparent that it’s not a guarantee.”
For Jade, guarantee or not, receiving her positive fertility report and storage confirmation was a weight off her shoulders that she describes as unforgettable. “I'll never forget that feeling,” she told me. “I still smile whenever I see the sample.”
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