Why might someone use donor sperm?

There are multiple scenarios in which the use of donor sperm may be indicated:ⁱ

• Significant sperm abnormalities, such as severe oligospermia (decreased sperm count in ejaculate) and azoospermia (no sperm in ejaculate)
• Ejaculatory dysfunction
• An individual has (or is a carrier of) a severe genetic disorder that could be passed on to offspring
• Failure of fertilization using in vitro fertilization (IVF) despite the use of intracytoplasmic sperm injection (ICSI)
• The person or people wanting to become parents do not have a partner that makes sperm, such as in the case of a single cisgender woman, a same-sex cisgender female couple, or a transgender male with or without a partner

A 2014 study published in the American Journal of Obstetrics & Gynecology found that 6.2 percent of assisted reproductive cycles in the United States used donor sperm.ⁱⁱ A national survey from 2015 to 2017 also found that donor sperm was used by up to 0.69 percent of all reproductive-aged females in the U.S.ⁱⁱⁱ

Emotional considerations of using a sperm donor

While it can be beneficial for individuals and couples, sperm donation also brings up complex emotions for the intended parents. Some men perceive sperm donation as a threat to their masculinity, since fertility is often associated with male sexual potency. Men may also feel guilty about their inability to successfully achieve a pregnancy with their partner.^iv

Females may find the use of a sperm donor challenging as well. One study by Patel et al (2018) found that individuals reported hesitancy over the procedural strain of using donor sperm, as well as fear that their spouse or their family members might reject, abuse, or neglect them or the child born out of the use of donor sperm.^v

Other people experience a grieving process when using a sperm donor, because sperm donation prevents a biological or genetic tie between the male partner (if there is one) and offspring.

Intended parents may also experience anxiety about disclosing the use of a sperm donor to their child in the future.^vi

Counselling and mental health support can be helpful for individuals using a sperm donor and should be encouraged. One 2020 study published in Reproductive BioMedicine Online found that 55 percent of females who used donor sperm reported unmet counselling needs.^vii

What should one look for in a sperm donor?

When facilitating sperm donation, fertility clinics typically use a rigorous screening process and a variety of tests that help improve the chances of a successful match between donor sperm and the intended parents. These tests include semen analysis, genetic screening, and medical and laboratory testing. Whether the sperm donor’s identity can be disclosed depends on several factors that vary by location and situation.

Semen analysis

Prospective donors need to undergo semen analysis to ensure the sperm is of adequate quality for donation. This analysis looks at sperm count, concentration, motility, and morphology (shape/appearance). A sperm donor must abstain from all forms of ejaculation for two to three days prior to providing a semen sample, which is typically collected via masturbation.^viii

Maintaining a short period of abstinence prior to donation has been shown to improve certain sperm quality parameters at the time of collection. A study by Comar et al (2017) found that two to five days', as well as greater than 5 days’ abstinence produced the greatest semen volumes and sperm concentrations when compared to two days’ abstinence.^ix

Genetic screening for sperm donors

Sperm donors typically undergo genetic testing prior to donation to reduce the chances of having offspring born with genetic disorders. The number of genetic variants (mutations) for which a donor is screened varies considerably by fertility clinic, egg bank, agency, and even country. Some agencies require the potential sperm donor to undergo a complete chromosome analysis before acceptance. Recipients should ask about the details of the genetic screening panel used for sperm donors when choosing a donor.^x

Genetic screening is important because even if a potential sperm donor does not have any symptoms of a genetic disorder, he may be a carrier of certain genetic conditions. If the egg provider is also a carrier of the same genetic condition, the embryo has a higher risk of developing that disorder. Note: Being a carrier for a genetic disorder is not the same as having the disorder.

Medical history

A detailed account of the sperm donor’s personal health history will be obtained prior to sperm donation, including the donor’s individual risk of infectious diseases, genetic conditions, and other disorders. Individuals at high risk for HIV or sexually transmitted infections (STIs) are not usually accepted as sperm donors.^xi Information about the donor’s family will also be obtained to screen for conditions that have a genetic component, which could be inherited by the offspring.

Sperm donor age is also an important factor when determining eligibility. Males can typically donate sperm up until age 40, due to an increased risk of certain genetic disorders in offspring from males of advanced paternal age. However, some fertility clinics and sperm banks set other age parameters.^xii

Laboratory testing

Before and throughout the donor sperm process, sperm donors must provide blood and urine samples that will undergo laboratory testing to assess for sexually transmitted infections (STIs). Blood tests for syphilis, hepatitis B, and hepatitis C are completed at the initial screening and should be repeated every six months. If an individual is positive for hepatitis B or hepatitis C, he should be excluded as a sperm donor. Urine tests for chlamydia and gonorrhea will also be completed at initial screening. If positive, they should be repeated after treatment and prior to sperm donation.

Testing for cytomegalovirus (CMV) should be completed initially and repeated every six months. If positive for an active infection, the individual will not be eligible for sperm donation. Sperm donation from a man who is CMV seropositive (without an active infection) can still be used after appropriate counseling. Testing for human immunodeficiency virus (HIV) and human T-lymphotropic virus (HTLV) should also be completed and repeated every six months.^xiii

Sperm donor anonymity

Sperm donors may be anonymous (closed ID), semi-anonymous/semi-open (limited information about the sperm donor is disclosed), open ID/identity release, or known/directed. Some countries require all sperm donations to be anonymous, while others require all donations to be open ID. Some countries offer both options.

In the U.S., most sperm donors are anonymous, and there is no legal obligation for donor identity disclosure.^xiv With the rise of publicly available genetic/ancestry testing, children conceived from anonymous donors are likely to be able to identify their donor and any biologically related relatives by submitting their DNA to available databases. Thus, donor anonymity is a moving target, and donors opting for this route should be counseled that there is a high likelihood any children that result from their donation may be able to find them in the future.

In the case of open ID sperm donors, the identity of the sperm donor (identity release) might not be revealed to the donor-conceived child until they are 18 years old. Known donors, who are sometimes a relative or friend of the intended parents,^xv generally allow for more frequent communication between the sperm donor and the intended parents.

How to choose between fresh vs. frozen donor sperm?

Usually, donor sperm samples are frozen and subsequently thawed prior to intrauterine insemination (IUI) or IVF.^xvi In general, fresh sperm transfer is not recommended due to the risk of transmission of disease. Thus, the American Society for Reproductive Medicine (ASRM) suggests that fresh semen only be used in the case of sexually intimate partners.^xvii

How many vials of sperm are needed?

Fertility clinics require different amounts of donor sperm depending on the assisted reproductive techniques used. For example, clinics may set different sperm parameters for use in IUI versus IVF; fewer sperm are often required for use with IVF.

Both the number and quality of sperm are used to determine if sperm collections are adequate for use in donation. For IUI, certain parameters have been suggested in various reports:^xviii

• Motile count after washing of at least 0.8 to5 million
• Percentage of normal sperm morphology greater than or equal to 5 percent
• Total motile sperm count greater than 5 to 10 million
• Total sperm motility greater than 30 percent

However, there is no consensus on exact values and each center is likely to have slightly different criteria.  

Once the appropriate number of vials has been determined and it is time for the sperm to be used in IUI or IVF, the vials are thawed (if frozen) and the sperm samples are washed. This step is done to concentrate the sperm into a smaller volume and remove other components of the seminal fluid that may interfere with fertilization.^xix  

In some cases, only a portion of the vial of sperm will be thawed, known as partial thawing or “shaving” of the donor sperm. This process is completed by shaving a small amount of frozen sperm from the vial and conserving the rest of the vial for later use. A 2018 study in the Journal of Assisted Reproduction and Genetics involving 198 patients showed that, while partial thawing does not affect fertilization rates, the number of high-quality embryos created with the shaving technique is significantly reduced. Therefore, this technique is not typically recommended and is only used if the amount of sperm from the sperm donor is limited. Similarly, repeated freeze-thaw cycles of the sperm are not recommended as it significantly affects motility.^xx

However, dependent upon the intended parents and the availability of a sperm donor, there may be no choice other than to use the shaving methodology. For example, it may be necessary if the intended parents are trying to create genetically matching siblings with limited availability of sperm from the first donor.

What are the fertility treatment options when using donor sperm?

Donor sperm is used in various assisted reproductive techniques, which are selected based on the intended parents’ preference and personal medical history. The most common fertility treatments involving donor sperm include IUI, IVF, and IVF with intracytoplasmic sperm injection (ICSI).

IUI with donor sperm

Intrauterine insemination (IUI) involves the injection of sperm into the uterine cavity. The goal of IUI is for the female’s own egg to become fertilized by the donor sperm, and for the embryo to implant into the uterine lining to achieve pregnancy. IUI is performed at the time of female ovulation.^xxi

IVF using donor sperm

In vitro fertilization (IVF) is the process by which a female’s egg is mixed with donor sperm in a laboratory dish. Once fertilization occurs, the embryo is cultured in the lab and transferred to the uterus of the recipient of the embryo.

ICSI using donor sperm

IVF may be completed with intracytoplasmic sperm injection (ICSI), in which a pre-selected sperm cell from the sperm donor is injected directly into the egg. It is especially useful in male factor infertility (MFI) because it overcomes the process of sperm cells having to swim to and penetrate the egg on their own. However, ICSI is becoming more and more common even in the absence of MFI.^xxii

Who carries the pregnancy?

The person who carries the pregnancy receives the embryo fertilized by donated sperm, whether by IUI or IVF. This person will either be a female intended parent who used IUI or IVF, or a gestational carrier in the case of IVF only.

Intended parent

If the intended parent plans to carry the pregnancy, she will need to undergo a pre-pregnancy medical assessment prior to embryo transfer or IUI. This assessment includes a detailed review of the intended parent’s medical, surgical, and psychiatric history, medication and substance use, and family medical history. The pre-pregnancy investigation also includes a physical exam to ensure that the recipient is a good candidate for carrying a pregnancy.  

Ultrasound imaging of the uterus using a sonohysterogram is often performed to look for uterine conditions that may interfere with pregnancy. Blood tests are also completed to determine blood type, vaccination status, and hormone levels, and to test for infectious diseases.^xxiii

Gestational carrier

A gestational carrier is a female who has an embryo transferred to her uterus for the purpose of carrying the pregnancy on another person or couple’s behalf. Embryos transferred to a gestational carrier’s uterus may be created using a sperm donor.  

A gestational carrier may be used if the intended parent is unable or unwilling to carry out a pregnancy. There are various reasons for using a gestational carrier:^xxiv

• ‍^‍Medical conditions where pregnancy is contraindicated for the intended parent (e.g., poorly controlled high blood pressure)
• Uterine conditions (e.g., absence of a uterus or a significant uterine abnormality)
• Logistical or personal reasons for not desiring a pregnancy  

In traditional surrogacy using donor sperm and the surrogate’s own eggs, IUI can be performed. However, it is no longer a common practice. More often, a gestational carrier is used so that the female carrying the baby does not have a genetic connection to the child.

What are the success rates for using donor sperm?

Reported success rates in achieving pregnancy with donor sperm vary depending on the oocyte age. The population that the donor-sperm embryos are compared against will also impact the results.

A 2017 study found an increased live birth rate in assisted reproductive cycles using donor sperm compared to cycles using partner (non-donor) sperm, after adjusting for maternal age.^xxv

Another study published in Human Reproduction analyzed 3,910 IVF cycles in females 40 years and older. The researchers compared live birth rates for individuals who underwent IVF using donor sperm (307 females, either unpartnered or in a same-sex couple) to those doing IVF with partner sperm (3,603 females). After adjusting for confounders, they observed higher odds of having a live birth in the donor sperm group compared to the non-donor sperm group.^xxvi The authors suggest that the reason may be because the people using donor sperm were less likely to be doing IVF due to female infertility; rather, they needed donor sperm because there was no male partner in the picture.^xxvii

Another study included 402 patients who underwent a total of 1,264 IUI cycles and they observed that the clinical pregnancy rate was 17.2 percent per IUI cycle with frozen donor sperm.^xxviii

These studies confirm that using a sperm donor will not negatively impact the chances of IUI/IVF success. In contrast, donor sperm may even increase chances of success, especially in cases where donor sperm is being used due to partner male factor infertility (MFI).

Conclusion

Couples and individuals interested in sperm donation should speak with their fertility clinic or medical team for more information. They should also consider asking for a referral to a mental health professional experienced with third-party reproduction who can ensure patients are adequately supported through this process. Both the decision to use donor sperm and the decision to be the donor require a great deal of thought and decision-making. The proper counselor can ensure that everyone involved is asking the right questions and getting sufficient answers.