Artificial insemination (AI) and donor-sperm in vitro fertilization (IVF) are the two main fertility treatments available for single mothers, lesbian couples and heterosexual couples whose own semen is non-viable.
Since artificial insemination is the least complicated procedure, it is usually chosen as the first choice. However, there are particular cases in which IVF is the first option, since success rates with AI are very low. Such cases are:
- Advanced maternal age
- Absence of tubal patency (i.e. tubal obstruction)
- Low ovarian reserve
- Ovulation disorders or in cases of irregular ovulation
In need of a sperm donor
These are the main reasons why a single person or a couple may need to use donor sperm:
- Poor-quality sperm: men with poor-quality sperm or suffering from any genetic disorder likely to be inherited by his offspring are recommended to use donor sperm. Azoospermia, oligospermia, and asthenospermia are some of the most common conditions why a men may have trouble conceiving.
In spite of this, most advanced in vitro fertilization procedures such as Intracytoplasmic Sperm Injection (ICSI) allow the achievement of pregnancy despite having poor-quality sperm. Usually, couples resort to donor sperm due to genetic disorders.
- Genetic disorder: when a man is a carrier of a contagious disease, he can undergo an IVF cycle using donor sperm to prevent his offspring from inheriting it.
- Absence of a male partner: when there is no male partner, either in cases of single women or lesbian couples. In such cases, using donor sperm is not only necessary but the only choice available to achieve pregnancy.
In the case of lesbian couples, a common option is that one of the partners acts as the “egg donor” and the other one as the recipient of the developed embryos thanks to the use of donor sperm and the partner’s eggs.
Semen samples of sperm donors must be of optimal quality and even surpass the reference values established by the World Health Organization (WHO). The donor is required to undergo not only a series of phycological assessments but also medical examinations and a thorough semen analysis in order to validate that the semen sample of the donor sperm can indeed be used.
Moreover, the American Society for Reproductive Medicine (ASRM) recommends specialists to resort only to frozen sperm and use it before 180 days after being frozen. The reason behind this guidelines is the window period for HIV infection. The sperm donor must take a blood test both at the beginning of the donation process and again after 180 days. In case both blood tests are free from viral infections, the semen of that potential donor will be declared as viable to be used in fertility treatments.
Other viral and bacterial infections such as syphilis, hepatitis B, cytomegalovirus (CMV), gonorrhea, chlamydia, trichomoniasis, and certain streptococcus species may not only have an impact on the recipient woman but also on the baby-to-be.
In addition to passing these series of medical tests in order to be accepted, neither the potential donor nor his partner, if any, should have gone through the following situations:
- Blood transfusion in that same year
- Having engaged into homosexual intercourse previously
- Having multiple sex partners
- Regular intake of Schedule 4 (IV) drugs (stimulants, antidepressants, narcotics, etc.)
- History of genital herpes
Choosing a sperm donor
Singles and couples have the right to decide which sperm bank they want to use and which sperm donor they want to choose. In the United States, this process is called known donation and is regulated by law. Usually, the chosen donor is a friend or relative of the recipient.
Conversely, if the intended parents prefer to choose anonymous sperm donation, they should bear in mind that some banks provide written information concerning the profiles of the potential donors such as physical characteristics, ethnic group, family history, education records, and any other general information regarding his state of health. This means the intended parents cannot meet the potential donor in person or find out identifiable information about him but they can get general data. In some centers, the intended parents can even get a picture of the donor as a child. This type of sperm donation is known as semi-known donation.
There is also the so-called anonymous donation, which means it is the clinic who allocates a suitable sperm donor to the intended parents, although the intended parents can indicate their preferences.
Regulations governing sperm donation
In the USA, there are no particular regulations governing who can engage in sperm donation. Nevertheless, the ASRM and other expert groups in this field have given a series of guidelines concerning this issue.
For instance, the ASRM guidelines establish a maximum of 25 live births per donor within a population area of 850,000 inhabitants. These are just guidelines and are not enforced by law. Besides, there is no central tracking for sperm donors; therefore, it is estimated that just 40% of births from sperm donors are reported. Some sperm donors may even have around 100 genetic children.
Some sperm banks establish lower limits. For example, there is a sperm bank from California that limits the donation to 10 families per donor. Others have stricter limits such as delivering the semen of a single donor to a maximum of around six different women.
Open donation: a way to identity disclosure
Some sperm banks have a donation arrangement known as “Open Donation”, which is included in anonymous donation programs. In this case, the donor has the right to engage into the identity-release program or not. In case the donor accepts it, the donor-conceived individual can request getting personal information about his donor to contact him. For this to be possible, the following requirements should be met:
- The donor-conceived individual must be older than 18 years old
- Personal data about the donor can only be given to donor-conceived individual
- The donor-conceived individual must request such information to the sperm bank through a duly written document
- The sperm donor must provide express permission so that the center is allowed to reveal his personal information
It is not about entering into a rapport of affiliation but just about letting the donor-conceived individual born from assisted reproductive technology find out about his/her own biological origin.
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