How Does IVF with Donor Sperm Work? – Cost & Success Rates

In vitro fertilization (IVF) will preferably be performed with the eggs and sperm of the future parents. However, when there is no male partner or when a male partner has serious fertility problems, IVF with donor sperm may be necessary.

This technique consists of the union of the eggs extracted from the future mother with the sperm from a sperm donor, who has decided to donate his gametes. Depending on the local law and private agreements, sperm donation can both be anonymous or public.

IVF procedure

IVF is an assisted reproduction technique that consists of the union of the gametes (egg and sperm) in the laboratory and not inside the woman's body.

This technique requires the stimulation of the ovaries to obtain various eggs, which are extracted by egg retrieval. The eggs are then fertilized with the sperm and the resulting embryo is transferred to the mother's uterus to achieve a pregnancy.

The phases that are carried out are described below.

Ovarian stimulation

The patient must undergo hormonal treatment for ovarian stimulation to occur. This step usually begins on day three of the menstrual cycle and lasts about 10 days, allowing for a larger number and size of eggs to be obtained. Various ultrasound checks are carried out throughout the phase.

When the desired number and size of the ovarian follicles are reached, their maturation is stimulated and the follicular puncture is performed.

Follicular puncture and sperm treatment

Follicular puncture or egg retrieval consists of a surgical procedure under ultrasound control in which the liquid from the ovarian follicles is aspirated vaginally after a small amount of sedation. The aspirated follicular fluid is analyzed in the laboratory to obtain the eggs.

In donor sperm IVF, the sperm comes from a donor bank. All donor samples are frozen after collection for a minimum of 6 months to ensure the absence of transmissible infections.

Follicular puncture and sperm capacitation

We recommend that you find out more about the egg retrieval phase in the following article: How does egg retrieval work during IVF?

Egg fertilization

Once the most suitable donor has been chosen, in compliance with current legislation and with similar characteristics to the mother-to-be or the couple, a sample is defrosted and processed in the andrology laboratory to obtain the spermatozoa.

The fertilization of the egg can be:

Classic IVF

the egg and a drop of donor sperm with thousands of sperm are placed in the same laboratory dish.

ICSI

means intracytoplasmic Sperm Injection (ICSI). In this case, the best spermatozoon selected is inserted into the egg. The process is carried out with the aid of a micro-injector.

Traditional IVF - ICSI

Embryo culture in the laboratory

After completing the fertilization of the eggs, the zygote will pass to the state of an embryo and will be left in culture in incubators, controlling its development and evolution until the day of the transfer to the uterus of the future mother.

Incubators have the necessary characteristics and the right temperature for embryonic development.

Embryo transfer

The transfer consists of depositing the embryos in the uterus with the help of a fine cannula. It is advisable to go on the day of the transfer with a slightly full bladder to encourage a straight path from the cannula to the uterus. This process does not cause pain or require anesthesia.

This phase is carried out on day 2-3 or day 5-6, depending on the characteristics of the situation and the approach of each laboratory. ,

The number of embryos to be transferred is highly debated and also depends on the legislation of the respective country limiting the number of transferred embryos to a maximum of 2, like is the case in the U.K. In other countries with more liberal legislation such as the U.S. there is still a consensus among specialists that not more than two embryos be transferred in order to minimize the risks of multiple pregnancies as this would implicate serious consequences to the health of the mother and fetuses.

The implantation of the transferred embryo(s) can be promoted by administering estrogen and progesterone orally, vaginally, or in patches to the patient. This hormonal medication will allow your endometrium to acquire the trilaminate aspect and an optimal thickness equal to or greater than 5 mm for embryo implantation.

IVF process with donor sperm

The rest of the embryos not transferred are preserved by freezing or vitrification for future cycles, without the need to repeat ovarian stimulation or follicular puncture. If no more cycles will be performed, there are several options:

• Keep the embryos frozen until they can be destroyed.
• Donate the embryos to other couples.
• Donate the embryos for scientific reseach purposes.

If you want to learn more about this process you can visit the link: Embryo vitrification.

Pregnancy test

Once the embryos have been transferred to the woman's uterus, the laboratory checks that there are no embryos left in the cannula. At this point, the transfer is considered to be correct.

12 days after the transfer, a pregnancy test is performed by determining the beta hCG also called Human Chorionic Hormone or Pregnancy Hormone.

In general, there are two options that can be given after the transfer of embryos to the future mother's uterus and they are detailed below.

Positive outcome

the treatment is successful. The administration of progesterone is continued until the pregnancy is confirmed by an ultrasound scan where the 6-7 week old embryo is observed and its heartbeat can be heard.

Negative result

the treatment is not successful and does not end in pregnancy. In this case, there is no need to despair or lose hope. If there are frozen embryos, a second cycle can be performed. If there are no frozen embryos, a second complete IVF cycle would have to be repeated.

Sperm donor selection

When the partner's sperm is not available or does not allow pregnancy, a sperm donor is used.

Sperm donors are young, healthy boys who undergo a series of physical and psychological tests that confirm their ability to be donors. Following requirements have to be met by the sperm donors:

• Being between 18 and 39 years old.
• No family or personal history of a chronic or serious disease.
• Not being adopted since his background must be known.
• Sampel with excellent sperm quality and a high concentration and mobility of the spermatozoa. Furthermore, since all samples are to be frozen, it is essential that the spermatozoa pass the thawing test, i.e. that they survive the sperm freezing.
• Karyotype without chromosomal alterations.
• HIV negative serologies, Hepatitis B, syphilis, etc.
• No sexually transmitted deseases such as chlamyidia and gonococcus.

Sperm donor selection requirements

The donation can be performed anonymous or public and is a voluntary act which is remunerated. However, the donor with the most similar phenotypical characteristics to the recipient or her partner will be selected.

On the other hand, the donation can be made known or the recipient may just receive general information from the donor but no identification.

When is it necessary?

The main indications for in vitro fertilization with donor sperm are as follows:

• Women without partner who want to become single mothers.
• Women in a lesbian relationship.
• Severe male factor: important alterations of the sperm quality might require a male gamete donation. Severe alterations in seminal concentration (oligospermia), motility (asthenospermia), morphology (teratozoospermia), or the combination of some or all of them, may make patients consider the use of donor sperm. These are usually cases in which one or more attempts have been made to use the partner's semen with poor results and in which the main factor involved in the failure of the technique is considered to be low seminal quality. Likewise, those patients who present a high level of double sperm DNA fragmentation that does not revert with antioxidant treatment or who want to maximize their chances of success may be an indication for switching to a sperm donor.
• Genetic diseases of the male: Certain diseases that cannot be diagnosed by Pre-implantation Genetic Diagnosis (PGD) as well as the impossibility or desire of couples not to resort to it, may make it necessary to use a sperm donor to avoid transmission to the offspring of the disease.
• Karyotype alterations: patients with karyotype alterations who do not wish to resort to PGD techniques or who, after having resorted to it, due to the high number of chromosomally altered embryos, decide to switch to the sperm bank.

How much does IVF with donor sperm cost?

In general, using donor sperm instead of the husband's increases the overall cost of an IVF cycle. On average, the cost of IVF with sperm donation ranges from €3,000 to €5,000, although it varies by country and clinic.

In the UK, for instance, treatment on the NHS may be offered to some couples aged 23 to 29 years provided that they meet all the requirements established by the local health authorities.

Often, this amount does not include:

• Prior medical tests: Since they vary from person to person depending on the medical history, giving a fixed price quotation is difficult.
• Medications: Although medications needed depend also on each patient, the average cost ranges from €350 and €650.
• Donor compensation: Donors are paid a compensation of about €40-50 per clinic visit.

If you decide to do IVF abroad, the costs derived from travel and accommodation should be added to the overall cost as well. Some fertility clinics arrange travel plans to make it easier and more affordable for their patients.

Reciprocal IVF

For lesbian couples, there is a variant of in vitro fertilization treatment called reciprocal or shared IVF.

Reciprocal IVF consists of obtaining the eggs from one of the women, which are fertilized with the sperm from a donor bank. The embryos generated are transferred to the uterus of the second woman, i.e. the one who has not provided the eggs. Therefore, the reciprocal IVF is the same as a normal IVF, but taking into account that both women participate in the process.

The costs of reciprocal IVF is similar to sperm donation IVF for which the costs are situated around £3,800–£4,500 plus the cost of fertility drugs.

If you want to learn more about this reproductive technique, we recommend you read on here: What is reciprocal IVF?

When is donor sperm needed?

What to expect: success rates and risks

Even if donor sperm is used for your treatment, the success rates of IVF are dependent on the age of the woman to a large extent. Nonetheless, if the woman meets all requirements in terms of age, normal egg supply, absence of menstrual irregularities, etc., using donor sperm normally increases the success rates.

The following are approximate percentages by female age:

• Women under 35: around 14%
• Women aged 35-39: around 11%
• Women aged 40-42: around 5%

As for the risks, the main one is linked to known sperm donations, especially when the donor is not extensively screened for infectious diseases that could be inherited by offspring. By ensuring that the donor has undergone a thorough screening process, this potential complication can be considerably reduced.

In addition to the physical risks, the issue of legal responsibility is often a concerning factor for many couples. This is the reason why a legal donor agreement is required: otherwise, the donor could be seen as the child's legal father. Seeking advice from fertility lawyers is strongly advisable.

On the other hand, coping with the fact that the child will not be biologically related with the intended father is hard for some couples. For this reason, and in order to avoid relationship problems, discussing matters with your partner at length as well as raising any concerns before getting started is crucial.

FAQs from users

What are the requirements for donors to donate their semen?

Sperm Banks ask donors to undergo a comprehensive health evaluation, including genetic screening and infectious disease testing with a complete physical exam.

Basic Requirements vary but examples are:

• Donors of all ethnicities, races and nationalities are encouraged to apply
• 5’7” tall for most donors (5’4” for donors of Hispanic or Asian descent)
• Between the ages of 18 and 44
• Physically and emotionally healthy
• College-educated professional, student pursuing a degree or certificate beyond high school, or in a successful, long-term career (i.e. Civil Service, Trade Specialty)
• Be willing to commit to a minimum of one visit per week for a minimum of 90 days

What are the main indications for IVF with donor sperm?

IVF treatment with donor sperm is usually indicated for women between 18 and 43 years old, single women, couples of women or women whose partner has azoospermia, poor sperm quality or genetic alterations.

For women who do not present alterations in fertility (low ovarian reserve, endometriosis, obstructed tubes, early ovarian failure...), we can evaluate the option of artificial insemination with donor sperm before performing an IVF, although In Vitro Fertilization always gives better results. IVF is indicated in these cases when no pregnancy has been achieved after 3-4 artificial inseminations.

Before undergoing assisted reproduction treatment, even if the woman does not present infertility, it is important to study the case of each patient or couple. With a basic fertility study, we can guide the patient or couple to the most appropriate treatment.

Can IVF be done using half donor sperm, half husband's?

In some countries, this practice is perfectly possible. Some fertility clinics offer this possibility to women in order to increase their chances for success in a single cycle. Some eggs are fertilized with donor sperm, and others with that of the husband/partner. Usually, embryo transfer is firstly done with the embryos obtained with the husband's sperm, and the remainder only in case the first cycle fails.

What are the advantages of IVF using donor sperm instead of the husband's sperm?

Sperm donation is a possibility offered when the man presents problems with sperm quality, a genetic disease or abnormality, or after undergoing cancer treatments that could lead to a considerable reduction of the chances for natural pregnancy. In this sense, the main advantage of sperm donation is that it increases the success rates of an IVF cycle, provided that the woman presents no fertility issue.

Is it possible to do IVF with both donor eggs and sperm?

Yes, it is. This technique is known as double-donor IVF and is indicated in the following cases: problems in the ovaries (either because of age or other unknown causes), sperm problems (zero or low sperm count, or poor motility), and single females.

For further information, we recommend you to visit the following post: What is double-donor IVF?