Sperm donation

Sperm donation is the provision (or 'donation') by a man, known as a sperm donor, of his sperm, known as donor sperm, with the intention that it be used to impregnate a woman who is not usually the man's sexual partner in order to produce a child.

Pregnancies are usually achieved using donated sperm by artificial insemination (either by ICI or IUI) and less commonly by in vitro fertilization (IVF), usually known in this context as ART but insemination may also be achieved by a donor having sexual intercourse with a woman for the sole purpose of initiating conception. This method is known as natural insemination, or NI.

The general process of sperm donation is described as third party reproduction.

A donor may donate sperm as an anonymous or non-anonymous donor through a clinic known as a sperm bank or through a third party or broker who makes arrangements between sperm donors and recipient women, known as a sperm agency. A sperm donor may also donate directly to the recipient and may be known to her. This may be done privately or through a sperm bank or fertility clinic. A sperm donor is the natural or biological father of every child produced as a result of his donations.

Sperm donation is used to assist heterosexual couples unable to produce children because of 'male factor' fertility problems, such as where the male partner produces no sperm. However, techniques have been developed which enable many 'male factor' problems to be overcome and which enable the couple to produce their own biological child. Sperm donation is now popularly used as a means to enable women who are single (sometimes known as choice mothers) or partnered lesbians to conceive children.[1]

When a donor's sperm is successfully used repeatedly to fertilize the same or different women, potentially several or many siblings and half-siblings will be born. Some refer to this process as 'fathering'. Laws in many countries and states require donors to be either anonymous or known to the recipient, or the laws restrict the number of children each donor may father. Although many donors choose to remain anonymous, new technologies such as the Internet and DNA technology have opened up new avenues for those wishing to know more about the biological father, siblings and half-siblings.

Provision
man who provides sperm as a sperm donor generally gives up all legal and other rights over the biological children produced from his sperm. This is why the process is known as 'sperm donation'.[citation needed] Sperm banks and fertility clinics provide significant access to sperm from anonymous sperm donors. There may also be sperm agencies that, usually via the Internet, mediate sperm delivery directly from a donor to the recipient. Private donors (see types of donors) donate independently of banks or agencies. Donors may operate either as anonymous donors or "directed" donors, who direct their sperm to be used by a specific person.

Sperm banks
In a sperm bank, the donor will usually donate sperm for a specified contractual period of time generally ranging from six to twenty-four months depending on the number of pregnancies which the sperm bank intends to produce from the donor. If a sperm bank has access to world markets e.g. by direct sales, or sales to clinics outside their own jurisdiction, a man may donate for a longer period than two years. The contract between the donor and the sperm bank will usually contain provisions about the place and hours for donation, a requirement to notify the sperm bank in the case of acquiring a sexual infection, and the requirement not to have intercourse or to masturbate for a period of usually two days before making a donation.

To donate sperm a man must generally meet specific requirements regarding age and medical history. In the United States, sperm banks are regulated as Human Cell and Tissue or Cell and Tissue Bank Product (HCT/Ps) establishments by the FDA. Many states also have regulations in addition to those imposed by the FDA. In the UK sperm banks are regulated by the HFEA. A man donates sperm at a clinic or sperm bank by way of masturbation in a private room or cabin, known as a 'men's production room' (UK) or a masturbatorium (USA). Many of these facilities contain pornography such as videos, magazines, and/or photographs which may assist the donor in becoming stimulated in order to facilitate production of the ejaculate, also known as the 'semen sample'.

The sample is then processed which may include 'washing' the sample so that sperm may be extracted from the rest of the material in the semen. An extender is added which also assists the freezing process, and the sample is then frozen in a number of vials. One sample will be divided into six to twelve vials depending on the quantity of the ejaculate and whether the sample is 'washed' or 'unwashed'. Following the necessary quarantine period, the samples will be thawed and used to impregnate women through artificial insemination or other ART treatments. 'Unwashed' samples are used in artificial insemination and in IVF treatments, and 'washed' samples are used in IUI and IVF procedures.

[edit] Medical screening
Sperm banks screen every potential donor for genetically inheritable diseases and infectious diseases that may be transmitted through sperm.

In the US, the screening procedures are regulated by the FDA, the ASRM, the American Association of Tissue Banks, and the CDC.[2] The screening regulations are more stringent today than they have been in the past.[3]

Screening includes:[2]

Taking a medical history of the donor, his children, siblings, parents, and grandparents etc. for three to four generations back.
HIV risk assessment interview, asking about sexual activity and any past drug use.
Blood tests and urine tests for infectious diseases, such as:
HIV-1/2 see sections below
HTLV-1/2
Hepatitis B
Hepatitis C
Syphilis
Gonorrhea
Chlamydia
Cytomegalovirus (CMV) see sections below
Blood and urine tests for blood typing and general health indicators: ABO/Rh typing, CBC, liver panel and urinalysis
Complete physical examination including careful examination of the penis, scrotum and testicles.
Genetic testing for carrier traits of:
Cystic Fibrosis
Sickle-cell disease
Thalassemia
Other hemoglobin-related blood disorders.
Cystic fibrosis carrier screening, chromosome analyses, and hemoglobin evaluations are performed on the majority of sperm donor applicants in the United States.[4] Donors of Jewish, Québécois, or Cajun descent may also get genetic testing for the carrier trait of Tay Sachs disease, but there is significant variation in screening for other disorders that occur with increased frequency in this population.[4]

Sperm donors are required to be fit and healthy and generally their 'sperm count' will be well above average to ensure that pregnancies may be easily and swiftly achieved by the use of their sperm.

HIV
The samples are generally frozen and stored for at least 6 months after which the donor will be re-tested for the HIV virus. The reason for this is that the virus takes time to establish itself in the body and a further test is therefore necessary. Providing the result is negative, the sperm samples can be released from quarantine and used in treatments.

Washing techniques are developing that purify sperm from viral load of HIV and hepatitis C.[5]

Cytomegalovirus
Screening for cytomegalovirus is only carried out in the UK and USA, and positive donors may still donate at sperm banks.[6]

Donor screening for cytomegalovirus (CMV) is carried out by testing for IgG antibodies against CMV that are produced if the donor ever has contracted CMV, which is the case in between 50% and 80% of adults.[7] Such antibody-positive individuals may potentially shed virus that remain latent in the body in the semen, infecting the mother and, in turn, the embryo/fetus. Most babies will not be harmed by the virus, but a small percentage may develop neurological abnormalities.[8] However, the risk of acquiring CMV infection from an antibody-positive sperm donor is believed to be extremely low, at least where sperm banks perform follow-up tests on antibody-positive donors for type IgM antibodies that indicate current or recent CMV infection, and where sperm preparations are performed that decrease the amount of white blood cells in the samples, e.g. in samples prepared for IUI.[8] In uncertainty, recipient women may do a blood sample test on themselves for IgG antibodies at their health care provider, determining immunity against the virus.[9]

Preparations
Donated sperm may be prepared for use by artificial insemination in intrauterine insemination (IUI) or intra-cervical insemination (ICI), or, less commonly, it may be prepared for use in other assisted reproductive techniques (ART) such as IVF. Donated sperm may also be used in surrogacy arrangements either by artificially inseminating the surrogate with donor sperm (known as 'partial surrogacy') or by implanting in a surrogate embryos which have been created by using donor sperm together with eggs from a donor or from the 'commissioning woman' ( known as 'full surrogacy'). Spare embryos from this process may be donated to other women or surrogates. Donor sperm may also be used for producing embryos with donated eggs which are then donated to a woman who is not genetically related to the child she produces.

In medical terms, using donor sperm to achieve a pregnancy is no different from using sperm from a woman's partner, and the resulting pregnancy will be the same as a pregnancy achieved through sexual intercourse.

Information about donor
Sperm banks maintain lists or catalogues of donors which provide basic information about the donor such as racial origin, skin color, height, weight, colour of eyes, and blood group.[10] Some of these catalogues are available for browsing via the Internet, while others are only made available to patients when they apply to a sperm bank for treatment. Some sperm banks make additional information about each donor available for an additional fee, and others make additional basic information known to children produced from donors when those children reach the age of eighteen. Some clinics offer "exclusive donors" whose sperm is only used to produce pregnancies for one recipient woman. How accurate this is, or can be, is not known, and neither is it known whether the information produced by sperm banks, or by the donors themselves, is true. Many sperm banks will, however, carry out whatever checks they can to verify the information they request, such as checking the identity of the donor and contacting his own doctor to verify medical details. Simply because such information is not verifiable does not imply that it is in any way inaccurate, and a sperm bank will rely upon its reputation which, in turn, will be based upon its success rate and upon the accuracy of the information about its donors which it makes available.

Other screening criteria
Sexually active gay men are prohibited or discouraged from donating in some countries, including the United States.[11] Some sperm banks also screen out some potential donors based on height, baldness, and family medical history.[10]

Sperm donation and reduced birth defects
Children conceived through sperm donation have a birth defect rate of almost a fifth compared with the general population.[12] This may be explained by the fact that sperm banks only accept donors who have good semen quality, and because of the rigorous screening procedures which they adopt. In addition, sperm banks may try to ensure that the sperm used in a particular recipient woman comes from a donor whose blood group and genetic profile is compatible with those of the woman.

Sperm donation and rhesus incompatibility
Sperm donation is also used in cases of rhesus incompatibility. This particularly occurs where a woman has a blood type which is rhesus negative, and where her partner is rhesus positive. The woman's body may reject a fetus if it has rhesus positive blood. Anti D injections have been developed and may be used to attempt to avoid this, and these are usually automatically given to rhesus negative women immediately after they give birth to their first child. However, in the past this was either not possible or was not always routinely undertaken where a woman gave birth or had an abortion and she may have trouble carrying a child later in life. Furthermore, for some women, the anti D injection does not provide the entire solution, particularly where there is a medical history of complications during pregnancy which risk the woman's blood and that of the fetus becoming mixed. In such cases, sperm from a rhesus negative donor can provide the solution and a woman may be able to conceive and carry a pregnancy to full term when otherwise this would not be possible. For this reason, sperm from rhesus negative sperm donors is often in great demand, particularly those with the O negative blood group who are universal donors.

Sperm agencies
Sperm may also be donated through an agency rather than through a sperm bank. The agency recruits sperm donors, usually via the Internet, and it also advertises its services on the Internet. Donors may undergo the same kind of checks and tests required by a sperm bank, although clinics and agencies are not necessarily subject to the same regulatory regimes. In the case of an agency, the sperm will be supplied to the recipient woman fresh rather than frozen. A woman chooses a donor and notifies the agency when she requires donations. The agency notifies the donor who must supply his sperm on the appropriate days nominated by the recipient women. The agency will usually provide the sperm donor with a male collection kit usually including a collection condom and a container for shipping the sperm. This is collected and delivered by courier and the woman uses the donor's sperm to perform her own artificial insemination, typically without medical supervision. The whole process preserves the anonymity of the parties and it enables a donor to produce sperm in the privacy of his own home. A donor will generally produce samples once or twice during a recipient's fertile period, but a second sample each time may not have the same fecundity of the first sample because it is produced too soon after the first one. Pregnancy rates by this method of sperm donation may vary more than those achieved by sperm banks or fertility clinics. Transit times may vary and these have a significant effect on sperm viability so that if a donor is not located near to a recipient woman the sperm may deteriorate. However, the use of fresh, as opposed to frozen semen will mean that a sample has a greater fecundity and this can produce higher pregnancy rates.

Sperm agencies may impose limits on the number of pregnancies achieved from each donor but in practice this is more difficult to achieve than for sperm banks where the whole process may be more regulated. Most sperm donors only donate for a limited period however, and since sperm supplied by a sperm agency is not processed into a number of different vials, there is a practical limit on the number of pregnancies which are usually produced in this way. A sperm agency will, for the same reason, be less likely than a sperm bank to enable a woman to have subsequent children by the same donor.

Sperm agencies are largely unregulated and, because the sperm is not quarantined, it may carry sexually transmitted diseases. This lack of regulation has led to the competent authorities in some jurisdictions bringing legal action against sperm agencies in certain cases. Agencies typically insist on STI testing for donors, but such tests cannot detect recently-acquired infections. Donors providing sperm in this way may not be protected by laws which apply to donations through a sperm bank or fertility clinic and will, if traced, be regarded as the legal father of each child produced by their sperm, (but see below, Private donors).

Private or "directed" donors
Some donors and recipients choose to arrange donations privately and directly. Recipients may approach a friend, or may obtain a "private" or "directed" donor by advertising. A number of Web sites seek to link such donors and recipients, while advertisements in gay and lesbian publications are common. Although artificial insemination is usually used, the parties may sometimes agree to inseminate by NI (see 'NI and sperm donation below'). Where a private or directed donor is used, sperm need not be frozen. Such donors may already know the recipients, or if arranged through a broker, may meet the recipients and may therefore become known to the recipient. Some brokerage services facilitate contact that maintains semi-anonymous identities for legal reasons.

Private donations may be free of charge - avoiding the significant costs of a more medicalised insemination - and fresh rather than frozen semen is generally deemed to increase the chances of pregnancy. However, they also carry the higher risks associated with any unscreened sexual or body fluid contact. Legal treatment of donors varies across jurisdictions, and in most jurisdictions, e.g., Sweden,[13] personal and directed donors lack legal safeguards that may be available to anonymous donors. However, the laws of some nations (e.g., New Zealand), recognize written agreements between donors and recipients in a similar way to institutional donations.

Donor payment
The majority of sperm donors who donate their sperm through a sperm bank receive some kind of payment although this is rarely a significant amount. The payments vary from the situation in the United Kingdom where donors are only entitled to their expenses in connection with the donation, to the situation with some US sperm banks where a donor receives a set fee for each donation plus an additional amount for each vial stored. At one prominent California sperm bank for example, TSBC, donors receive roughly $50 for each donation (ejaculation) which has acceptable motility/survival rates both at donation and at a test-thaw a couple of days later. Because of the requirement for the two-day celibacy period before donation, and geographical factors which usually require the donor to travel, it is not a viable way to earn a significant income—and is exponentially less lucrative than selling human eggs.

Some private donors may seek remuneration although others donate for altruistic reasons. Equipment to collect, freeze and store sperm is available to the public notably through certain US outlets, and some donors process and store their own sperm which they then sell via the Internet.

The selling price of processed and stored sperm is considerably more than the sums which are received by donors. Treatments with donor sperm are generally expensive and are seldom available free of charge through national health services. Sperm banks often package treatments into e.g. three cycles, and in cases of IVF or other ART treatments, they may reduce the charge if a patient donates any spare embryos which are produced through the treatment. There is often more demand for fertility treatment with donor sperm than there is donor sperm available, and this has the effect of keeping the cost of such treatments reasonably high.