Jessica Manns, MBMS
January 27, 2023
Reproductive Health

6 Things to Consider When Choosing to Use Donor Sperm

Why Use Donor Sperm?

Insemination refers to the process in which a sperm cell comes into contact with an egg (oocyte) and deposits its genetic material (DNA) into the egg. More specifically, the sperm burrows through the egg’s shell (zona pellucida) and fuses with its plasma membrane. This sets off a chain of events that cause fertilization to occur.

Once these events occur, the fertilized egg (now called a zygote, or early embryo) begins to undergo cell division. In other words, the one-celled zygote divides into two cells. Those two cells then divide into four cells, and so on. If the embryo implants into the uterine lining (endometrium), it should continue to develop into a fetus until birth occurs roughly 8.5 months later.

Assisted reproductive technology (ART) has helped millions of infertile (unable to conceive or maintain a pregnancy after 12+ months of actively trying) people and couples conceive and establish pregnancies for over 40 years. In fact, it’s estimated that nearly 1.9% of babies born in the US are conceived through ART.

According to Medical News Today, ARTs “involve the manipulation of eggs, sperm, or embryos to increase the likelihood of a successful pregnancy.” These technologies consist of in vitro fertilization (IVF), intrauterine insemination (IUI), and third-party reproduction (the use of donor eggs, sperm, or embryos, and/or the use of a gestational carrier), among others.

Regardless of the type of ART performed, the process requires fertilization of an egg with a sperm cell to create an embryo. Sperm cells are produced in the male testes and are typically retrieved through an ejaculation. The source of the sperm can either be from a male partner (e.g. a woman’s husband) or a sperm donor (e.g. from a sperm bank).

The use of donor sperm is quite common. In fact, according to a 2019 study that estimated the use of donor sperm in the USA, nearly 441,000 women utilized donor sperm to achieve a pregnancy. There are many reasons why donor insemination is performed. Some common reasons are:

  • The male partner cannot produce sperm, or the sperm that is produced is of inadequate quality (e.g. there is a low sperm count or motility).
  • The male partner produces sperm, but an obstruction blocks the sperm from exiting the body during an ejaculation (e.g. when a male has a vasectomy performed).
  • The male partner has a genetic condition that can be passed on to his offspring.
  • The male partner has undergone chemotherapy, radiation, or another surgery that has impacted his ability to produce normal, healthy sperm.
  • A single female, lesbian couple, and/or LGBTQ+ person/couple would like to conceive to achieve a pregnancy.
  • Other personal reasons.

If you are considering utilizing donor sperm for assisted reproduction, there are a few important things to consider beforehand. This article will guide you through the process and provide some helpful resources to help you along the way.

It’s estimated that nearly 1.9% of babies born in the US are conceived through Assisted Reproductive Technology.

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1. There are two types of donor sperm.

Donor sperm refers to sperm that is not produced by a female’s sexually intimate partner. Most people think of donor sperm as the vials that are purchased through a sperm bank and shipped to an IVF clinic for insemination. In many cases, these sperm donors are anonymous (their identity is unknown to the recipient).

But sperm donors do not have to be anonymous. In fact, in some parts of the world such as Germany and Portugal, the identity of all sperm donors are known. This does not necessarily mean that the recipients of the donor sperm know the sperm donor, but that any offspring resulting from the donor sperm have the right to learn the identity of the sperm donor when they are older. In other cases, sperm donors may opt for future offspring to learn their identities when they are older, but the recipient(s) must approve this option, otherwise the donor cannot be utilized.

It’s important to keep in mind, though, that future genetic technologies may allow offspring from donor sperm to identify the sperm donor even if he is an anonymous donor. Anonymous sperm donors should sign a consent prior to their donation acknowledging that there is a chance that offspring resulting from their donated sperm may be able to identify them in the future due to the creation of unforeseen genetic technologies. As the recipient of donor sperm, you should sign a similar consent acknowledging that, though any offspring resulting from donor sperm are legally your children, they may eventually be able to identify the donor whose sperm was used to create them.

In other cases, the sperm donor can be someone that the recipient personally knows, such as a close friend (this is known as a directed donation). This may sound like a simple process, but it’s actually a prolonged legal process that contains certain risks. For example, the sperm donor and recipient(s) should sign legal consents stating that the sperm donor will relinquish all rights to any offspring resulting from his donated sperm and will not be responsible for any genetic conditions, birth defects, or handicaps in any offspring that result from the donated sperm.

In addition to the legal processes, there are the mental and emotional aspects of directed donation to consider. Will the donor want to be involved in the child’s life? Will the donor attempt to fight for custody of the child in the future? Will the children know that the donor is genetically related to them? What happens if the known sperm donor has biological children of his own?

This isn’t to say that using known donor sperm is a bad idea. In fact, utilizing known donor sperm has helped to grow many families without any legal, emotional, or mental repercussions.

But, if you are planning to utilize known donor sperm, here are some things to consider:

  • The known donor and the recipient(s) should seek assistance from a licensed medical professional, such as a psychiatrist that specializes in third-party reproduction.
  • The known donor and recipient(s) should seek legal counsel from an attorney that specializes in third-party reproduction and make sure that everything is in writing. This can save all parties involved a lot of unnecessary problems in the future.
  • Per FDA regulations, the known donor will be required to complete an infection panel before the sperm is frozen, wait six months, and then have another infection panel performed. The results of these panels will determine if the sperm can be donated or not.
  • The recipient(s) will likely be responsible for more legal, medical, and storage fees than they would if they utilized a sperm bank.

2. Not all donor sperm banks are created equal.

When it comes to choosing a sperm donor, it’s important to also consider what is included when you choose that donor. In the United States, donor sperm banks must adhere to guidelines from the FDA (Food and Drug Administration) when screening sperm donors. However, there are other important screening tests that should be performed that are not included in these requirements.

While some clinics perform a multitude of screening tests, others perform only those that are required by the FDA. It’s important that your selected sperm donor has been properly screened for infectious diseases that can be transmitted through the sperm (such as Hepatitis), genetic abnormalities that can be passed onto the offspring, and other pertinent medical information.

Infectious Disease Screening: Sperm donors should be screened at minimum for the following infectious diseases:

  • Human Immunodeficiency Virus (HIV), types 1 and 2 
  • Hepatitis B Virus (HBV) 
  • Hepatitis C Virus (HCV) 
  • Treponema pallidum (i.e. syphilis)
  • Chlamydia trachomatis
  • Neisseria gonorrhea
  • Human T-lymphotropic virus (HTLV), types I and II
  • Cytomegalovirus (CMV)

In an effort to provide a more holistic health screening of the donor, some donor sperm banks perform additional tests, as well, including:

  • West Nile Virus
  • Zika virus
  • A complete blood count
  • A metabolic panel
  • HPV
  • Herpes Simplex Virus, types 1 and 2

Further, sperm banks are required to quarantine donated sperm samples for six months. This is because some infectious diseases, such as HIV, can take up to six months to be detected in the blood. Therefore, the donor is screened prior to the sperm donation and then again in six months before the sperm is eligible for use.

Keep in mind that many donor sperm banks will require that the recipient(s) is also screened for infectious diseases before insemination with the donated sperm.

Genetic Carrier Screening: Genetic diseases are caused by gene mutations that are either inherited or acquired. These mutations can cause genetic diseases such as Cystic Fibrosis or Tay-Sachs disease. While some people are directly affected by these diseases, others are carriers of the diseases (and most do not even know that they are). If a sperm and/or egg cell are affected by or carriers of genetic mutations, the resulting child is at-risk of being affected by or a carrier of the same genetic condition.

For these reasons, it is important that sperm donors undergo genetic carrier screening. This is normally performed through a blood test, though saliva tests are also sometimes used. However, these screening tests are not required for all sperm banks, and some sperm banks have more advanced screening procedures than others.

Genetic carrier screening determines if a person is a carrier of certain genetic mutations that can cause genetic diseases. Both a sperm donor and the egg source (female recipient or donor) should have carrier screening performed. If the carrier screening determines that the sperm donor carries the same mutation as the egg source, that sperm donor should not be used because it significantly increases the chances of any resulting offspring being directly affected by or a carrier of that genetic disease (there is a 50% chance that the offspring will be a carrier of the disease, a 25% chance that the offspring will be affected by the disease, and a 25% chance that the offspring will not be affected by the disease). If only one source (either the sperm donor or the egg source) is a carrier of a mutation, it is okay to use that sperm donor (there is a 50% chance that the offspring will be a carrier of the disease and a 50% chance that the offspring will be unaffected). However, many donor sperm banks disqualify any sperm donor that is a carrier of any genetic mutation. This website provides more information about the process of genetic carrier screening.

There are many different panels used for genetic carrier screening. While some donor sperm banks may test for hundreds of diseases (this is known as expanded carrier screening), others may only test for the most common diseases (such as Sickle cell anemia, cystic fibrosis, and Tay-Sachs disease). If you choose a sperm donor that completed expanded carrier screening, you will want to also be tested using expanded carrier screening for the most informative results.

Chromosomal Analysis (Karyotype): A karyotype determines if the sperm donor’s cells have the right number of chromosomes. In a normal human cell (aside from sperm and egg cells), there are 46 chromosomes (23 pairs: one pair from the egg and one pair from the sperm). In some cases, there may be abnormalities in the number or structural arrangement (such as a translation or inversion) of the sperm donor’s chromosomes. When these abnormalities are present, they can have detrimental effects on any offspring, so males exhibiting them are excluded from donating their sperm.

Like carrier screening, donor sperm banks are not required to perform karyotypes.

Some final notes on genetic carrier screening and karyotypes:

  • Some donor sperm banks may allow you to pay to have a sperm donor undergo these screening tests, but this is not common and is quite costly. 
  • Carrier screening cannot screen for every genetic mutation. Some mutations are still unknown, and others cannot be detected with the current genetic screening methods.
  • Both screening tests are very accurate, but, like any screening test, there is the possibility for errors such as false positives and negatives. 
  • If the sperm was frozen many years ago, it’s possible that the donor did not undergo expanded carrier screening since this is a newer technology. The screening also may not have been as efficient as if the donor was screened in more recent years.
  • This website answers some common questions about carrier screening.

Other Pertinent Medical Information: Sperm donor screening consists of more than just blood tests. Let’s break down the other screening tools required by the FDA guidelines:

“Donor screening consists of reviewing the donor's relevant medical records for risk factors for, and clinical evidence of, relevant communicable disease agents and diseases [1271.75]. These records include a current donor medical history interview (with the donor or another individual who is able to provide information about the donor's medical history and relevant social behavior), a current physical assessment, and, if available, medical records, laboratory test results, coroner and autopsy reports, and records or other information received from any source pertaining to risk factors for relevant communicable disease (e.g., social behavior, clinical signs and symptoms of relevant communicable disease, and treatments related to medical conditions suggestive of risk for relevant communicable disease) [1271.3(s)].”

Yeah, so that’s a lot. Let’s break it down:

  • The sperm bank wants to make sure that the donor is not at risk for communicable diseases (particularly AIDS).
  • For example, has the donor used recreational drugs with needles, had multiple sexual partners, had sex with another male, or engaged in sexual activity with someone who is suspected of having HIV or hepatitis?
  • Many of these diseases are screened for during the bloodwork for infectious diseases.
  • Applicants that are at high risk are typically not eligible to continue the screening process.
  • It’s important to know if the donor has any family history of certain hereditary conditions that can be passed onto any offspring.
  • The donor’s medical history can also determine what medications (or drugs) the donor has taken, which (if any) surgeries the donor has had performed, and if the donor was ever hospitalized or institutionalized.
  • A physical assessment determines if the donor has any serious physical abnormalities, particularly pertaining to his reproductive organs.

So, that is what sperm donor banks are required to complete for each sperm donor. However, some banks require their donors to undergo a much more thorough screening procedure in order to be eligible for donation. Other common types of donor screening include:

  • A mental health assessment, which is often performed by a licensed professional. This helps determine if the donor is at risk for any behavioral conditions such as bipolar disorder or schizophrenia. 
  • Routine physical examinations, which often include EKGs (electrocardiograms).
  • A background check.
  • Proof of education (many sperm banks require that the donor has completed at least some level of college).
  • A semen analysis to ensure that the sperm is of sufficient quality for insemination.
  • A urinalysis.
  • A test of the donor’s blood type, which can help avoid rhesus incompatibility

Some final notes on this topic:

  • As much as we hope that sperm donors are providing accurate information, it’s possible that some may lie or omit pertinent medical information. It’s also possible that the donor inadvertently omits information or puts false information on his application.
  • Some sperm donors are adopted or not biologically related to their parents. Therefore, it is sometimes impossible to obtain a full family history of the sperm donor.

3. Offspring from sperm donors may not look or act anything like the donors.

Have you ever met someone’s parents and thought to yourself: “how are they are nothing like their parents?” This isn’t uncommon, and it shouldn’t be an excluded thought when it comes to choosing a sperm donor.

You may find a sperm donor’s baby picture to be adorable, and the donor may check every box on your wishlist (e.g. blue eyes, brown hair, athletic, etc.). But remember that the donor’s sperm only comprises half of the offspring’s DNA. For example, you may love that the sperm donor has blue eyes, but, unless you also have blue eyes, that doesn’t guarantee that the offspring will also have blue eyes. Additionally, the sperm donor may claim to love sports and hiking, but that doesn’t guarantee that any of his offspring will enjoy these activities.

Of course, this is not always the case. In fact, most donor sperm recipients are pleased at the options they are given when choosing a sperm donor. 

4. Even with donor sperm, nothing is guaranteed.

A semen analysis should be performed each time a sperm donor provides a semen sample. Semen analyses should at least evaluate the sperm count, motility (how many sperm are moving), and morphology (how many sperm appear normal) before the sample is frozen. Once the sperm is thawed, it should appear similar to how it was before it was frozen.

However, there are still risks. It’s possible, though rare, that the sperm will not survive or will be damaged by the thawing process. In these cases, it may not be possible to perform an insemination with the sperm.

Even if the sample is of good quality when it is thawed, there is no guarantee that the sperm will fertilize an egg (or eggs) or result in a healthy pregnancy.

Finally, it’s possible that a sperm that fertilizes an egg has damaged or abnormal DNA, which can cause the resulting embryo’s cells to also not have the correct amount of DNA. Sperm DNA damage cannot be detected even when insemination occurs in an IVF lab under a microscope. In most cases, these genetically abnormal embryos do not implant or miscarry. In some cases, these embryos result in pregnancies, though the pregnancies are often complicated and the resulting babies are at a higher risk of birth defects and other health conditions. Many people elect to have preimplantation genetic testing (PGT) performed on their embryos, which screens some of an embryo’s cells to determine if the cells have the correct number of chromosomes. Embryos that have a large number of cells with an abnormal number of chromosomes are not recommended for transfer. PGT can also determine the gender of the embryo.

5. Sperm donors are limited in how many offspring they can produce from their samples.

In the movies, we often see sperm donors that have hundreds of biological children. Fortunately, that is not realistic because sperm banks limit how many offspring can be produced by a single sperm donor to prevent inbreeding/incest and consanguinity. 

Sperm donation laws differ between countries and, in some cases, sperm banks within a country. For example, France only allows one sperm donor to yield 10 offspring, while California Cryobank allows “25-30 family units worldwide per donor.” Further, some sperm banks only allow sperm donation to occur in specific areas to “spread out” the donor’s offspring (for example, only 2 families can have children from the same donor in New York City).

If you are worried about this, try searching for a sperm bank that has a lower limit in the number of offspring that one sperm donor can yield. You can also talk with the sperm bank directly to address your questions and concerns (this is usually free of charge) about their policies.

Some final notes on this topic:

  • If you want to have multiple children with one donor’s sperm, it’s important to inquire about the sperm bank’s policies.
  • If you plan to have multiple children or ART treatments using the same sperm donor, it’s advised that you own multiple vials of that donor’s sperm prior to the start of your treatment. Though you may incur a storage fee for having multiple vials frozen, you will not run the risk of “running out” of the donor’s sperm.

6. There are multiple ways to perform donor insemination.

We’ve already discussed how donor sperm can be utilized in a fertility clinic. To review, donor sperm can be used for:

  • Intrauterine insemination (IUI): the sperm is thawed, processed, and injected into a woman’s uterus near the time of ovulation.
  • In vitro fertilization (IVF): the sperm is thawed and is used to inseminate eggs. The resulting embryos are grown in the IVF lab and later transferred to a woman’s uterus.

Though IVF cannot be performed outside of an IVF lab, intracervical inseminations (sperm is inserted into the vagina near the cervix instead of directly into the uterus) are able to be performed in your own home using at-home insemination kits. These kits normally include a specimen cup, a needless syringe, and an instruction manual. When ovulation is approaching (confirmed with an ovulation predictor kit), a sperm sample is loaded into the syringe and injected into the vagina near the cervix. Some sperm banks can ship your pre-selected donor sperm along with an at-home insemination kit to your home, as well.

There are pros and cons to at-home insemination:

  • Pros:
  • It circumvents driving to the clinic and having a healthcare provider perform your insemination.
  • It eliminates the risk of sample mix-ups (which are not common, but there is no risk in your home).
  • It is affordable (and some devices are even HSA/FSA eligible).
  • It has already helped many people conceive and, according to a 2017 study, has demonstrated a 69% success rate in women 20-33 years of age over 6 cycles.
  • It allows for more flexibility and less stress than in-clinic inseminations.
  • Cons:
  • It is not useful if you have an underlying fertility issue. For example, it will likely not be successful if the male partner has a low sperm count or motility, or if the female partner’s Fallopian tubes are blocked. Further, at-home insemination kits do not bypass the cervix like an in-clinic intrauterine insemination would.
  • Infectious disease testing and carrier screening are not required for at-home insemination, so there is an increased risk of transmitting infectious diseases and/or genetic diseases to the offspring (if these tests are not performed). Sperm banks will often complete some or all of these tests.
  • There are no legal consents required for at-home insemination, so there could be potential legal consequences for at-home insemination if no legal documents are completed beforehand (sperm banks will likely require consents for the donors).
  • If multiple attempts are required, it may not actually save you a lot of money.

Some final notes on this topic:

  • Intrauterine inseminations can also be performed with some at-home insemination kits, but these are only advised if they are performed by a medical professional. Intracervical at-home insemination kits can be performed by anyone.
  • Some sperm banks offer washed and unwashed sperm specimens. Washed specimens have already been cleaned (the excess debris from the ejaculate has already been removed), while unwashed specimens contain all of the contents of an ejaculate (prostaglandins, seminal fluid, etc.). If you are performing an intracervical insemination, either type can be utilized. But if you are performing an intrauterine insemination, a washed sample must be used.

The use of donor sperm has helped so many people achieve healthy pregnancies through assisted reproduction. And, fortunately, the choosing and utilizing donor sperm have become routine and efficient processes. Additionally, the guidelines for screening sperm donors are constantly improving to increase the chances of healthy, successful pregnancies. Despite these improvements, it’s important to do your research before choosing a sperm bank and donor. I hope this article helps you along your journey!


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Popular Sperm Banks in the United States:

Seattle Sperm Bank

California Cryobank

Xytex Sperm Bank

Cryos International

Fairfax Cryobank

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