Sperm donation

Sperm donation is the name of the provision (or 'donation') by a man, known as a sperm donor, of his semen with the intention that it be used to achieve a pregnancy and produce a baby in a woman who is not the man's sexual partner and with whom the man does not have sexual intercourse. Attempts are made to impregnate a woman with the donor's sperm using third party reproduction techniques notably artificial insemination.

A sperm donor may donate his sperm directly to recipient women, at a clinic known as a sperm bank or through a third party which brokers arrangements between sperm donors and recipient women, known as a 'sperm agency'.

Sperm provided in this way is known as donor sperm.

Sperm donation commonly assists couples unable to produce children because of 'male factor' fertility problems, but it is increasingly used as a means to enable single women (termed choice mothers) and single and coupled lesbians to have children. The sperm donor is the genetic or biological father of each child produced with the use of his sperm. When a donor's sperm is successfully used repeatedly for impregnation in the same, or different, women, numbers of siblings and half-siblings will be produced.

Donors may be either anonymous or non-anonymous, although laws may require donors to be one or the other, or 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 has opened up new avenues for those wishing to know more about the biological father, siblings and half-siblings.

Provision
Sperm is generally provided by sperm banks or fertility clinics. 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 rather independently of banks or agencies.

Sperm banks
In a sperm bank, the donor will usually enter into a contract to donate sperm for a specified contractual period of time generally ranging from six to twenty four months. 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 semen sample. The sample is then processed, frozen and, following the necessary quaratine period, it is used in artificial insemination or other ART treatments in women wishing to become pregnant.

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. The screening regulations are more stringent today than they have been in the past.

Screening includes: Donors of Jewish, Québécois, or Cajun descent may also get genetic testing for carrier trait of Tay Sachs disease
 * 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
 * HTLV-1/2
 * Hepatitis B
 * Hepatitis C
 * Syphilis
 * Gonorrhea
 * Chlamydia
 * CMV
 * Blood and urine tests for blood typing and general health indicators: ABO/Rh typing, CBC, liver panel and urinalysis
 * Complete physical examination.
 * Genetic testing for carrier traits of:
 * Cystic Fibrosis
 * Sickle-cell disease
 * Thalassemia
 * Other hemoglobin-related blood disorders.

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.

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.

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 reproduction techniques (ART) such as IVF. Donated sperm may also be used in surrogacy arrangements either by artifically 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, height, weight, colour of eyes, blood group etc. Some of these catalogues are available for browsing via the internet, whilst 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.

Reduced birth defects
Children conceived through sperm donation have a birth defect rate of almost a fifth compared with the general population. 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 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 undergo the same kind of checks and tests required by a sperm bank. However, 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 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 insemination. 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 twice each week to coincide with the ovulation cycles of a number of recipient women, but the second sample each time may not have the same fecundity of the first sample because it is produced too soon after the first one. However, since fresh semen is used, pregnancy rates may be higher than those obtained by sperm banks or fertiltiy clinics which invariably freeze and quarantine donated sperm.

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 proceesed into a number of different vials, there is a practical limit on the number of pregnancies which are ususally 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 risks which are not associated with sperm banks. Donors providing sperm in this way will 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 donors
Besides the men who donate to a sperm bank there are also less institutional donations. For example, mother may approach a friend, or may obtain a "private" donor by advertising. A number of web sites seek to link such donors and donees, while advertisements in same sex publications are not uncommon. Although artificial insemination is usually used, sperm need not be frozen. Most such donors meet the donees and are therefore usually known to the recipient. Private donations are usually free - avoiding the significant costs of a more medicalised insemination - and theoretically, where fresh rather than frozen semen is used the chances of pregnancy may be higher. Against this are the usually higher risks of disease transmission and the risk of a legal dispute regarding access or maintenance. The laws of some nations (e.g. New Zealand), allow for recognition of written agreements between donors and donees in a similar way to institutional donations. In others, e.g. Sweden, this is not guaranteed.

Donor payment
The majority of sperm donors who donate their sperm through a sperm bank receive some kind of payment. This varies 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. Whilst the amounts concerned in each case are not excessive, some donors are known to donate to more than one sperm bank every week and they are thus able to secure a reasonable monthly income.

Some private donors may seek remuneration although the majority of these 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 eg 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 fertiltity treatment with donor sperm than there is donor sperm available, and this has the effect of keeping the cost of such treatments reasonably high.

Samples per child
How many donor samples (ejaculates) that are required to help giving rise to a child varies substantially from donor to donor, as well as from clinic to clinic.

However, the following equations generalize the main factors involved:

For intracervical insemination:
 * $$N = \frac{V_s \times c \times r_s}{n_r} $$




 * N is how many children a single sample can help giving rise to.
 * Vs is the volume of a sample (ejaculate), usually between 1.0 mL and 6.5 mL
 * c is the concentration of motile sperm in a sample after freezing and thawing, approximately 5-20 million per ml but varies substantially
 * rs is the pregnancy rate per cycle, approximately 10% to 15%
 * nr is the total motile sperm count recommended for use in a cycle, approximately 20 million. The pregnancy rate increases with increasing number of motile sperm used, but only up to a certain degree, when other factors become limiting instead.

With these numbers, one sample would on average help giving rise to 0.1-0.6 children, that is, it actually takes on average 2-5 samples to make a child.

For intrauterine insemination, a centrifugation fraction (fc) may be added to the equation:
 * fc is the fraction of the volume that remains after centrifugation of the sample, which may be about half (0.5) to a third (0.33).


 * $$N = \frac{V_s \times f_c \times c \times r_s}{n_r} $$

On the other hand, only 5 million motile sperm may be needed per cycle with IUI (nr=5 million)

Thus, only 1-3 samples may be needed for a child if used for IUI.

Using ART treatments such as IVF can result in one donor sample (or ejaculate) producing on average considerably more than one birth. However, the actual number of births per sample will depend on the actual ART method used, the age and medical condition of the woman bearing the child, and the quality of the embryos produced by fertilization. Donor sperm is less commonly used for IVF treatments than for artificial insemination. This is because IVF treatments are usually required only when there is a problem with the female conceiving, or where there is a 'male factor problem' involving the woman's partner. Donor sperm is also used in surrogacy arrangements where an embryo may be created in an IVF procedure using donor sperm and this is then implanted in a surrogate. In a case where IVF treatments are employed using donor sperm, surplus embryos may be donated to other women or couples and used in embryo transfer procedures. When donor sperm is used for IVF treatments, there is a risk that large numbers of children will be born from a single donor, and many sperm banks therefore limit the amount of semen from each donor which is prepared for IVF use, or they may restrict the period of time for which such a donor donates his sperm.

Anonymous or non-anonymous
Anonymous sperm donation is where the child and/or receiving couple will never get to know the identity of the donor, and non-anonymous when they will.

A donor who makes a non-anonymous sperm donation is termed a known donor, open identity or identity release donor.

Non-anonymous sperm donors are, to a substantially higher degree, driven by altruistic motives for their donations.

In any case, some information about the donor may be released to the woman/couple at the time of treatment. A limited donor information at most includes height, weight, eye, skin and hair colour. In Sweden, this is all the information a receiver gets. In the US, on the other hand, additional information may be given, such as a comprehensive biography and sound/video samples.

For most sperm recipients, anonymity of the donor is not of major importance at the obtainment or tryer-stage,. The main reason for anonymity is that recipients think it would be easiest if the donor was completely out of the picture. However, some recipients regret not having chosen non-anonymous donor years later, for instance when the child desperately wants to know more about the donor anyway.

One in three of donor conceived children want information about their biological father.

There is a risk of bias in the information given by clinics or sperm banks regarding anonymity, making anonymous sperm donation seem more favorable than it may actually be, resulting from that anonymous sperm donations are easier for them to handle in the long term, because anonymity doesn't put the clinic or sperm bank responsible for safely storing donor information for a long period of time.

In law
The law usually protects sperm donors from being responsible for children produced from their donations, and the law also usually provides that sperm donors have no rights over the children which they produce.

Several countries, e.g. Sweden, Norway, the Netherlands, Britain, Switzerland, Australia and New Zealand only allow non-anonymous sperm donation. The child may, when grown up (15-18 years old), get contact information from the sperm bank about his/her biological father. In Denmark, however, a sperm donor may choose to be either anonymous or non-anonymous. Nevertheless, the initial information which the receiving woman/couple will receive is the same. In the United States, sperm banks are permitted to disclose the identity of a non-anonymous donor to any children brought to the world by that donor, once the child turns 18.

Desire to know
For most sperm recipients, anonymity or not is not of major importance. For the donor conceived children, on the other hand, it may be devastating not having the possibility of contacting or knowing almost nothing about the biological father. One in three of donor conceived children want information about their biological father. In case of non-anonymous sperm donation, most of the donor conceived people contact the clinic as soon as they reach the required age.

Approximately 60% of requesters are female. Approximately 40% of requests are from people raised by single women, 30% from those raised by lesbian couples, and 20% from those raised by heterosexual couples. Approximately 60% of them are of the opinion that all sperm donations should include identity release.

Limitation
Where a sperm donor donates sperm through a sperm bank, the sperm bank will generally undertake a number of medical and scientific checks to ensure that the donor produces sperm of sufficient quantity and quality and that the donor is healthy and will not pass diseases through the use of his sperm. The donor's sperm must also withstand the freezing and thawing process necessary to store and quarantine the sperm. The cost to the sperm bank for such tests is not inconsiderable. This normally means that clinics may use the same donor to produce a number of pregnancies in a number of different women.

The number of children permitted to be born from a single donor varies according to law and practice. Laws vary from state to state, and a sperm bank may also impose its own limits. The latter will be based on the reports of pregnancies which the sperm bank receives, although this relies upon the accuracy of the returns and the actual number of pregnancies may therefore be somewhat higher. Nevertheless, sperm banks frequently impose a lower limit on geographical numbers than some US states and may also limit the overall number of pregnancies which are permitted from a single donor. When calculating the numbers of children born from each donor, the number of siblings produced in any 'family' as a result of sperm donation from the same donor are almost always excluded (but see below for the provisions in various states). There is, of course, no limit to the number of offspring which may be produced from a single donor where he supplies his sperm privately.

Where a limit on the number of offspring which are allowed to be produced from each donor is imposed, this is usually in order to reduce the chance of consanguinity by the half-siblings of the donor. However, some donors may produce substantial numbers of offspring, particularly where they donate through different clinics, where sperm is onsold or is exported to different jurisdictions, and where countries or states do not have a central register of donors.

Sperm agencies, in contrast to sperm banks, rarely impose or enforce limits on the numbers of children which may be produced by a particular donor partly because they are not empowered to demand a report of a pregnancy from recipients and they are rarely, if ever, able to guarantee that a woman may have a subsequent sibling by the donor who was the biological father of her first or earlier children.

Sperm shortage
Countries that have banned anonymous sperm donation have a substantial sperm shortage, because only a fraction of sperm donors want to continue their contributions if they know that the donor conceived children may contact them one day. Banning of payment to donors has also caused shortages. This has caused fertility tourism to other countries to get the treatment.

For instance, when Sweden banned anonymous sperm donation in 1980, the number of active sperm donors dropped from approximately 200 to 30. Sweden now has an 18 month long waiting list for donor sperm. At least 250 Swedish sperm recipients travel to Denmark annually for insemination. Some of this is also due to the fact that Denmark also allows single women to be inseminated.

After the United Kingdom ended anonymous sperm donation in 2005, the numbers of sperm donors went up, reversing a three-year decline. However, there is still a shortage, and some doctors have suggested raising the limit of children per donor. Sperm exports from Britain are legal (subject to the EU Directive on Tissue Exports) and donors may remain anonymous in this context. Some UK clinics export sperm which may in turn be used in treatments for fertility tourists in other countries. UK clinics also import sperm from Scandinavia.

Korea has a sperm shortage because their Bioethics Law prohibits selling and buying of sperm between clinics, and a donor may only help giving rise to a child to one single couple.

Canada also has a shortage because it has been made unlawful to pay people for donating it, requiring recipients who wish to purchase it to import it from the United States.

The United States, on the other hand, has had an increase in sperm donors during the late 2000s recession, with donors finding the monetary compensation more favorable.

Onselling
There is a market for vials of processed sperm and for various reasons a sperm bank may sell on stocks of vials which it holds (known as 'onselling'). Onselling therefore enables a sperm bank to maximize the sale and disposal of sperm samples which it has processed. The reasons for onselling may be where part of, or even the main business of, a particular sperm bank is to process and store sperm rather than to use it in fertility treatments, or where a sperm bank is able to collect and store more sperm than it can use within nationally set limits. In the latter case a sperm bank may sell on sperm from a particular donor for use in another jurisdiction after the number of pregnancies achieved from that donor has reached its national maximum..

A UK sperm bank however, may only onsell sperm before the national limit of ten families has been achieved from one donor within the UK. This means, for example, that a sperm bank may recruit a donor and prepare samples for ICI, IUI and ART use from his donations. After 9 months it is able to release the 10 or so samples donated within the first 3 months, from 6 month quarantine ( approximately 100 vials) and it uses these to achieve 6 pregnancies (although more pregnancies could, of course, be achieved from the number of vials prepared as illustrated). The sperm bank is then able to onsell sperm from that donor to sperm banks and clinics outside the UK and it can illustrate the fecundity of the various types of samples it sells from the pregnancy rates it has achieved. The donor may continue to donate for several years (usually 3 or 4) and the UK clinic will be able to achieve a further 4 pregnancies in the UK at the end of that period within the UK rules. It will also continue to hold stocks of that donor's sperm for sibling use after that time. The donor must however, have agreed to the export and to the use of his donations abroad, and he must be told that reguations for use outside the UK will vary. He must not have put a limit on the number of births which may be achieved from his donations. The HFEA must be notified of exports of sperm from the UK but it does not limit these since it is only concerned with the storage and use of sperm within the UK.

Emrbyos may also be onsold. These are usually spare embryos which are created through IVF treatment where a woman achieves the number of pregnancies she requires and the resulting embryos may therefore be disposed of. Donor sperm (and donor eggs) may be used in IVF treatments, and as many as eighteen eggs may be fertilized using one vial of donor sperm, although only the most viable of these will be subsequently implanted in a woman in an attempt to achieve a pregnancy. In the case of the UK, because an embryo wll have been created in the UK under a regulated process, the consent of the HFEA must be obtained if these are to be exported.

Onselling is normally only appropriate where the donor remains anonymous. Sperm banks purchasing sperm samples may in turn onsell these to other sperm banks. Onselling may therefore give rise to numerous pregnancies being produced from individual donors which can sometimes total 100 or more (see above 'Limitation' and the associated link) particularly where a sperm donor donates his sperm for a period of two years or more and where his samples are prepared for IVF use. Sperm from certain donors, such as those with particular blood groups, physical features or intellect, may also be more in demand than sperm from other donors. However, in every case rules as to use and the limitation on the number of pregnancies which apply locally will reduce the risk of consanguinity. The lack of overall records as to use and success will mean that the numbers of pregnancies achieved from the samples of an individual donor will not exist and the donor will not be at risk of knowing the large number of births that were produced from the samples he donated.

Sperm may also be sold on for research or educational purposes, usually after the number of births from the donor concerned has reached its maximum. Sperm is used for genetic and fertility testing, and also for research into birth control.

Donor tracking
Even when the donor had chosen to be anonymous, there are still opportunities for children to find their biological father. Registries and DNA-databases are useful for this purpose.

Tracking by registries
Some donors are non-anonymous, but most are anonymous, i.e. the donor conceived person doesn't know the true identity of the donor. Still, he/she may get the donor number from the fertility clinic. If that donor had donated before, then other donor conceived people with the same donor number are thus genetic half-siblings. In short, donor registries matches people who type in the same donor number.

Tracking by DNA-databases
However, even sperm donors who have not initiated contact through a registry are now increasingly being traced by their children. In the current era there can be no such thing as guaranteed anonymity. Through the advent of DNA testing and internet access to extensive databases of information, one sperm donor has recently been traced. In 2005 it was revealed in New Scientist magazine that an enterprising 15-year-old used information from a DNA test and the internet to identify and contact his father, who was a sperm donor. This has brought into question the ability of sperm donors to stay anonymous.

International comparison
On the global market, Denmark has a well developed system of sperm export. This success mainly comes from the reputation of Danish sperm donors for being of high quality and, in contrast with the law in the other Nordic countries, gives donors the choice of being either anonymous or non-anonymous to the receiving couple. Furthermore, Nordic sperm donors tend to be tall and highly educated and have altruistic motives for their donations, partly due to the relatively low monetary compensation in Nordic countries. More than 50 countries worldwide are importers of Danish sperm, including Paraguay, Canada, Kenya, and Hong Kong. Several UK clinics also export donor sperm and no restriction is placed on the number of times this may be used to achieve a pregnancy provided that the maximum number of permitted births has not been achieved in the UK at the time of the export. The use of the sperm outside the UK will be subject to local rules but no overall limit isimposed by the exporting clinic. Within the EU there are now regulations governing the transfer of human tissue including sperm between member states to ensure that these take place between registered sperm banks. However, the Food and Drug Administration (FDA) of the US has banned import of any sperm, motivated by a risk of mad cow disease, although such a risk is insignificant, since artificial insemination is very different from the route of transmission of mad cow disease. The prevalence of mad cow disease is one in a million, probably less for donors. If prevalence was the case, the infectious proteins would then have to cross the blood-testis barrier to make transmission possible. Transmission of the disease by an insemination is approximately equal to the risk of getting killed by lightning.

Psychological and social issues
Common reasons to donate are to help childless couples, and, for some, the monetary compensation. Reluctance to donate may be caused by a sense of ownership and responsibility for the well-being of the offspring.

Telling the child
Many donees do not tell the child that they were conceived as a result of sperm donation, or, when non-anonymous donor sperm has been used, they do not tell the child until it is old enough for the clinic to provide the contact information about the donor.

For children who find out after a long period of secrecy, their main grief is usually not the fact that they are not the genetic child of the couple who have raised them, but the fact that the parent or parents have kept information from or lied to them, causing loss of trust. Furthermore, the overturn of the sense of who were the parents through the whole life may cause a lasting sense of imbalance and loss of control.

However, there are certain circumstances where the child very likely should be told:
 * When many relatives know about the insemination, so that the child might find it out from somebody else.
 * When the husband carries a significant genetic disease, relieving the child from fear of being a carrier.
 * Where the child is found to suffer from a genetically-transmitted disorder and it is necessary to take legal action which then identifies the donor.

Families sharing same donor
Having contact and meeting among families sharing the same donor generally has positive effects. . It gives the child an extended family and helps give the child a sense of identity by answering questions about the donor. It is more common among open identity-families headed by single women. Less than 1% of those seeking donor-siblings find it a negative experience, and in such cases it is mostly where the parents have disagreed with each other about how the relationship should proceed.

History
In the past, sperm donation was rather a hush-hush business, used mainly by private doctors to treat infertile couples. During the last two decades it has grown into becoming more commercial, with sperm banks offering sperm in an increasing amount to single mothers and lesbian couples.

The first recorded sperm donation that took place on a medical center was carried out with few of the ethical considerations that are mandated in clinics today: It was performed in 1884 at Philadelphia medical school for an infertile couple. Instead of taking the sperm from the husband, the doctor chloroformed the woman, then let his medical students vote which one of among them was "best looking", with that elected one providing the sperm for the insemination. After talking to the husband, they decided it was best not to let the woman know.