Sperm bank

A sperm bank, semen bank or cryobank is a facility or enterprise that collects and stores human sperm from sperm donors for use by women who need donor-provided sperm to achieve pregnancy. Sperm donated by the sperm donor is known as donor sperm, and the process for introducing the sperm into the woman is called artificial insemination, which is a form of third-party reproduction.

From a medical perspective, a pregnancy achieved using donor sperm is no different from a pregnancy achieved using partner sperm, and it is also no different from a pregnancy achieved by sexual intercourse.

General

Sperm banks enable greater control, especially in relation to the access and timing of pregnancies, since they check and screen potential donors, and provide formerly infertile couples or single women the chance to have babies.

Some controversy stems from the fact that donors father children for others and usually take no part in the upbringing of such children. In addition, some sperm banks supply or treat single women and coupled lesbians so that they can have their own biological children by a donor. Donors may not have a say in who may use their sperm.

The increasing range of services which is available through sperm banks nevertheless enables more couples to have choices over the whole issue of reproduction. Women may choose to use an anonymous donor who will not be a part of family life, or they may choose known donors who may be contacted later in life by the donor children. Women may choose to use a surrogate to bear their children, using eggs provided by the woman and sperm from a donor. Sperm banks often provide services which enable a woman to have subsequent pregnancies by the same donor, but equally, women may choose to have children by a number of different donors. Sperm banks sometimes enable a woman to choose the sex of her child, enabling even greater control over the way families are planned. Sperm banks increasingly adopt a less formal approach to the provision of their services thereby enabling people to take a relaxed approach to their own individual requirements.

Men who choose to donate sperm through a sperm bank also have the security of knowing that they are helping women or childless couples to have children in circumstances where they, as the biological father, will not have any legal or other responsibility for the children produced from their sperm. Whether a donor is anonymous or not, this factor is important in allowing sperm banks to recruit sperm donors and to use their sperm to produce whatever number of pregnancies from each donor as are permitted where they operate, or alternatively, whatever number they decide.

However, in many parts of the world sperm banks are not allowed to be established or to operate. Sperm banks do not provide a cure for infertility in that it is the sperm donor who reproduces himself, not a partner of the recipient woman. Most societies are built upon the family model and sperm banks may be seen as a threat to this, particularly where a sperm bank makes its services available to unmarried women.

Where sperm banks are allowed to operate they are often controlled by local legislation which is primarily intended to protect the unborn child, but which may also provide a compromise between the conflicting views which surround their operation. A particular example of this is the control which is often placed on the number of children which a single donor may father and which may be designed to protect against consanguinity. However, such legislation usually cannot prevent a sperm bank from supplying donor sperm outside the jurisdiction in which it operates, and neither can it prevent sperm donors from donating elsewhere during their lives. There is an acute shortage of sperm donors in many parts of the world and there is obvious pressure from many quarters for donor sperm from those willing and able to provide it to be made available as safely and as freely as possible.

Recruitment

The finding of a potential sperm donor and motivating him to actually donate sperm is typically called recruitment. A sperm bank can recruit donors by advertising, often in colleges and in local newspapers, and also on the internet.

A donor must be a fit healthy male, normally between 18 and 45 years of age, who is willing to undergo frequent and rigorous testing and who is willing to donate his sperm so that it can be used to impregnate women who are unrelated to and unknown by him. The donor must agree to relinquish all legal rights to all children which result from his donations. The donor must produce his sperm at the sperm bank thus enabling the identity of the donor, once proven, always to be ascertained, and also enabling fresh samples of sperm to be produced for immediate processing.

Screening of donors

A sperm donor must generally meet specific requirements regarding age and medical history.

Sperm banks typically screen potential donors for a range of diseases and disorders, including genetic diseases, chromosomal abnormalities and sexually transmitted infections that may be transmitted through sperm. The screening procedure generally also includes a quarantine period, in which the samples are frozen and stored for at least 6 months after which the donor will be re-tested for the STIs. This is to ensure no new infections have been acquired or have developed during the period of donation. Providing the result is negative, the sperm samples can be released from quarantine and used in treatments. Children conceived through sperm donation have a birth defect rate of almost a fifth compared with the general population.[1]

A sperm bank takes a number of steps to ensure the health and quality of the sperm which it supplies and it will inform customers of the checks which it undertakes, providing relevant information about individual donors. A sperm bank will usually guarantee the quality and number of motile sperm available in a sample after thawing. They will try to select men as donors who are particularly fertile and whose sperm will survive the freezing and thawing process. Samples are often sold as containing a particular number of motile sperm per millilitre, and different types of sample may be sold by a sperm bank for differing types of use, e.g. ICI or IUI.

The sperm will be checked to ensure its fecundity and also to ensure that motile sperm will survive the freezing process. If a man is accepted onto the sperm bank's program as a sperm donor, his sperm will be constantly monitored, the donor will be regularly checked for infectious diseases, and samples of his blood will be taken at regular intervals. A sperm bank may provide a donor with dietary supplements containing herbal or mineral substances such as maca, zinc, vitamin E and arginine which are designed to improve the quality and quantity of the donor's semen, as well as reducing the refractory time (i.e. the time between viable ejaculations). All sperm is frozen in straws[2] or vials and stored for a minimum of 6 months before being released for sale and use to ensure that the donor remains healthy.

Donors are subject to tests for infectious diseases such as human immunoviruses HIV (HIV-1 and HIV-2), human T-cell lymphotropic viruses (HTLV-1 and HTLV-2), syphilis, chlamydia, gonorrhea, Hepatitis B virus, Hepatitis C virus, cytomegalovirus (CMV), Trypanosoma cruzi and Malaria as well as hereditary diseases such as cystic fibrosis, Sickle cell anemia, Familial Mediterranean fever, Gaucher's disease, Thalassaemia, Tay-Sachs disease, Canavan's disease, Familial dysautonomia, Congenital adrenal hyperplasia Carnitine transporter deficiency and Karyotyping 46XY.[3] Karyotyping is not a requirement in either EU or the US but some sperm banks choose to test donors as an extra service to the customer.

A sperm donor may also be required to produce his medical records and those of his family, often for several generations. A sperm sample is usually tested micro-biologically at the sperm bank before it is prepared for freezing and subsequent use. A sperm donor's blood group may also be registered to ensure compatibility with the recipient.

Sexually active gay men are prohibited or discouraged from donating in some countries, including the United States. Some sperm banks also screen out some potential donors based on height, baldness, and family medical history.[4]

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. A review including 29 studies from 9 countries came to the result that the amount of money actual donors received for their donation varied from $10 to €70 per donation or sample.[5] 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 far less lucrative than selling human eggs. Some private donors may seek remuneration although others donate for altruistic reasons. According to the EU Tissue Directive donors in EU may only receive compensation, which is strictly limited to making good the expenses and inconveniences related to the donation. A survey among sperm donors in Cryos International Sperm bank [6] showed that altruistic as well as financial motives were the main factors for becoming a donor. However, when the compensation was increased 100% in 2004 (to DKK 500) it had no significant impact on neither the numbers of new donor candidates coming in nor the frequency of donations from the existing donors. When the compensation was reduced to the previous level (DKK 250) again one year later in 2005 there was no effect either. This led to the assumption that altruism is the main motive and that financial compensation is secondary.

Collection

A sperm donor will usually donate his semen to a sperm bank under a contract, which would typically specify the period during which the donor will be required to produce sperm, which generally ranges from 6–24 months depending on the number of pregnancies which the sperm bank intends to produce from the donor. Where local regulations or the sperm bank's own rules limit the number of pregnancies which a single donor can achieve, his donations will be limited for this reason. In the United Kingdom, for example, where a donor is not permitted to father more than ten families, a sperm bank will generally need a maximum of 100 straws prepared for IUI insemination, so that a man will generally not donate for more than twelve months.

However, not all donors complete the intended program of donations. 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, as the risk of consanguinity is reduced (although local laws vary widely). Some sperm banks with access to world markets impose their own rules on the number of pregnancies which can be achieved in a given regional area or a state or country, and these sperm banks may permit donors to donate for four or five years, or even longer. Faced with a growing demand for donor sperm, sperm banks may try to maximise the use of a donor whilst still reducing the risk of consanguinity.

The contract may also specify 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 2–3 days before making a donation.

A sperm donor generally produces and collects sperm at a sperm bank or clinic by masturbation in a private room or cabin, known as a 'men's production room' (UK), 'donor cabin' (DK) or a masturbatorium (USA). Many of these facilities contain pornography such as videos/DVD, magazines, and/or photographs which may assist the donor in becoming aroused in order to facilitate production of the ejaculate, also known as the "semen sample". In some circumstances, it may also be possible for semen from donors to be collected during sexual intercourse with the use of a collection condom.

Processing sperm

Sperm banks and clinics usually 'wash' the sperm sample to extract sperm from the rest of the material in the semen. A cryoprotectant semen extender is added if the sperm is to be placed in frozen storage.[2] One sample can produce 1-20 vials or straws, depending on the quantity of the ejaculate and whether the sample is 'washed' or 'unwashed'. 'Unwashed' samples are used for intracervical insemination (ICI) treatments, and 'washed' samples are used in intrauterine insemination (IUI) and for in-vitro fertilization (IVF) procedures.

Storage

Further information: Semen cryopreservation

The sperm is stored in small vials or straws holding between 0.4 and 1.0 ml of sperm and cryogenically preserved in liquid nitrogen tanks.[2] It has been proposed that there should be an upper limit on how long frozen sperm can be stored, however, a baby has been conceived in the United Kingdom using sperm frozen for 21 years.[7]

Before freezing, sperm may be prepared (washed or left unwashed) so that it can be used for intracervical insemination (ICI), intrauterine insemination (IUI) or for in-vitro fertilization (IVF) or assisted reproduction technologies (ART).

Following the necessary quarantine period, which is usually 6 months, a sample will be thawed and used to artificially inseminate a woman or used for another assisted reproduction technologies (ART) treatment.

Services

Use

Subject to any regulations restricting who can obtain donor sperm, donor sperm is available to all women who, for whatever reason, want or need them. These regulations vary significantly between jurisdictions, and some countries do not have any regulations. When a woman finds that she is barred from receiving donor sperm within her jurisdiction, she may travel to another jurisdiction to obtain sperm. Regulations change from time to time. In general, donor sperm is readily available to a woman if her partner is infertile or where he has a genetic disorder, and the categories of women who may obtain donor sperms is expanding, with its availability to single women and to lesbian couples being now more widely available. Increasingly, donor sperm is used to achieve a pregnancy where a woman has no male partner, such as lesbian and bisexual women, and some sperm banks supply fertility centres which specialise in the treatment of such women.. Men may also store their own sperm at a sperm bank for future use particularly where they anticipate traveling to a war zone or having to undergo chemotherapy which might damage the testes.

Sperm from a sperm donor may also be used in surrogacy arrangements and for creating embryos for embryo donation. Donor sperm may be supplied by the sperm bank directly to the recipient to enable a woman to perform her own artificial insemination which can be carried out using a needleless syringe or a cervical cap conception device. The cervical cap conception device allows the donor semen to be held in place close to the cervix for between six and eight hours to allow fertilization to take place. Alternatively, donor sperm can be supplied by a sperm bank through a registered medical practitioner who will perform an appropriate method of insemination or IVF treatment using the donor sperm in order for the woman to become pregnant.

Choosing donors

Information about donor

In the United States, sperm banks maintain lists or catalogs of donors which provide basic information about the donor such as racial origin, skin color, height, weight, colour of eyes, and blood group.[4] Some of these catalogs are available for browsing on the Internet, while others are made available to patients only 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 18. Some clinics offer "exclusive donors" whose sperm is used to produce pregnancies for only 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.

In the United Kingdom, most donors are anonymous at the point of donation and recipients can see only non-identifying information about their donor (height, weight, ethnicity etc.). Donors need to provide identifying information to the clinic and clinics will usually ask the donor's doctor to confirm any medical details they have been given. Donors are asked to provide a pen portrait of themselves which is held by the HFEA and can be obtained by the adult conceived from the donation at the age of 18, along with identifying information such as the donor's name and last known address. Known donation is permitted and it is not uncommon for family or friends to donate to a recipient couple.

Qualities that potential recipients typically prefer in donors include the donors being tall, college educated, and with a consistently high sperm count.[8] A review came to the result that 68% of donors had given information to the clinical staff regarding physical characteristics and education but only 16% had provided additional information such as hereditary aptitudes and temperament or character.[5]

Recipient's selection of donors

Sperm banks make information available about the sperm donors whose donations they hold to enable customers to select the donor whose sperm they wish to use. This information is often available by way of an on-line catalog. A sperm bank will also usually have facilities to help customers to make their choice and they will be able to advise on the suitability of donors for individual donors and their partners.

Where the recipient woman has a partner she may prefer to use sperm from a donor whose physical features are similar to those of her partner. In some cases, the choice of a donor with the correct blood group will be paramount, with particular considerations for the protection of recipients with negative blood groups. If a surrogate is to be used, such as where the customer is not intending to carry the child, considerations about her blood group etc. will also need to be taken into account.

Information made available by a sperm bank will usually include the race, height, weight, blood group, health and eye colour of the donor. Sometimes information about his age, family history and educational achievements will also be given. Some sperm banks make a 'personal profile' of a donor available and occasionally more information may be purchased about a donor, either in the form of a DVD or in written form. Catalogs usually state whether samples supplied in respect of a particular donor have already given rise to pregnancies, but this is not necessarily a guide to the fecundity of the sperm since a donor may not have been in the program long enough for any pregnancies to have been recorded.

If a woman intends to have more than one child, she may wish to have the additional child or children by the same donor. Sperm banks will usually advise whether sufficient stocks of sperm are available from a particular donor for subsequent pregnancies, and they normally have facilities available so that the woman may purchase and store additional vials from that donor on payment of an appropriate fee. These will be stored until required for subsequent pregnancies or they may be onsold if they become surplus to the woman's requirements.

The catalogue will also state whether samples of sperm are available for ICI, IUI, or IVF use.

Sex selection

Some sperm banks enable recipients to choose the sex of their child, through methods of sperm sorting. Although the methods used do not guarantee 100% success, the chances of being able to select the gender of a child are held to be considerably increased.

One of the processes used is the 'swim up' method, whereby a sperm extender is added to the donor's freshly ejaculated sperm and the test-tube is left to settle. After about half-an-hour, the lighter sperm, containing the male chromosome pair (XY), will have swum to the top, leaving the heavier sperm, containing the female chromosome pair (XX), at the bottom, thus allowing selection and storage according to sex.

The alternative process is the Percoll Method which is similar to the 'swim up' method but involves additionally the centrifuging of the sperm in a similar way to the washing of samples produced for IUI inseminations, or for IVF purposes.

Sex selection is not permitted in a number of countries, including the UK.

Other uses

Main article: Onselling of sperm

A sperm bank may onsell sperm stocks to another entity instead of using it in fertility treatments.

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 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 onsell sperm from a particular donor for use in another jurisdiction after the number of pregnancies achieved from that donor has reached its national maximum.

Sperm banks may supply other sperm banks or a fertility clinic with donor sperm to be used for achieving pregnancies.

Sperm banks may also supply sperm for research or educational purposes.

Regulation

In the United States, sperm banks are regulated as Human Cell and Tissue or Cell and Tissue Bank Product (HCT/Ps) establishments by the Food and Drug Administration (FDA) with new guidelines in effect May 25, 2005.[9] Many states also have regulations in addition to those imposed by the FDA, including New York and California.

In the European Union a sperm bank must have a license according to the EU Tissue Directive which came into effect on April 7, 2006. In the United Kingdom, sperm banks are regulated by the Human Fertilisation and Embryology Authority.

In countries where sperm banks are allowed to operate, the sperm donor will not usually become the legal father of the children produced from the sperm he donates, but he will be the 'biological father' of such children. In cases of surrogacy involving embryo donation, a form of 'gestational surrogacy', the 'commissioning mother' or the 'commissioning parents' will not be biologically related to the child and may need to go through an adoption procedure.

As with other forms of third party reproduction, the use of donor sperm from a sperm bank gives rise to a number of moral, legal and ethical issues.

See also

Footnotes

  1. ↑ motherearthnews.com - THE SPERM CRISIS
  2. 1 2 3 Cryos International – What is a straw?
  3. ↑ Cryos International - Donor screening
  4. 1 2 http://www.livescience.com/health/060523_bad_banks.html
  5. 1 2 Van Den Broeck, U.; Vandermeeren, M.; Vanderschueren, D.; Enzlin, P.; Demyttenaere, K.; d'Hooghe, T. (2012). "A systematic review of sperm donors: Demographic characteristics, attitudes, motives and experiences of the process of sperm donation". Human Reproduction Update. 19 (1): 37–51. doi:10.1093/humupd/dms039. PMID 23146866.
  6. ↑ Attitudes among sperm donors …
  7. ↑ "Q&A:Frozen sperm". BBC News. 25 May 2004.
  8. ↑ Almeling, Rene. American Sociological Review. Vol. 72, No. 3 (Jun 2007), pp. 319-340.
  9. ↑ "HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS". CFR - Code of Federal Regulations. The Federal Government of the UNi. Retrieved 9 April 2012.
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