Selection Of Sperm Donors
Sperm donors should be of legal age and ideally less than 40 years of age to minimize the potential hazards of aging. Traditionally, donors have been anonymous; however, the donor also may be known or directed to the couple or single woman. The ASRM believes it is important that both anonymous donors and donors known to the recipient–though not necessarily intimate sexual partners–undergo the same initial and periodic screening and testing process. However, the FDA only requires that anonymous sperm donors be screened for risk factors for, and clinical evidence of, communicable disease agents or diseases.
A donor is ineligible if either screening or testing indicates the presence of a communicable disease or of a risk factor for a communicable disease. A comprehensive medical questionnaire to evaluate the health of a donor and review his family medical history is the primary focus in selecting a donor. Particular attention is paid to the potential donor’s personal and sexual history to exclude those males who are at high risk for communicable disease including HIV, hepatitis, and other sexually transmitted diseases. A family medical health history is obtained for at least two generations of family members. Prospective donors then undergo a physical examination with screening for visible physical abnormalities, as well as testing for sexually transmitted diseases. Routine blood analysis includes documentation of the donor’s blood type. Current FDA regulations require infectious-disease testing to be performed and noted to be negative within 7 days of all sperm donations. The sperm are then collected by masturbation, concentrated into small volumes of motile sperm, and frozen until used. For anonymous donors, testing for Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, HIV-1, HIV-2, human T-lymphotropic virus (HTLV)-I and HTLV-II, CMV, hepatitis B surface antigen, and hepatitis C antibody are performed prior to donation and thereafter should occur at six-month intervals, according to FDA guidelines. Although the FDA exempts directed sperm donors from the six-month retesting requirement, the ASRM recommends that directed donors be retested just as anonymous donors are retested. In contrast to the other communicable diseases, a positive CMV result does not make the sperm donor ineligible, since many programs allow his sperm to be used with CMV-positive recipients. Comprehensive genetic testing is impractical; however, ethnically based genetic testing is standard in most sperm banks.
It is recommended that all sperm donors, anonymous and directed, have a psychological evaluation and counseling by a MHP. The assessment should seek any psychological risks and evaluate for financial and emotional coercion. The donor should discuss his feelings regarding disclosure of his identity and plans for future contact. Psychological testing may be performed, if warranted.
Ideally, the sperm donor should undergo a semen analysis, and the test sample should be thawed to evaluate post-freezing/thawing semen parameters. Sperm susceptibility to damage with freezing varies among individuals, as well as among samples of a given donor. Donors are selected if the post-thaw semen parameters meet a minimum standard. In general, specimens should contain a minimum of 20 to 30 million motile sperm per milliliter after thawing. Post-thaw motility is generally in the range of 25% to 40%. There are two types of samples offered by most sperm banks. Intracervical insemination specimens (ICI) are prepared for intracervical inseminations only and must be washed if used for intrauterine inseminations. Although sperm preparations for ICI are available, the majority of reproductive endocrinology practices perform intrauterine insemination (IUI). IUI samples are pre-washed for intrauterine insemination. Both ICI and IUI semen samples are frozen and quarantined for a minimum of 180 days. They are not released until the donor is retested for communicable diseases and the results are negative.
In addition to the medical information that is obtained from the donor, donors are asked to provide detailed information about their personal habits, education, hobbies, and interests. Sperm banks may provide pictures of the donor and video or audiotapes from the donor. Donors may identify themselves as open to contact from any child conceived through DI once a child reaches legal age.