Sperm bank

The first sperm banks began as early as 1964 in Iowa, USA and Tokyo, Japan and were established for a medical therapeutic approach to support individuals who were infertile. As a result, over 1 million babies were born within 40 years.[3]

Sperm banks provide the opportunity for individuals to have a child who otherwise would not be able to conceive naturally. This includes, but is not limited to, single women, same-sexed couples, and couples where one partner is infertile.[2]

Where a sperm bank provides fertility services directly to a recipient woman, it may employ different methods of fertilization using donor sperm in order to optimize the chances of a pregnancy. Sperm banks do not provide a cure for infertility in individuals who produce non-viable sperm. Nevertheless, the increasing range of services available through sperm banks enables people to have choices over challenges with reproduction.

Individuals may choose 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. People may choose to use a surrogate to bear their children, using eggs provided by the person and sperm from a donor. Sperm banks often provide services which enable an individual to have subsequent pregnancies by the same donor, but equally, people may choose to have children by a number of different donors. Sperm banks sometimes enable an individual to choose the sex of their 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 donate semen through a sperm bank provide an opportunity for others who cannot have children on their own. Sperm donors may or may not have legal obligations or responsibilities to the child conceived through this route. 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.

In many parts of the world sperm banks are not allowed to be established or to operate. 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.[5]

The finding of a potential sperm donor and motivating them to actually donate sperm is typically called recruitment. A sperm bank can recruit donors by advertising, often in colleges, in local newspapers, and also on the internet.[6]

A donor must be a fit and healthy male, normally between 18 and 45 years of age, and willing to undergo frequent and rigorous testing. The donor must also be willing to donate their sperm so that it can be used to impregnate people who are unrelated to and unknown by them. Some sperm banks require two screenings and a laboratory screening before a donor is eligible.[7] The donor must agree to relinquish all legal rights to all children which result from their donations. The donor must produce their 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. Some sperm banks have been accused of heightism due to minimum height requirements.[8]

A sperm bank will aim to provide donor sperm which is safe by the checking and screening donors and of their semen. A sperm donor must generally meet specific requirements regarding age and medical history. Requirements for sperm donors are strictly enforced, as in a study of 24,040 potential sperm donors, only 5620, or 23.38% were eligible to donate their sperm.[9]

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 six 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. Common reasons for sperm rejection include suboptimal semen quality and STDs.[9] Chromosomal abnormalities are also a cause for semen rejection, but are less common.[9] Children conceived through sperm donation have a birth defect rate of almost a fifth compared with the general population.[10]

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 milliliter, 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 or vials and stored for as long as the sperm donor may and can maintain it.

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. 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 their medical records and those of their 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.

Some sperm banks may disallow sexually active gay men from donating sperm due to the population's increased risk of HIV and hepatitis B. Modern sperm banks have also been known to screen out potential donors based on genetic conditions and family medical history.[11]

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 nine 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.[12] 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 sperm donor will usually be required to enter into a contract with a sperm bank to supply their semen, typically for a period of 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, 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.

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.[13]

The contract may also describe the types of treatment for which the donated sperm may be used, such as artificial insemination and IVF, and whether the donor's sperm may be used in surrogacy arrangements. It may also stipulate whether the sperm may be used for research or training purposes. In certain cases, a sperm donor may specify the maximum number of offspring or families which may be produced from the donor's sperm. 'Family' may be defined as a couple who may each bear children from the same donor. The contract may also require consent if the donor's samples are to be exported. In the United Kingdom, for example, the maximum number of families for which a donor is permitted to bear children is ten, but a sperm bank or fertility center in the UK may export sperm to other fertility centers so that this may be used to produce more pregnancies abroad. Where this happens, consent must be provided by the donor. Faced with a growing demand for donor sperm, sperm banks may try to maximize the use of a donor whilst still reducing the risk of consanguinity. In legislations with a national register of sperm donors or a national regulatory body, a sperm donor may be required to fill in a separate form of consent which will be registered with the regulatory authority. In the United Kingdom this body is the HFEA.

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 (US). 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" but the increasing usage of porn in the U.S. has dulled many men to its effects.[14] Often, using any type of personal lubricant, saliva, oil or anything else to lubricate and stimulate the genitals is prohibited as it can contaminate the semen sample and have negative impacts on the quality and health of sperm.[15] 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 which results in higher sperm counts.[16]

After collection, sperm must be processed for storage. According to the Sperm Bank of California, sperm banks and clinics can use the 'unwashed' or 'wash' method to process sperm samples. The 'wash' method includes removing unwanted particles and adding buffer solutions to preserve viable sperm. However, this approach can contribute to further stress on the sperm cells and decrease the survival of sperm after freezing. The 'unwashed' approach allows for more flexibility to freeze the semen sample and increases the number of sperm survival.[17] 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) or assisted reproduction technologies (ART) procedures.

A cryoprotectant semen extender is conducted if the semen sample is placed in the freezer for storage. Semen extenders play a key factor in protecting sperm sample from 'freeze and osmotic shock, oxidative stress, and cell injury' due to the formation of ice crystal during frozen storage. The collection of semen is preserved by stabilizing the properties of the sperm cells such as the membrane, motility, and 'DNA integrity' in order to create a sustainable viable environment.[18] There are two common forms of medium for sperm cyropreservation, one containing of egg yolk from hens and glycerol, and the other containing just glycerol.[19] One study compared media supplemented with egg yolk and media supplemented with soy lecithin, finding that there was no significance between sperm motility, morphology, chromatin decondensation, or binding between the two, indicating that soy lecithin may be a viable alternative to egg yolk.[19]

After the sample has been processed for cryoprotection, the sperm is stored in small vials or straws holding between 0.4 and 1.0 ml of sperm and then cryogenically preserved in liquid nitrogen tanks. Two approaches for sperm cryoperservation include conventional freezing and vitrification. The conventional technique consist of a slow freezing process that is most commonly used for assisted reproduction technologies (ART). Whereas the vitrification method is a faster approach for sperm cryopreservation in converting liquid to solid state. The disadvantage of this latter process is increase in contamination from the liquid nitrogen and smaller sperm sample size to improve the speed for 'high cooling rate'.[20]

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[21] and andrology experts believe sperm can be frozen indefinitely.[22] The UK government places an upper limit for storage of 55 years.[23]

Following the necessary quarantine period, which is usually six months, a sample will be thawed. To thaw a sperm sample, the vial or straw is left at room temperature for approximately 30 minutes, and then brought to body temperature by holding it in the hands of the person performing the insemination.[24] Once a sperm sample is thawed, it cannot be frozen again, and should be used to artificially inseminate a recipient or used for another assisted reproduction technologies (ART) treatment immediately.[24]

Freeze-drying is another promising alternative for storing semen for its accessibility with regular refrigerator. This method has been successfully replicated in animal species. However, DNA can be damaged in this process, therefore further research is warranted to determine factors that can effect the efficacy of this method.[25]

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.[35] 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, including, but not limited to the right of the sperm donor remaining anonymous, and the child's right to know their familial background.[36]

Furthermore, as local regulations reduce the size of the donor pool and, in some cases, exclude entire classes of potential buyers such as single women and lesbian couples, restricting donations to only heterosexual couples who are married. Some customers choose to buy abroad or on the internet, having the samples delivered at home.[37]

There have been reports of incidents of abuse regarding forced insemination with sperm samples bought online.[38]

Further abuse of sperm banks comes from the fertility clinic staff themselves. There have been a number of reports of staff at sperm banks and fertility clinics providing their own sperm in place of donor sperm. There have also been cases in which men have claimed their sperm sample was used by a clinic to inseminate a woman without his consent.[39][40][41] This has led to cases of malpractice, and in some states, lobbying to create fertility fraud laws.[42] These incidents have also led to outcry by people who had been conceived by such incidents, raising concerns of consanguinity, as well as the simple right to know who their siblings and biologic parents are.[42]