Donor Conception

Sperm Donation – Why Go to a Sperm Bank to Find a Donor?

Eloise Edington  |   26 Mar 2021

Today we hear from fertility specialist, Jaime Shamonki M.D., who is the Chief Medical Officer of Generate Life Sciences at California Cryobank and is a devoted advocate for family equality rights and newborn stem cell education. She shares her take on using a sperm donor (especially during the pandemic), including screening for genetic and infectious diseases, legal implications and much more.

California Cryobank is giving TRB readers special access to all of these items and more with a free Level 3 Subscription ($250 value). Just use promo code: RIBBON24

Jaime Shamonki M.D | @cryobank

If you or a loved one have been struggling with trying to conceive as a result of unexplained infertility or other medical complications, and have thought about using a sperm donor to build a family, you may have read with interest the recent publications in the New York Times and NBC Connecticut that highlighted an alarming new trend. Increasing numbers of people are turning to social media to find a sperm donor and directly arrange for a donation, rather than relying on a licensed commercial sperm bank to provide this service. I suppose we shouldn’t be surprised that some people in need of donor sperm, particularly those motivated to avoid the fees associated with traditional sperm banks, would join Facebook groups like “Sperm Donation USA” where they can arrange to meet up with one of the many men who have volunteered to directly (and freely) donate their sperm in a mutually agreeable way.

I think and talk about donor sperm a lot. I am the Chief Medical Officer of California Cryobank, one of the largest sperm banks in the world. My reason for going to work every day (well, virtually these days) is to oversee policies and procedures that serve to optimize reproductive outcomes and best protect the families who rely on donor sperm. My goal is to help create the happiest and healthiest families possible. Commercial sperm banks are sometimes portrayed as uncaring corporations that exist to monetize something that should be free. This is an unfortunate stereotype which has been perpetuated, often to fit a Hollywood or “clickbait” narrative, despite it being far from the truth.

Like the many fertility specialists who work at California Cryobank, I am a human with a beautiful, messy, blended and unconventional family; and I am 100% behind the human right to build your family in the way that you envision, with whom you choose. I am particularly concerned with issues around single women and same-sex couples not having uniform access to “infertility” insurance because being single and being gay are — drum-roll — not medical conditions! We need to improve access to donor gametes (sperm and egg cells) for the thousands of people around the world who rely on these services every day to build a family. I could go on about the disparity of health care coverage in this country and how arbitrary allocation of resources excludes a large portion of our population, but that is an editorial session best left for a different day. Today I want to present the many reasons why we should encourage our loved ones to use a licensed donor sperm bank if they need a donor to conceive.

Before I enumerate these reasons, please note that using a commercial sperm bank does not mean you can’t ever know the donor (if that’s something you or your future children desire). Plenty of people use “known” donors, called “directed donors” in FDA parlance, who may be a friend or the relative of a non-biological intended parent. Commercial sperm banks frequently help facilitate directed donations, and there is also the option for people to pick ID disclosure donors from our catalog of available sperm doors, meaning the conceived children will have the opportunity to know their donor’s identifying information when they turn majority age.

Related Article – Moving on to Donor Sperm: Morgan and Wyatt’s Journey to Baby H

The Sperm Bank Service

What I am advocating for here is the service a sperm bank provides. These are the services reflected in the price of a vial of sperm, whether you are selecting it from our catalog or asking your gay bestie to donate. These are the services to which I apply my medical training (and my colleagues’ legal training, psychology training and genetics training) so that we can optimize the outcomes of this baby-making endeavor for everyone involved. I should start by stating the obvious – making babies is never going to be a 100% risk-free endeavor no matter how you go about it.

Notably, there are several additional risks involved in donor sperm conception that may not be obvious to the person who isn’t the medical director of a sperm bank. Here’s a partial run-down of these major areas of risk, and how we try to mitigate them through the application of good science, rigorous screening and what the FDA calls “good tissue practices” (GTP).

Screening for Infectious Diseases

The FDA requires all tissue donors, sperm donors included, to be screened for many infectious diseases. The methodology is much more comprehensive than you might expect, and way more extensive than the sexually transmitted disease panel you’d get from your community Planned Parenthood clinic.

Sperm donors are screened directly for many infectious diseases, such as HIV and Hepatitis B; these kind of blood tests are important as, without them, it can seriously affect the health of a recipient or the child if transmitted through insemination. Donors aren’t screened just once; in fact, the FDA requires donors be re-screened multiple times at regular intervals while donating, and again six months after they leave the donation program. Sperm is frozen and subjected to a six-month quarantine period before it’s released for clinical use. Certain viral diseases can be acquired and be infectious prior to the period of time where a person tests positive for that virus. This is known as a “window period,” a well-described phenomenon in infectious disease and the basis of the regulatory requirements that reproductive tissue be subjected to quarantine and donors subjected to repeat testing.

There are several additional diseases which we don’t have good direct tests for, but for which we indirectly screen. An example is Zika virus, which is spread by mosquitos and is still endemic in many parts of the world. Sexual transmission is well-described, and we know that pregnant women who become infected have a high chance of delivering a baby with severe birth defects. Sperm donor travel to a Zika-endemic region leads to a six-month deferral for that donor to mitigate the risk that the virus could be transmitted through his sperm. A donor can also be deferred for non-specific high-risk behavior, such as illicit drug use or recent history of unknown sexual partners. In addition to frequent blood testing, a commercial sperm bank should enact rigorous, consistent policies and procedures to ensure donors are surveyed for their social risk factors and travel history every time they donate.

Related Article – Five Essential Functional Medicine Tests for Fertility

Reducing Genetic Diseases in Donor-Conceived Children

When I started medical school in 1998, we hadn’t yet sequenced the human genome, and genetics was a two-week course we breezed through. When I was pregnant with my son in 2001, the extent of my genetic screening was the “triple screen” test to determine whether I should have an amniocentesis. We mostly crossed our fingers and hoped things looked good at the 20-week ultrasound. Knowing the frequency of genetic disease in children born to phenotypically normal couples, I felt that I had dodged a bullet playing the reproductive version of Russian roulette when my healthy son was born.

Fast forward twenty years and it is now the standard of care to offer reproductive couples some form of genetic counseling as well as recessive gene carrier screening (screening for diseases where you have to inherit two copies of a mutated gene to be affected) for certain heritable conditions before attempting conception. The same thing is true for people planning donor sperm insemination. Given the high quality and relatively low cost of recessive carrier screening available today, there’s no reason to not have at least the minimum American College of Medical Genetics recommended screening for common and serious heritable conditions such as Cystic Fibrosis and Spinal Muscular Atrophy. These screening panels are typically covered by most health insurance plans but must be ordered and interpreted by a medical professional. Sperm banks like California Cryobank screen donors for over 280 recessively inherited conditions. A complementary screening panel performed on the biological intended parent can virtually ensure the conceived child will not be affected by one of these devastating conditions.

High quality genetic screening goes far beyond carrier screening. My team of licensed genetic counselors performs a thorough, three generation family history review on every donor applicant to identify certain potentially life-threatening and heritable traits, such as heritable cancer syndromes or heritable forms of cardiovascular diseases, which are more challenging to test for directly. This is one of the main reasons California Cryobank accepts fewer than 1% of applicants into our donor program.

You got that right, it’s harder to get into our sperm bank than into Harvard or Stanford; and there’s more. My genetics team continues to follow the health of the donor well after he’s left our program. We collect, analyze and report any relevant family or personal health developments to the families of his donor-conceived offspring. The relevance of this health information may only be evident to our trained genetics team; for example, development of a condition in the donor’s aunt may have implications for your donor-conceived child that warrant early health screening. You can start to imagine how a fleeting meeting with a self-represented, seemingly healthy sperm donor offers no such follow-up.

Related Article – What Do Fertility Tests Involve? By Blair Nelson

Legal Protection and Concern for Privacy

Reproductive and parentage laws are complex. They vary from state to state and country to country. My company has worked with well-respected reproductive attorneys, both in the US and outside the US, to craft contracts designed to protect all participants in the donor conception “ecosystem”. Working with a sperm bank is the easiest way to ensure parental rights remain with the intended parents and to further ensure no such rights could be claimed by the donor. These legal rights should concern intended parents whether they know the donor before the insemination, or whether he’s an unknown donor selected from our catalog. Knowing a donor’s identity should not be a consideration in whether an intended parent receives legal protection of their status. The same is true for donors — they are typically keen on remaining donors, and not becoming parents. We help to keep those lines very bold and well-defined.

Much has been discussed in the press lately about donor “anonymity” (misnomer!!) and privacy issues. I plan to devote an entire future commentary to this subject as it’s increasingly important to all parties participating in donor conception and, as such, an issue I care a lot about. I’ll address the issue here in the context of advocating for sperm bank services: while an intended parent may like the idea of knowing other families who have used the same donor, this may not always be the case for everybody who has used that donor. While our efforts can’t guarantee a perfect outcome, we have had a lot of experience helping to educate and reinforce the mutual respect deserved by all parties who use our services. We have successfully coordinated communication between hundreds of donor-conceived persons and their donors, in a manner that honors the delicate and important nature of this relationship but respects the desired privacy of all involved.

In a Facebook group model where a donor chooses who he offers sperm to, and for how long, families with children conceived from that donor quickly lose control over the size of their children’s biological family tree. With no formality and no uniform contract signed by all parties, there’s no way to control the implications on various future desired acts of kinship which may not be bilateral. With no legal framework for this conception arrangement, privacy may be much harder to protect.

Related Article – How to Choose a Fertility Clinic: 9 Top Tips

Psychological Screening and Donor Informed Consent

Shortly after I joined the Cryobank about eight years ago, we decided to start a formal psychological screening program for the sperm donor applicants. The catalyst was actually the result of years of social and technological progress resulting in an acceptance of the fact that donor anonymity is a bygone fantasy. How could a sperm bank offer anonymity to donors? In my mind it was a bait-and-switch. Along with the idea that donors could only select “ID disclosure” as an orientation, it was clear to me that they would need psychological screening and deserved the education that accompanies good quality, informed consent.

We would ensure that donors were altruistically motivated, supportive of single moms, lesbian moms, trans parents, and up for the life-long commitment that we demand of donors (remember those genetic counselor updates?). Our program is the only one that relies on PhD level psychologists with special training in donor conception to screen donors. They conduct formal psychometric testing as well as a clinical interview and educatio
n session. It turns out that a number of the men who apply to be a sperm donor are disqualified due to abnormal psychological screening. Common findings in disqualified young men are narcissistic qualities, inability to empathize or understand the gravity of what they’re offering to sign up for. Men in this category may be simply too immature or may indeed show evidence of a personality disorder. Either way, they are screened out of the program. Those fewer than 1% of applicants who qualify for our sperm donor program are not just physically healthy, they need to be mentally sound, mature and altruistic people.

I suspect that most of the men who are on Facebook freely donating their sperm to anyone who will receive it are more likely to cluster with the self-centered applicants who believe their sperm is a gift to the world. I’ll give these men the benefit of the doubt that they are well-intentioned, but they are unlikely to pass our psychological screening. I can’t help but wonder if any of these men determined to spread their seed had already applied to California Cryobank and got rejected.

Limiting the Number of Offspring

Accidental consanguinity has always been a concern for families of the donor-conceived. Practically, this should be less of a concern for several reasons. For one thing, the majority of families are transparent with children about their donor conception story these days. This empowers the donor-conceived to know this very important fact about their biological story, including when they meet a potential partner in the future. The other reassuring fact is math. California Cryobank distributes a limited number of vials of sperm to over 40 countries. The average donor has fewer than 20 family units resulting from his donations, based on our restriction of vials that are created and shipped. When diluted over the populations within our distribution network, it markedly decreases the clusters of individuals living in the same area.

Nevertheless, people in society typically agree that limiting the number of children conceived from one donor is a good idea. One of the major reasons to limit the number of offspring from one man is to mitigate genetic risks. Often, heritable disease cannot be detected prior to reproduction, however conditions tend to manifest in offspring, at a rate proportional to the number of children conceived. Sperm banks not only limit those numbers of family units, but they also serve as the repository of information and expertise to ensure a genetic finding in one child doesn’t warrant notification to other families, or rarely, suggest that nobody should use this sperm again given the implicit risks.

Related Article – Multiple Births: The Latest UK Figures

So How Much Does it Cost?

While the actual cost of a vial and the number of vials one needs to get pregnant can vary, the average price of a vial of sperm from California Cryobank is around $950. If you are less interested in the perks we offer like adult photos, voice interviews and donors’ DNA Ancestry report, you can find donors with a similar degree of rigorous screening for a lower price from sperm banks like Northwest Cryobank (our sister company). Either way, I totally get the fact that it’s pricey. Let’s face it, raising kids is pretty expensive. I’m not trivializing the fact that it can be hard for people to afford our services, but I can’t help but think that this is probably not the area to cut corners.

The important point to take home is that we are not selling sperm. This should not be confused with a commodity product. Our clients are paying for the service we provide to help build a family while using our sophisticated systems and processes to mitigate many of the risks associated with donor insemination. For every individual there will be a unique cost-benefit ratio associated with these choices. As long as individuals are aware of all of the benefits to using a commercial sperm bank, I am supportive of the value-based decision they ultimately make.

“Price is what you pay, value is what you get.” – Warren Buffett

As mentioned above, California Cryobank is giving TRB readers special access to all of these items and more with a free Level 3 Subscription ($250 value). Just use promo code: RIBBON24.

Related Article – Fertility Treatment Costs: The Ultimate Breakdown

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