Introduction

Most people take it for granted that they’ll have children one day.  Yet 10 – 35 percent of all couples are infertile. Twenty-five to fifty percent of this unfortunate event is due to male factor infertility. Azoospermia (no sperm present) may exist from birth or may have developed  later on in life due to illness, injury, surgery or poor lifestyles.   

Assisted reproductive treatment (ART) using donor gametes have provided new opportunities for treating infertile couples, single women and same sex couples.  Sperm banking or more formally referred to as sperm cryopreservation has become one of the major assisted reproductive treatments.

Cryopreservation is low temperature storage of biological cells and/or tissues for an indefinite period of time.  Cryopreservation utilizes liquid nitrogen as both the refrigerant and storage medium.  A sperm cryobank is a facility that collect, freezes and stores the sperm.

Once thawed, sperm are introduced into  the female by artificial insemination (AI) either depositing the sperm into endocervical canal or the intrauterine cavity, or are used to inseminate oocytes (eggs) during in vitro fertilization (IVF) or intra cytoplasmic sperm injection (ICSI).

Ethical aspects of donor sperm

Because artificial insemination by donor (AID) introduces a third party it gives rise to diverse moral, ethical, legal and even genetic health issues. 

Furthermore social embarrassment and conservative mindset are still responsible for a lukewarm response among people with infertility.  Most husbands still hesitate at the idea of his wife accepting somebody else’s sperm.  People should not see this concept as frivolous or sexual but as a benevolent act such as blood donation.

There are two sources of extra marital gametes commonly used, those donated by relatives or friends, or those from completely anonymous sources.  Anonymous donors are always preferred though, to avoid the risk of conflict of attitude toward offspring from an identifiable non-parental source.  Concealing information about the conception of these offspring may become a problem later on in life when genetic fingerprinting is recorded.

In South Africa the law prohibits disclosure of donor and recipient identities. The identity of the donor shall remain anonymous and the clients have in no way the right to learn the identity of the donor or solicit donor-identifying information from any other source.  The donor shall also be free from any responsibility to the biological offspring produced by his sperm.  It is the right of the sperm donor to indicate to whom he would like to donate his sperm (marital status of the couple, religion, sexual preference, and ethnic grouping).  

The recipients have the right to be informed of the limitations and potential complications involved with sperm donation.  Sperm donation is not always successful and multiple treatments might have to be performed.  Also, the sperm bank cannot completely guarantee that the sperm they provide is disease free or free of genetic abnormalities.  Although genetic testing and disease screening techniques are advanced and sensitive, they are not foolproof. 

Counseling and an informed consent are recommended for it establishes the donor and recipients rights about disclosure.  This consent is signed and verified by the donor, the recipient and the recipient’s doctor.  This form ensures that the client understands his/her rights and the rights of the sperm donor.  The principle of informed consent is based on the principles of scientific and medical ethics. 

The recipients also must understand that she/he is fully responsible for the offspring conceived of the specimen.  Any woman who gives birth to the baby is the legal parent.  In the case of sperm donation, her partner is the legal parent with her so long as he has given written consent to treatment and they are being treated together as a couple.  The child’s birth certificate would state that they were the legal parents.  However, being a legal parent does not necessarily give the man full parental responsibility unless he is married to the child’s mother. 

Medical aspects of donor sperm

Infectious diseases

Proper screening requires sperm to be frozen and quarantined in a licensed storage facility before it can be used for treatment.  All donor sperm banks in South Africa should be registered at Health Professions Council of South Africa (HPCSA) and should have a practicing license; therefore sperm from unlicensed sperm banks is illegal.

The number of times the same donor is used should be controlled. If a donor sires too many children, the incidence of intermarriage (consanguinity) increases. The limitation of numbers of live births prevents above mentioned problem and must be employed by all sperm banks.

The American fertility society guidelines recommend that each donor should be limited to10-15 successful pregnancies, though less in smaller local areas. In South Africa a donor is limited to five births.

The Ethics of Choosing Sperm

The doctor used to be the major selector of donors, but today the patients assisted by embryologists choose a donor according to preference.  Donors are usually selected to match their partners, which includes skin colour, eye colour, hair colour, height, build and finally, blood group where possible.  Other factors that play a role are interests, religion and social background.  This helps reduce excessive use of a donor within a limited geographic area.  It is important to remember that any child born from using donor sperm will be a random combination of the male and female characteristics, and so the characteristics of the result cannot be predicted.

Sperm donor screening

Donors are ordinary, physically healthy men from across society whose ages range from 21-35 years with normal, fertile sperm parameters.  All potential donors undergo rigorous assessment before being accepted.  Donor screening consists of questionnaires, blood screening, semen specimen screening and donor history.

An extensive semen analysis follows which includes a sperm count, motility, morphology, CMA₃, and freezing and thawing ability.

When the candidate passes these tests, they will go on to being tested for infectious diseases.  These tests include: 

• Hepatitis B Surface Antigen
• Hepatitis B Core Antibody
• HTLV-I, HTLV-II Antibody
• Sexual Transmitted Diseases
• Chlamydia
• Ureaplasma
• Mycoplasma

Other blood tests done are ABO-Rh Blood Typing.

Once the participant has been chosen as a donor, sperm samples can be donated at least once a week, but most donors produce twice a week.  If the donor was sexually active and had too much alcohol within 24 hours, is under a lot of stress or is ill, it will be possible that the sample will not pass.  Samples will be needed on a regular basis until the pregnancy quota has been reached. 

What is the compensation for a sperm donor?

In South Africa, the Human Tissue Act prohibits donors from selling organs or tissue, and therefore the donor is only entitled to be given an honorarium to cover his expenses.  

Will the donor be able to find out of his sperm has produced any pregnancies?

If the donor would like to know if he has produced any pregnancies, he may ask.  Alternatively, if he would prefer not to know, he may indicate so initially.  This is a personal issue. The donor will not receive any information regarding the recipients of the sperm.

What if the donor changes his mind?

The donor is at anytime allowed to leave the program. Although any sperm that remains in the sperm bank would be the donor sperm bank’s property.

Donor sperm bank

One of the major advantages of frozen sperm is the almost indefinite storage period, without any genetic and functional characteristics being lost.  It can also more readily be shipped anywhere in the world using dry ice or ice powder in special containers that can withstand the rigors of transport. 

This practice has increased with the demand for fertile and safe sperm.  If the sperm are quarantined in the liquid nitrogen, the donor can be examined repeatedly for disease exposure over months or years before the sperm are used.  The Centers for Disease Control has cautioned that fresh anonymous donor sperm should not be used for artificial insemination or ART, and frozen anonymous donor sperm should be used only if the donor tests negative for human immunodeficiency viruses after a minimum of 90 days quarantine. 

Medfem Donor Sperm Bank

We at Medfem have a selection of 27 donors available to patients.  Although 120 would-be-donors have applied in the past 18 months, only a handful has passed our very strict criteria.

Donor recruitment is an ongoing process, since finding the most suitable match for our patients is our top priority.

Medfem Donor Sperm Bank meets all the standards set by the South African Human Tissue Act.

We at Medfem strive to offer the best care and service to all our patients!