BY MARGARET J. VEREB, M.D.

As an andrologist, I am the doctor who treats couples with male factor infertility. It is estimated that 50 percent of all fertility issues are male factor, and yet it usually comes as a shock, and may even bring feelings of shame. Men most often need a donor because they can’t make useful sperm or because they can’t afford the technology to use what they have. (One round of in vitro fertilization [IVF] with Intracytoplasmic sperm injection costs roughly $12,000, while one donor insemination is about $1,000.) I wanted to share these families’ stories to let you know that good things can come from this.

“I can love any child who is half my wife”

Stan was sent to me from his primary doctor for low testosterone. At 28 years old he had premature testis failure, the male equivalent of premature ovarian failure, when women begin menopause very young. This is one of the hardest conversations a doctor can have. The money it would have cost to treat him was the down payment they had been saving for a house. Using it for himself was out of the question for Stan. Even so, he and his wife needed time to decide between adoption, living childless, or donor sperm.

When Stan called back a few months later he told me that he had decided that, as long as the child was half his wife, he would love him or her. Once they had decided, I was able to treat his low testosterone and he now feels much better and ready to be a dad. Stan and his wife are six months pregnant with their first child and they plan to have one more.

“Accepting the need to use a donor was hard”

Tom came from a big family and wanted one of his own. When he and his wife, Becky, were told that he had no sperm, they were sure the lab had made a mistake. Once the test was confirmed, they decided on donor, but Tom kept hesitating to move forward.

For some couples, infertility is a long road and they are almost relieved to move on to donor. When it comes as a shock, the patient has to go through the stages of grief. I had Tom and Becky see a counselor who specializes in helping couples deal with loss. Tom had to grieve for the loss of a genetic connection to the large brood of children he had envisioned. Both men and women who need donors must go through this process. If the grief is never recognized, guilt and shame can come between spouses, and resentment can even overflow onto the child. Depression may need to be treated with medications, and denial can lead to inaction until it is too late. Marriages can be either strengthened or lost during this process, especially when spouses come to different conclusions. But with patient acceptance, a decision can be made on how to move forward.

Because most donor sperm is anonymous, profiles don’t usually include pictures. But using facial recognition software allowed us to find a donor who resembled Tom. This helped confirm the decision for him. Their beautiful daughter looks just like Becky, with Tom’s eyes. When she was born, Tom held her quietly for several minutes, then said, “You know, we did the right thing.”

Love has little to do with genetics

Donor sperm is frequently used by single women and same-sex couples, and it may be the answer for heterosexual couples with male infertility, but donor gametes should never be used until intended parents are sure they can accept the child they produce as their own. You don’t want unresolved grief to lead you to think, “My child would never have gotten a B in Math. If those had been my genes….” Try to think of it from the child’s perspective. When she looks at you, all she will think is, “That’s my daddy.”

Genes are funny things. Look at the families you know. Most children aren’t perfect little replicas of their parents. Many of us are a bit dumbfounded as to the origin of our children’s traits. As a reproductive scientist I believe that loving a child really has little to do with genetics. And as these examples show, everyone can have a happy ending.

Also published on buildingyourfamily.com

Selecting a sperm or egg donor is one of the more difficult decisions anyone could face. After all, this person will be contributing 50% of the child’s genetic traits, so how can one be sure they are choosing the right donor? While every person who selects a donor will do so using their own criteria, below is a list of common categories people may consider during their selection process.

1) PHYSICAL

The most common way to select a donor is by physical appearance. Studies have shown adults to be more emotionally invested in a child who resembles them, which is one of the leading motives behind searching for donors with similar features to the prospective parents. Donor banks and online donor databases allow users to sort donors by general physical characteristics, such as eye color, hair color, height etc., which narrows the available donor pool to a more manageable number. Some banks, in addition to written donor descriptions, will also furnish baby and/or adult photos of the donors, as well — though these are much less common in sperm donation than in egg donation. And now, through the use of advanced facial recognition software, prospective parents can _use large online databases to automatically match their appearance with donor photos, ensuring a greater chance that the child will look more like them.

2) MEDICAL

This is one of the easiest of categories to include or eliminate a donor. Medical would include such issues as:

Blood Type: This relates to a decision to inform the child that they were conceived using donor gametes. For example, if the prospective parents choose a donor with a blood type different from their own and the baby receives the donor’s blood type, it is biologically impossible for those two intended parents to produce a baby with that blood type. Choosing to tell a child is a personal decision, but selecting a donor with a blood type the two parents could not possibly produce might force the issue.

Genetic Predisposition to Race Specific Diseases: Certain types of genetic diseases are inherited along ethnic lines (Tay-Sachs in people of Ashkenazi Jewish descent, Sickle Cell Anemia in people of African American descent, etc.). If you or your partner belong to a group that may include such risk factors, finding a donor without that risk factor could be important.

Family Medical History: Although most serious genetic conditions would disqualify a potential donor, if either parent are in a high-risk group for more common medical conditions (high blood pressure, heart disease, cancer, etc.), there may be a wish to select a donor who does not have a family history of the same risk factors.

3) SOCIAL

There’s a vast list of possible social criteria for donor selection. It can encompass everything from personality to education to occupation and even personal interests. The importance for a donor to have certain characteristics in any of these criteria depends entirely on the potential parents. It’s important to also remember that, even if behavior, tastes, talents, etc. are genetic in nature, the donor is only supplying 50% of the genetic material. Knowing which social aspects of the donor and of the parent will be dominant or recessive is anyone’s guess, but being overly specific in this area can eliminate worthwhile donors and leave a smaller pool to choose from.

4) PRACTICAL

 There are several “factual” aspects to donor selection that must be considered.

Cost: The cost of a donor can vary from bank to bank and sometimes even from donor to donor within the same bank.

Location: Sperm, usually cryogenically preserved, can be shipped anywhere and held indefinitely. Although frozen eggs are becoming more available, eggs are usually harvested and used right away. Since many programs require the egg donor and prospective parent be in proximity to one another, choices can sometimes be defined by geography.

Known vs Anonymous: A known donor is a donor willing to be contacted directly by the child or the parents. Known donors represent less than 5% of the current donor pool, so if having a known donor is something you would prefer, you may greatly limit the available donors from your pool of acceptable candidates.

Supply and Demand: Some prospective parents wish to use the same donor to conceive several children. In situations like these, the parents-to-be will often purchase the entire supply of a particular donor, or place the donor under contract. Donors can only be used so many times in one geographic area, which can sometimes make a desired donor unavailable.

Program Preference: Many fertility programs will suggest particular banks or have donors of their own that they will recommend. In most cases, the suggested banks are ones the program has had experience with in the past. If you suggest using a donor from another bank, 9 times out of 10 the fertility program will make the arrangements. The more banks involved in the search process the more donors prospective parents will have to choose from, which can only increase the odds of finding the “perfect match.”

The search for “the right donor” can take many forms. Most often, couples work together to establish their “perfect donor” criteria. While it’s important to have a list of desired donor qualities, it is equally important to remember that over specifying can be a problem. Being hyper-specific can eliminate too many donors, leaving prospective parents dissatisfied with their pool of available candidates. The recommended approach is to determine which qualities are a priority and which are just “nice to haves” before beginning the donor search. In doing so, prospective parents are able to keep a broader pool of potential donors. Another recommendation is to increase the search radius by browsing multiple banks or using online services that aggregate results from donors across the country. While finding the “perfect” match is never guaranteed, the chances are significantly increased by taking the steps listed above.

For someone new to the world of sperm donation, the wide range of prices—from approximately $290 to $795—can be extremely confusing, especially since the reasons for this range are not often made clear. However arbitrary they may seem at first, there are many factors that cause variations in price between sperm banks. Like most businesses, sperm banks have to account for overhead costs such as real estate, staffing and marketing. Sperm banks also have many of the same costs as other medical offices, including specialized equipment and scientific-grade materials and procedures, as well as some additional expenses unique to their industry. To understand why sperm prices vary, it can be helpful to familiarize one’s self with some of these costs.

Location
A majority of sperm donors are college or graduate students.  It is therefore beneficial for banks to be located in areas of dense student populations—most often in large cities. In these areas, real estate is typically more expensive.  The high rent a sperm bank pays for its location is reflected in a higher cost-per-vial. As a result, sperm from San Francisco, for example, may cost more than sperm from a small city in the Midwest.  The size of the bank can also play a role in location costs: larger banks with more than one office will have higher overhead as a result of paying multiple rents in multiple cities.

Administration and Staffing
There are some very good, smaller banks with only one or two locations, staffed by a small group of employees, which operate efficiently in today’s market. These banks carry relatively little overhead. By contrast, larger banks often have multiple layers of administration, multiple locations, more employees, etc… therefore much higher overhead.

Marketing
For many businesses, marketing and advertising campaigns can result in increased revenue. However, not all marketing is successful, and the benefits of advertising are not always immediately realized. The more marketing a bank does–via print media, websites, and trade shows–the more cost they must absorb. Depending on the success of this marketing, these costs may ultimately result in an increased cost-per-vial.

Equipment and Consumables
Most banks still use some form of liquid nitrogen storage to safeguard their inventory.  Liquid nitrogen creates an ideal environment for tissue storage, keeping sperm stable at temperatures between -346°F to -320.44°F. However, the same property  that makes it ideal for tissue storage will damage or destroy containment systems over time.  Liquid nitrogen must also be replenished periodically, more frequently in older systems and less frequently in newer, more efficient ones. The price of liquid nitrogen can vary depending on market supply and demand—taken together with the periodic cost of replacing equipment, and the efficiency of existing equipment, these equipment costs can make a difference in the cost of sperm from bank to bank.

Testing
There are several levels of testing that have to be run on each prospective donor, and many donors fail. In fact, it is estimated by the industry that only 1 in 100 prospective donors are accepted.  When first applying, each donor is asked to give a sperm sample for analysis. The sample must test negative for all  sexually transmitted diseases. The sample must also test negative for inheritable disease that may be likely based on genetic risk. For example, every donor receives both a Karyotype and Cystic Fibrosis test, while Tay-Sachs disease—more commonly carried in Ashkenazi Jewish populations—is tested for in that group, and African Americans are screened for Sickle-cell disease. Some of these tests are more expensive than others, and the costs of performing these tests are rolled into the price of a good vial.

Losses
Not all sperm samples make it into the available, searchable part of a bank. Testing, as described above, is a costly process that disqualifies many samples. However, even qualifying samples sometimes become “losses” before they can be released for sale. All new sperm donor samples have to be quarantined for 6 months, at the end of which period a donor is given an HIV blood test. Only when both their initial test and their 6-month blood test come back negative can their donations be released. Unfortunately, during that six-month window, donors sometimes become unavailable due to graduation, vacations, or relocation. If their six-month blood test cannot be completed, their samples, the cost of testing those samples, and the money paid for their donation must all be counted as losses. The more losses a bank has, the greater the effect on their cost-per-vial.

Supply and Demand
Like any commodity with steady demand, the shorter the supply of sperm, the higher its cost. Each year there are fewer and fewer donors available:  fewer candidates are passing all of the screenings, and donors whose sperm has proved popular become unavailable due to limits on the number of donations they can make in a geographical area. The price of sperm is therefore in part determined by the market, the effect will change from month to month, and from year to year.

There are many factors that influence the price of sperm, and it is helpful to remember that price is not always an indicator of quality. So, when considering where to purchase your sperm, remember to work with a reputable bank that complies with FDA, AATB, and ASRM guidelines, and to consider a range of different sizes and locations before making a choice that is right for you..