Infertility, defined as the inability to conceive after one year of unprotected intercourse, affects approximately 15% of couples worldwide, with roughly 13.4% pre-menopausal women in the United States affected. This article aims to address options available to female patients and couples to have children and the processes in place to protect all parties involved.
Sperm Donation
Sperm donations should be considered when the male partner has severe abnormalities in the semen or reproductive system, or in the case of congenital diseases and disorders the patients do not wish to pass on to their children. Screening donors involves taking a thorough medical history, physical examination, and lab testing for infectious diseases. Semen samples require at least a six-month quarantine period for HIV and other infectious diseases. Semen analysis should also include a check for sperm-related abnormalities or ejaculatory dysfunction.
It is recommended that donors receive psychological evaluation by a qualified mental health professional to gauge psychological risks and any financial or emotional coercion. Donors can be either direct, meaning they are known by the recipient from the beginning, or non-direct (due to DNA testing services like 23andMe, there is no guarantee of anonymity), meaning the donor is completely unknown at insemination.
Recipients should be medically and physically screened in the same manner as donors, with lab testing for infectious diseases and an added evaluation for the cause of infertility. There should also be a solid understanding of the recipient’s ovulation period for the insemination process with a recommended hysterosalpingogram or saline sonohysterogram to indicate the shape of the uterine cavity and whether the fallopian tubes are open (prior to insemination). Partners of recipients should also be screened for infectious diseases, as those could pass to the recipient or child through sexual activity.
It’s recommended that psychoeducational counseling is provided to both partners due to the complexity of the decision-making process. This counseling would address crucial implications for family planning and the potential impacts on relationships that come naturally with gamete tissue donations. Recipients should be provided with crucial medical information and testing results. If the donor tests came back with any health concerns, they are no longer eligible to be a non-direct donor.
Egg Donation
Egg donations are considered when the female partner has had their ovaries removed or they are functioning poorly, they have poor egg quality, or they have genetic diseases or conditions they do not wish to pass on to their child. Screening egg donors is a similar process to screening sperm donors, including psychological evaluation. However, donated eggs do not require a quarantine period (this is only recommended for frozen transfers, not required). Donors also require a pelvic ultrasound to check the anatomy of the ovaries, and an antral follicle count is recommended. To prepare for egg donation, the donor is provided a combination of hormonal medications to stimulate the development of multiple eggs within the ovary. The development is monitored via ultrasound, measurement of hormones in the blood, and follicle size.
Egg recipients go through the same screening process as sperm recipients, with an additional saline infusion sonogram of the uterine cavity to ensure embryo implantation will be successful. To prepare for embryo transfer, either the ovulation cycle needs to be aligned with the donor’s (fresh transfer) or hormonal treatments are provided to prepare the uterine lining (frozen transfers), which is then assessed via ultrasound and blood tests. Progesterone is taken a day after the donor receives an injection to trigger ovulation.
Both donors and recipients should go through psychoeducational counseling as well, due to the ethical and emotional challenges that arise from egg donation. An egg donor encounters more inconvenience, discomfort, and health risks than a sperm donor, so counseling is important. Recipients and partners should be informed of the psychological implications involved with family planning via donation. It is recommended to have a joint session with both parties when the donor is known to discuss communication expectations, preferences for remaining eggs, etc.
Conclusion
It’s important for both donors and recipients to receive proper screening and psychological counseling prior to insemination or embryo transfer due to the health risks, ethical, and emotional aspects involved in the process. Clinicians should know the proper recommendations, regulations, and processes involved with third-party assisted reproduction in order to properly inform and counsel patients.
References:
Centers for Disease Control and Prevention. (2024, October 1). FastStats - infertility. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/infertility.htm
Gamete and embryo donation guidance (2024). ASRM. (2024, November). https://www.asrm.org/practice-guidance/practice-committee-documents/guidance-regarding-gamete-and-embryo-donation
Third-party reproduction patient education booklet. patient education booklet | ReproductiveFacts.org. (2018). https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/third-party-reproduction-booklet
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