As assisted reproductive technology has progressed and inclusive employer-sponsored fertility coverage has made it more accessible, the LGBTQ+ community has more family building options than ever before. Many LGBTQ+ singles and couples look to donor tissue to help create their families, but it can be a confusing process. Join us as we explore how and why donor egg or sperm may be a good option, what to consider during the process, and the difference between private donations versus egg and sperm banks.
The host for this webinar, Dr. Georgia Witkin, is an expert about reality of tissue donation. She has specifically looked at the sperm donation shortage during COVID-19, the myths around asking a donor, and the realities of egg donation.
LGBTQ+ Family Building: Donor 101
- Jaime Shamonki, Chief Medical Officer at Generate Life Sciences
- Juan P. Alvarez, Reproductive Endocrinologist at Fertility Centers of Illinois
- Georgia Witkin, Head of Member Services Development at Progyny, Assistant Professor of OB-GYN and Reproductive Sciences and Assistant Clinical Professor at Mount Sinai
Myths vs. Facts
Many turn to egg or sperm donation on the path to parenthood, including single-parents-by-choice, LGBTQ+ individuals and couples, and those who cannot use their own genetic material. However, there are many misconceptions about egg and sperm donation, which can hold people back or create extra stress on the journey to parenthood.
Myth or Fact? If you are a woman using donor eggs, you are not the mother.
There is only one way to create a baby, and it requires a female’s body to not only build the baby in her body, but also from her body. This baby is her gestational child just like every baby whose mother received sperm donation—which is every woman who has ever had a child. Furthermore, for nine months, her own environment will be interacting with the baby’s DNA so while she may not be giving the baby her own gene pool, but she is both building a baby and making it uniquely hers.
Myth or Fact? Donating sperm is easy.
Both anonymous and known sperm donors must undergo extensive testing, especially those who are anonymous. These tests include:
- Semen analysis
- Genetic testing
- Physical testing
- Physiological testing
- STD evaluation
They must complete a full medical and family history. Some sperm banks also have the donors submit childhood and current photos, as well as a personal essays, hobbies and other interesting facts.
In addition, sperm is tested twice before transfer to confirm the male continues to pass the tests. Donor sperm also needs to be quarantine for six months before it can be used. Since it is possible to test for HIV using RNA, donors freeze their sperm at the same time as STD testing and a physical exam. This way, the sperm can be readily available after the quarantine period.
Known vs. Anonymous Donors
For some, using an egg or sperm bank is the best choice for donor tissue. For others, using a family member or friend is more appealing. Both have benefits and risks, so it is important to talk with a counselor and with your partner before committing either way.
General Questions to Consider
When beginning thinking about this, here are some questions to consider:
- How do you control the quality? What is the age of the donor? Men over 40 begin to see decreases in sperm mobility and an increase in their risk for diabetes, hypertension, and obesity—all of which can affect sperm and a potential embryo.
- What’s the price? Since private donors are usually more costly.
- What does the legal proceedings and legal protection look like?
- For a known donor, what will involvement look like?
If you are moving forward with an anonymous donor, you want to make sure the egg or sperm bank is stringent in their testing, as we touched on above. A perk of using an anonymous donor is that you will likely have legal protection through the egg or sperm bank, and you will not have to face potentially uncomfortable conversations with a close family member or friend about involvement levels. Additionally, you can have faith that donor tissue will be top tier because of the intensive testing banks put them through before offering them. For example, less than 10% of men who apply to be sperm donors end up being accepted by sperm banks.
If you pursue a known donor, you can feel comfortable in knowing the individual and how they carry themselves as a person. This route requires some more conversation between parent(s) and the donor in terms of the desired level of involvement past donation. Known donors also go through intensive testing, and if results come back less than stellar, it might make a successful pregnancy more challenging.
Benefits of Using Donation Bank – Regardless of Donor Choice
Regardless of whether you decide to use an anonymous or known donor, it is important to use an egg/sperm bank or IVF clinic for the process. Some reasons for this include:
- Screening for infectious diseases.
- Mitigating risk for genetic diseases through screening for recessive carrier status but and thorough family history review.
- Legal protection for your family and concern for privacy issues.
- Psychological screening and eliciting informed consent from the donor.
- Limiting the number of offspring and tracking health outcomes in donors and offspring.
Breakdown of Donor Tissue
Same-Sex Female Couples
For women in same-sex relationships, there are various questions to think about before starting on the path to parenthood.
A few questions to consider:
- Whose egg do you use?
- Who is going to carry the baby?
For same-sex female couples where both partners are able to conceive, reciprocal IVF is also an option. In this scenario, one woman donates her egg to be mixed with donor sperm, and the second woman carries the embryo. It is important to check in with yourself, your partner, and ideally a non-biased third party to ensure everyone is on the same page moving forward—especially when it comes to who will fill each role.
Donor Sperm Considerations
Donating sperm is not easy. Banks put men (and their sperm) though intensive testing to ensure the best candidates are selected. For banks like California Cyrobank, less than <1% of donors are accepted.
Once you’ve chosen your donor, you’ll need to purchase their sperm. When it comes to the number of vials you buy, you’ll want to consider the following:
- Are you pursuing IUI or IVF?
- How many rounds of treatment are you thinking about/expecting?
- How many children do you want long term?
Depending on how you answer these questions will help you gauge how many vials to purchase. For example, it’s common to go through multiple rounds of IUI before a pregnancy is successful, so if you are going this route, you would want to purchase more vials. In addition, if you want more children, you will want to talk to your cryobank about how to purchase and store the vials until you are ready to pursue additional pregnancies.
Same-Sex Male Couples
For men in same-sex couples, they have similar questions to consider:
- Whose sperm will be used?
- Do you want to do known or anonymous egg donation?
- How do you select a gestational carrier?
Egg Donor Considerations
Egg donors will all undergo ovarian reserve testing, and this allows doctors to understand how successful ovarian stimulation (treatment to retrieve the eggs) will be. Oftentimes egg donors will need to be 34 years old or younger to ensure the best chance of high-quality eggs. Donors will also be tested on medical history, surgical history, family, and genetic history.
When it comes to buying eggs, it’s important to know one “vial” of eggs often contains six to eight eggs. For couples where only one partner wants to be a parent, using one vial is a great choice. For couples where both partners wish to be parents, using a fresh anonymous donor is the best choice, since this option can usually yield 10-20 eggs from one ovarian stimulation cycle.
Searching for Donor Egg or Sperm
Finding the right donor is a big decision and at first it may feel overwhelming. Here are some tips for narrowing down your search:
- Consult with a fertility doctor. Clinics often have a list of donor banks they are familiar with and have good relations with. This makes the search a bit easier on the couple since the doctor can help guide their search based on their criteria and goals.
- Consider the option of a genetic carrier screening panel. If going anonymous, this can be more important so that you ensure you’re aware of a donor’s potential carrier status.
- Make a list of your priorities when it comes to the donor’s background.
- How important is “knowableness” status? Do you want someone who is totally anonymous, open, or has their ID fully disclosed?
- Ethnicity? Height? Eye color? Education level?
- Does the donor have a general similar look to your/your partner?
- Do you need to be looking for a CMV negative donor? This won’t be relevant to everyone but be sure to speak to a health care provider about it if it might apply to you/your partner.
Here are some questions to think about when trying to get a grasp on these processes:
- Does the bank have a clear policy on family unit limits, does the bank have the infrastructure and expertise to help families if an unexpected adverse genetic even occurs?
- Does the bank have experience in helping promote privacy and facilitating contact between donor conceived persons and donors?
The bank is not there to just provide a healthy sperm vial or donor egg; they should be there to support the welfare and health of donor conceived families well into the future. It is important to think about the long-term relationships and communication, and this can be hard when you’re in the thick of donor processes.
Progyny is proud to support all paths to parenthood. If you are a Progyny member, your Patient Care Advocate is always available for emotional support or fertility advice. Please don’t hesitate to reach out.
To learn more videos, articles, infographics and podcasts about LGBTQ+ family building, visit Progyny’s education page.