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Dilemmas for donor sperm selection, provider information explained

Valerie Shaikly, PhD, FRCPath, FAHCS
Founding partner , Fertility Genetics

Category:
Male Factor, Sperm donation

sperm-donor-selection-dillemmas
From this video you will find out:
  • What physical/personal characteristics are available on sperm donor bank profiles?
  • Is the family medical history of the sperm donor available? What information is available?
  • How are the sperm donors screened? What genetic tests are performed?
  • What is expanded carrier screening (ECS)?
  • What diseases can be detected through genetic testing?
  • What should I look for when buying a sperm sample? How many vials of sperm should I buy?

How do I choose the right sperm donor?

In this webinar, Valerie Shaikly, PhD, FRC Path, FA HCS, founding partner of Fertility Genetics has discussed sperm donor selection. She has explained how sperm donors are screened, and what to look out for when choosing a sperm donor from a sperm bank.

Sperm donor – selection

When looking for a donor sperm and donor egg bank, it is important to consider the competitive nature of the international market. Therefore, the following pieces of information must be considered to navigate and research:

  • Physical/ personal characteristics
  • Family health history
  • Genetic testing
  • Sample options

Physical/ personal characteristics

It is probably the easiest aspect to find and navigate. Generally, information regarding eye colour, hair colour, build, and height will be provided as well as ethnicity and heritage details based on DNA testing.

Pen Portrait Essay provides the donor with the opportunity to express the wish to donate as well as share personal attributes. Personality profiles are usually provided, which might include psychometric testing.

Family medical history

It is known that whenever a donor is recruited to a donor bank, a two-generational family history will be elicited from the donor by specialists that implies a list of conditions and how they were treated for background information.

Genetic testing and screening of the donor

In the first place, all donors who have any positive antibodies for HIV, hepatitis, and gonorrhea, for instance, will be excluded. Moreover, all donors will be tested for Karyotype which is a test that looks at the number of chromosomes a person has, making sure the correct number and structure is appropriate. Given the karyotype test is not normal, donors will not be recruited.

Another type that can be provided by banks is genetic screening. It is mainly used for recessive conditions. Extended carrier screening (ECS) is also required. The minimum screen is for Cystic Fibrosis. It can be between 4 and 283 conditions depending on the donor bank. Most people are carriers of a condition, despite the fact this has no impact on health. However, co-carriers can have an affected child.

Purchasing a donor with a positive career status, it is suggested to arrange a session with a suitable professional to:

  • Assess your personal medical history in the context of the family of the donor
  • Review the testing results of the donor
  • Understand the limitations of the testing
  • Provide a risk assessment for using the donor with a known carrier status based on emerging data from reliable resources

It is important to have co-carrier testing and not to order tests from a company on the Internet, as these testing needs to be properly validated. Therefore, these tests must be ordered by doctors and clinical scientists.

Find a professional who can provide:

  • Pre- and Post-test support and information.
  • A validated testing laboratory that matches the screening of the donor bank
  • That can support if a finding has implications for your family

What donor banks do not test for?

  • Disease risk genes, e.g. cancer
  • Dominantly inherited disease, e.g. Huntington’s
    Multifactorial diseases, e.g. Diabetes

Sample Options and Quantity

It is significant to consider the sample looks that the donor banks offer. From a commercial perspective, the sperm with a high number of motile sperm will be of a high price considering the portion.

The term MOT stands for the number of motile sperm per millilitre. Depending on your treatment, a higher or lower number of motile sperm will be required and necessary. It is suggested to check with the clinic which sample would be preferred to purchase.

Another option regarding the samples is whether they are washed or unwashed. In other words, all assisted reproductive clinics wash the sperm for use in treatment, putting the sperm on a density gradient to gather all motile sperm together for higher concentration in a small volume.
Then, the number to purchase is suggested to be checked with your clinic depending on your needs.

 

 

- Questions and Answers

If the egg donor and intended father don’t have a common carrier disease, both did the Invitae 301 Comprehensive Carriers Screen, including the add-on genes. Would surrogate be able to ‘switch on’ one of the genes in pregnancy if they had any of those carrier diseases of egg donor or sperm? No one has the BRCA 1 or 2. Is this also called Ataxia-telangiectasia (A-T)?

If you have an egg donor screened with the Invitae panel 301 diseases, and the biological father has been screened, the genetic background of the surrogate won’t make any difference. They wouldn’t be able to switch anything on.

There is little of an argument whether the uterine environment affects the development of a baby, so perhaps their genes impact the genetic functioning of the child. There is still little known about that.  There may be subtle things that we don’t understand at the moment. Perhaps the environment that a baby grows in may affect which genes can be, as you said, switched off or on or perhaps more active. For recessive diseases, the answer is no. 

I was told not to use any donor with Ataxia-telangiectasia (A-T) as that gives an implication of future cancer?

‘ll have to check that and get back to you why you were told that, but I would have thought that if a donor has been recruited, and was going through the recruitment process, there wouldn’t be anything unless you were a carrier of the same condition. 

Some recessive diseases actually can slightly increase your risk of cancer. However, there’s a lot of other unknown factors, such as environmental factors,  and perhaps other genes working alongside or confounding gene, as well. It may be that those people who are a carrier of that condition, but I would need to check that I don’t know of the top of my head.

Do you know why TESA is not accepted into guaranteed life birth packages?

As an embryologist, I can answer that. Generally,  I’m assuming that you’re talking about live birth packages for the number of treatments and using donor eggs. The reason is that generally, TESA sperm tends to be of lower quality and so you don’t actually see as many moving sperm, and perhaps the morphology of the sperm is not as good.

Most of the live birth packages they offer will need the sperm to meet certain parameters because they don’t want the sperm factor involved. They’re offering you eggs, and they’re guaranteeing the eggs, but they can’t guarantee the eggs if the sperm doesn’t reach those criteria.

Do you know if the genetic screening of sperm donors is the same across European countries?

I would say that in the European countries it’s variable. I’ll count the UK as being part of Europe as it was before December.  For a lot of the UK banks, they will test for a minimum, they will only test for cystic fibrosis.

Some European donor banks will do carrier screening of about 47- 48 genes, others will do less than that. Some will also offer a carrier match option where you would go to them, and you could pay extra to be tested to see if you’ll carry a match with the donor if you wanted to, but then you’re not given the results of that finding, so you wouldn’t know, but they can just tell you whether it’s safe to use or not. I think that’s because of the laws in that country, I think specifically, in Denmark, it’s not allowed to find out the results. If they did tell you your results, then the donor would have. There’s an option for that information to be out.

I know a donor bank at the moment that screens for 46-47 in Europe. If a donor is a carrier, they exclude them. There’s a paper that just came out in human reproduction last week saying that this isn’t sustainable because if we’re going to carry a screen, we won’t have enough donors,  and being a carrier doesn’t have an effect on health, and so there won’t be sufficient donors. This is why the U.S. banks that screen for more conditions give that information, so it’s evaluated. People have the information to make informed decisions about how they want to proceed.

Do you know where I can find African sperm donors? I would like to get a non-anonymous donor, not sure where to look for it.

There is a shortage of African donors, I was speaking to a lady today who was finding it difficult, but there are some. Perhaps if you went to some big U.S. donor banks and if you’re looking for non-anonymous, then there are boxes to do your search criteria. If you do your search criteria by countries that only allow non-anonymous donors, such as the UK, then they will come up.

What is your opinion on carrier screening of 600 genes for donor matching as offered by f.e., IGENOMIX? Would you recommend it? Egg donor and my husband can be screened.

Not many donors I know are tested for 600 genes at the moment, so if you were tested for 600 genes and the donor was only tested for 283, there’s a chance that you could come up as being a carrier for something that the donor isn’t, and then you’re almost back to square one. Again that information can be valuable. You’re more likely to come up with a carrier status of an egg donor and a husband if you screened for more things.

Going back to our example of purple, both being purple, for example, the more you look, perhaps it’s slightly more likely to find that. I would say that it’s about how far we want to look, so do we say that looking at 40 conditions is sufficient, do we say 283, or do we look at the whole genome, it’s really about minimizing the risk rather than eliminating it.

Generally, donor banks at the moment are offering 283, some are doing 40, so you know 600 probably is a top option at the moment. If it’s offered as a package, I think they call it like a carrier match, they look at it and then tell you we’ve screened these 600 genes, and you don’t have alterations in the same gene that pose a risk to a child, and that’s what they would tell you, so it would be the most risk-reducing, but then you have to look at it from the point of view of expense and value as well.

I know in Europe some clinics are offering their own carrier screening, so they’ll do it in-house, for example, they say we’re testing a thousand genes but then sometimes what can happen is you can find a change in a gene and people were not sure what that means, and there’s a question mark over that, do we know this causes disease, is it likely pathogenic or lightly pathogenic, there may not just be that information. You end up with lots of question marks and perhaps worry about something that might not happen or might not be important, and they’re called a variance of unknown significance. When they start to get reported, when you’re starting to get nitty-gritty, it can be a can of worms that can be difficult to interpret and perhaps cause anxiety around things that normally wouldn’t be considered.

I ordered straws from the European sperm bank out of Denmark and have done some screening from Invitae (I can’t recall the name, I was not a carrier of anything notable), donor screening was extra. Since straws have yet to be shipped, I can request the test. Am I responsible for making sure everything matches up or the clinic, or do I supply my test results to the bank?

 In this situation, I would contact the bank because I think the European sperm bank may be the one in Denmark or have to be under the rules of Denmark where they’re not allowed to tell you what the donor is a carrier of, for example. Whereas if you submitted your test report on the official Invitae report, if you then send that to them, they will be able to check with their findings if there’s a carrier match, and so that’s the way I would do that. The donor bank will perhaps have more information and understand how to do that a little better than the clinic. You would have that reassurance before you purchase the donor as well.

It depends on if the donors have the extended screening or not, so I think some donors will have had the extended carrier screening, and some of them don’t. There’s a special term they give on their website for a donor who had the extended carrier screening, so first, check that. If the donors are having extended carrier screening, then share your report with the donor bank.

They may not have used the Invitae panel, so it could be that you’ve been tested for some things that the donor hasn’t been tested for and vice versa, and they would perhaps need to be able to look at that, and their genetics team would be able to help you I’m sure.

Can the same donor provide sperm for more families in the UK, and outside of the UK?

There’s a 10 family limit in the UK, and then every country may have its own regulations about how many families each donor can have, but it can be cumulative across countries.  I don’t know how many in the U.S. or Europe are allowed, so yes is the answer.

You have to purchase a pregnancy slot in the UK for a 10 family limit as part of the 10 families, and then if you do achieve your family, you hold that slot, that’s yours, and you can use the donor for sibling use, but it does mean that the donor will be used for family building outside the UK as well. When you’re perhaps looking for how many genetically related individuals there will be from that donor and whereabouts they are in the world, that’s something that it’s very difficult to ascertain at the moment.

Is there a maximum worldwide number for the same donor?

I don’t even know whether it would be monitored worldwide at the moment, but I would think that in each European country, they would have their regulation for their own country, and then they may ship to the UK where there’s a regulation.

Some European donor banks have outlets in the US where you can order a donor from the US that can be shipped to Europe and then to somewhere else, so I don’t think that is monitored at the moment, definitely not worldwide. It may be within individual donor banks, they may have some policy around that, but I’m not sure that it is a requirement.

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Authors
Valerie Shaikly, PhD, FRCPath, FAHCS

Valerie Shaikly, PhD, FRCPath, FAHCS

Valerie Shaikly, PhD is a founder partner of Fertility Genetics, graduated in Biology in 1990 and began training as an embryologist under the tutorship of Lord Winston. She has since gained a master’s degree in Health Promotion, PhD in Reproductive Immunology, Fellowship of the Royal College of Pathologists, Academy of Healthcare Science and Institute of Biomedical Scientists and is registered as a consultant clinical scientist specializing in genomic medicine within reproductive science. Valerie works with IVF providers and their patients to support understanding of the growing volume of genetic testing options and fertility treatment pathways.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.