Sperm, also called spermatozoa, is the mobile male reproductive cell or gamete that combines with the egg (the female reproductive cell or gamete) to undergo fertilisation and give rise to the zygote. Spermatozoa cells have a flagellum that makes them mobile, which is an essential characteristic needed to meet the female ovum, or egg, which remains stationary in the female reproductive tract after release. The zygote, which contains a mixture of both paternal and maternal traits within one cell, divides further and becomes a multicellular structure, giving rise to the embryo. Specialised structures, sacs and fluid accumulate and the embryo undergoes differentiation to give rise to a fetus that will become a fully formed and developed baby after nine months of gestation in a womb.

Infertility is described as the inability to conceive a child by a heterosexual couple after intentional regular unprotected sexual intercourse for a period of six months (when the female partner is older than 35 years old) to one year (when the female partner is under the age of 35 years). It may be said to be of a primary nature, when the couple has not had previous pregnancies, or of a secondary nature, when infertility develops after having conceived at least one pregnancy, irrespective of the outcome. Infertility can arise due to factors affecting the female partner, the male partner or both partners. Traditionally, the female partner undergoes fertility testing first in the absence of obvious impotence or dry orgasms without ejaculation in the male partner. If the female partner is found to be fertile and in good reproductive health, the male partner must undergo fertility testing. Male infertility can either be due to ejaculation dysfunction or defective spermatozoa cells. Ejaculatory dysfunction refers to the spectrum of disorders, arising due to various causes, in which the male partner is unable to ejaculate properly to impregnate the female partner. The four types of ejaculatory dysfunction are – premature ejaculation (when the ejaculate is released too soon), delayed ejaculation (when the ejaculate is released too late), retrograde ejaculation (due to dysfunction of the urinary bladder neck sphincter it fails to contract and the semen is redirected into the urinary bladder, later being expelled through urine) and anejaculation (the inability to ejaculate altogether). Both retrograde ejaculation and anejaculation result in dry orgasms (which means no semen comes out of the male penis) and the chances of successful pregnancy become very slim. While ejaculatory dysfunction can cause male infertility, the absence of ejaculated semen does not imply the unviability of the sperm. With appropriate treatment, conception is highly possible. The possible causes of male infertility due to sperm defects include:

  • Ineffective production of sperm
  • A low sperm count
  • Defects in the shape of the sperm
  • Abnormal movement of the sperm

While problems related to sperm count may be able to be remedied to a certain extent, it is very likely that assisted reproductive techniques (ART) will be needed to conceive a child successfully.

  1. What is sperm donation
  2. Sperm donor screening
  3. Preparation for sperm donation
  4. Procedure of sperm donation

If the female partner is reproductively healthy, fertile and fit to carry a child to term in her womb, the use of donor sperm is generally the way to go. Additionally, single women or homosexual lesbian couples that wish to procreate can also seek assisted reproductive technology (ART) treatments with donor sperm. Sperm donation is the process of donating semen for assisted reproductive techniques to help a reproductively challenged couple or single woman conceive a child. The donor may be known to the recipients or may remain anonymous. Sperm donors who are known to the recipients are said to make directed donations. Donors can also anonymously donate semen, typically for monetary compensation, at a sperm bank, which is then approached by couples or individuals, usually through an appropriate intermediary, looking to procure sperm for assisted reproductive techniques. The sperm donor and recipient parties remain unknown to one another and the anonymity of the sperm donor is ensured. Although multiple sperm donations do not pose a risk to the donor, most countries and authoritative bodies place a cap on the number of sperm donations that can be made by a male individual in a month. Before an adult male, over the age of 18, can make sperm donations, he must undergo screening tests. A semen sample may also need to be provided by the donor for testing.

(Read more: How to increase sperm count)

All prospective sperm donors, even the ones known to the reproductively challenged couple or individual, need to undergo some screening tests to rule out infectious diseases and genetic tests to rule out anomalies that could pose a risk to the future progeny. A thorough medical history (including family history) and physical examination are also conducted to assess the suitability of the donor. The following factors are taken into consideration and assessed before approving an individual to donate sperm.

  • Age: Sperm donations are usually only accepted from male individuals between the ages of 18 and 40. Some highly selective sperm banks may draw the line at 35 years as the quantity, quality and motility of sperm diminish with age. 
  • Medical history: A thorough medical history is taken from the prospective donor to note any major illnesses, diseases, injuries, conditions, past surgeries or medicines they may be taking. 
  • Family history: Special emphasis is laid on eliciting an accurate family history (including both maternal and paternal sides of the family) to rule out any diseases or conditions that run in the family. Besides genetically transmissible diseases like thalassemia, even lifestyle diseases like diabetes mellitus have a tendency to be present in multiple members of a family. 
  • Personal and sexual history: A history of personal habitual practices like the use of alcohol, recreational drugs or smoking is obtained. Sexual habits and practices are also asked about. These factors can influence an individual’s risk of contracting HIV (human immunodeficiency virus). HIV (human immunodeficiency virus) positive status is grounds for rejection of sperm donors. Other personal habits, hobbies and interests (like reading, music, etc.) are also asked about. Any special skills or talents are noted as well. Sperm banks may also request the submission of a photograph or video recordings of the sperm donor for prospective parents to see in order to envisage the possible appearance of their future baby. 
  • Physical examination: A thorough clinical examination is carried out. Any diseases or conditions that may be uncovered may prompt referral to a doctor for treatment. Individuals who are regular male donors are required to undergo a physical examination and laboratory tests every six months while they are actively making sperm donations. 
  • Psychological evaluation: A psychiatrist or other appropriate medical professional will carry out a psychological assessment, and counselling if needed, of the prospective sperm donor. Issues like whether the individual is ready to become the biological father of multiple children who he may never meet, the impact of the decision on his family or partner or whether he may wish to be contacted by any biological children in the future are discussed. If the recipient is known to the donor, the impact on their relationship will also be discussed. (Read more: Psychotherapy)
  • Laboratory tests: Blood tests, urine tests and special tests for infectious diseases like HIV (HIV Test) and hepatitis B virus (Hepatitis B Test) are carried out.  
  • Genetic testing: Genetic diseases that may not be present in the prospective donor but can be potentially transmitted to the progeny due to defective genes can be tested for with a blood test. Genetic testing is carried out on a blood sample taken from the patient. 
  • Semen analysis: Prospective sperm donors can be asked to provide a few samples of semen in order to test it for quantity, quality and motility of sperm. The prospective donor is asked to abstain from ejaculation by avoiding sexual intercourse and masturbation for 48 to 72 hours before providing a semen sample. If the sperm parameters are found to be adequate and all other assessment criteria are fulfilled, the sperm donor will be approved to make donations.

Normal sperm parameters: When testing a male for infertility or screening donor sperm, the following parameters are considered to deem the sperm healthy or fit to impregnate a female recipient:

  • Semen or ejaculate volume: 1.5 ml or more
  • pH: 7.2 or more
  • Sperm concentration: 15 million spermatozoa per ml or more
  • Total sperm number: 39 million spermatozoa per ejaculate or more
  • Total motility (percentage of progressive motility and non‑progressive motility): 40% or more motile or 32% or more with progressive motility
  • Vitality: 58% or more live spermatozoa
  • Sperm morphology (percentage of normal forms): 4% or more.

While these are the parameters outlined by the World Health Organisation (WHO), the interpretation of the test, as well as the cut off values, can vary depending on various factors. It is best to rely on the assessment of a qualified doctor trained in the matter.

(Read more: Homeopathic Treatment, Medicines, Remedies for Low Sperm Count)

After the screening process, the prospective sperm donor is asked to sign a consent form stating that they deny having any risk factors for sexually transmitted infections or genetic conditions. Other paperwork pertaining to the possibility of the biological child being able to contact the sperm donor is also filled out. When making a sperm donation for a recipient that is known to the sperm donor, it is advisable to hire a lawyer and draft out a contract that defines financial and parental rights and obligations. After being screened, receiving approval and signing the necessary consent form and other paperwork, the individual can proceed to make sperm donations at the sperm bank. Some preparatory measures are advised to the donor before making a sperm donation, the main one being abstinence from ejaculation (either through sexual intercourse or masturbation) for at least 48 to 72 hours prior to the sperm donation appointment.

The sperm donors are required to make sperm donations at the sperm bank. The donor will be allotted a private room where they will deposit a semen sample in a sterile plastic cup through masturbation.

After the semen sample has been submitted at the sperm bank, it is frozen in cryopreservation for a minimum of six months or until a recipient seeks it. At the end of the six month quarantine period, the sperm donor will be directed to undergo another HIV test. If the donor tests negative, the semen sample will be thawed and semen analysis will be conducted again. Usually, the semen sample does not deteriorate but some samples may become unviable. If the semen analysis results are positive, the sample will be released to the hopeful parents (or parent) for use in artificial reproductive techniques for artificial insemination or intrauterine insemination. Usually, the sperm donors are paid a fraction of the amount at the time of making the semen sample deposit and the remaining when the cryopreserved sample is procured by hopeful parents seeking artificial reproductive technology treatment.

(Read more: Ayurvedic Treatment, Medicines, Remedies, Herbs for Low Sperm Count)

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References

  1. Fainberg J, Kashanian JA., Recent advances in understanding and managing male infertility. F1000Res. 2019 May 16;8:F1000 Faculty Rev-670. PMID: 31143441.
  2. Gong D, Liu YL, Zheng Z, Tian YF, Li Z. An overview on ethical issues about sperm donation. Asian J Androl. 2009 Nov;11(6):645-52. PMID: 19767762.
  3. Adams DH, Clark RA, Davies MJ, de Lacey S. A meta-analysis of sperm donation offspring health outcomes. J Dev Orig Health Dis. 2017 Feb;8(1):44-55. PMID: 27573256.
  4. Colaco S, Sakkas D. Paternal factors contributing to embryo quality. J Assist Reprod Genet. 2018 Nov;35(11):1953-1968. PMID: 30206748.
  5. Omu AE. Sperm Parameters: Paradigmatic Index of Good Health and Longevity. Med Princ Pract. 2013;22 Suppl 1(Suppl 1):30-42. PMID: 24051979.
  6. Tiegs AW, Sun L, Scott RT Jr, Goodman LR. Comparison of pregnancy outcomes following intrauterine insemination in young women with decreased versus normal ovarian reserve. Fertil Steril. 2020 Apr;113(4):788-796. PMID: 32147173.
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