The decision to use donor sperm when pursuing fertility treatments is obvious for many patients. When there is no male patient involved, donor sperm is an available solution. Many patients with a male partner involved need donor sperm due to medical reasons. Some males do not produce viable sperm cells, while others carry dominant disorders and they do not want to pass this on to their offspring. But what about those situations that are not so obvious?
Patients with a seemingly normal semen analysis (or normal enough) who struggle with a history of failed fertility treatments find themselves in a difficult dilemma. When treatment doesn’t work, one reason could be the sperm source, but how do you know when to assume this is the culprit?
The semen analysis is a helpful diagnostic tool that is used worldwide to determine male fertility. The test measures several parameters. When collected manually, the semen analysis measures the volume of semen in a single ejaculate, total sperm count (the total number of sperm cells present), total motile count (the total of sperm cells that are moving), and morphology (percentage of sperm cells that are normally shaped).
Many clinics will check pH, viability (percentage or sperm cells that are alive including non-motile sperm), survivability (sample is left out for 24 or 48 hours to determine the sperm cells ability to survive over time), fragmentation test (gives us the percentage of sperm cells with fragmented DNA within the cell), and directional testing (the path and direction the sperm cells take as they swim, as well as speed).
One thing to understand is there are times where sperm cells just do not have a high rate of success even if the semen analysis is normal. Remember, the semen analysis tests everything we can see. There are many factors to the sperm cell and its ability to create an embryo that is able to implant and result in an ongoing pregnancy, and ultimately a live birth, that we can’t see. A normal semen analysis does not guarantee the male will have fertility success.
How do you know if donor sperm is needed?
If you have had many failed IUI cycles, or failed IVF cycles, you may be asking yourself if the problem is the egg, the sperm, or something else. While many times, it is clear where the problem lies (maybe the eggs show signs of abnormalities or are poor quality in general), more often than not, the reasons are unclear.
In an IVF cycle, there are hundreds of factors as to why it could have failed. Anything from egg/sperm quality, air quality in the environment, laboratory conditions, medications, timing, temperatures, etc. When a cycle fails, your fertility team and its physicians can offer only likely possibilities. The best way to know if there is a severe male factor when other tests seem to be acceptable is a side-by-side comparison that eliminates all factors but the sperm cell.
Using Eggs to Determine Male Factor
At Atlantic Shared Beginnings, fresh donor eggs are shared among multiple patients. This allows our team to gain solid insight about the ability of each sperm source. For instance, if there are three recipients each getting a cohort of eggs from an egg donor, and two of those recipients have successful fertilization, quality embryo development and ultimately an ongoing pregnancy, but one recipient did not, we know that the only thing different was the sperm source and all the other factors were the same. This is a strong indication of a severe male factor with an otherwise acceptable semen analysis. Recipients in this situation at Atlantic Shared Beginnings can try again with donor sperm with a second set of fresh donor eggs at no cost.
For fertility patients who are not in the ASB program, or those using their own eggs, it is possible to split your next round of IVF. You can fertilize half the eggs with partner sperm, and the other half with donor sperm. This allows you to see a real side-by-side comparison to determine a male factor. This will also provide possible embryos from donor sperm if the partner sperm embryos do not develop. If both sets fail, then you are most likely dealing with an egg factor and may need to consider donor eggs.
Talk to a Doctor
Anyone facing this decision should be discussing options in depth with an endocrinologist, as well as a reproductive psychologist. Many couples and single patients who are facing fertility treatments using donor gametes are faced with big decisions and it is usually an emotionally, physically, and financially taxing situation. When deciding to use donor eggs, donor sperm, or both, most fertility clinics require their patients to discuss the journey with a reproductive psychologist, so scheduling this appointment early on is a great way to discuss if the option is a good one for you.