In assisted reproduction, when is it necessary to use donor sperm?

Approximately 30% of couples seeking treatment for infertility can be shown to have a male factor. Semen analysis abnormalities can range from mild to severe, and sometimes there are no sperm present in the ejaculate or in the seminiferous tubules of the testicle. Therefore, sperm donation allows these couples, or women who wish to become single mothers, to fulfill their dream of starting a family. Dr. Josvany René Sánchez Curbelo, attending physician and Head of the Andrology Testing/Treatment Unit at the Puigvert Foundation, answers our questions. 

When there are alterations in the quality of a man's semen, is it always necessary to use donor gametes (sperm)?

No, in some men with abnormal semen analysis results, it's possible to improve semen quality and/or select sperm for use in assisted reproductive technologies (ART). However, there are cases where semen quality is extremely poor, making it impossible to find viable sperm, and using donor gametes would be an option.

Can a woman without a male partner use donor sperm to become a mother?

Yes, in cases where there is no male partner and there is a desire for fertility, donor sperm can be used. Female same-sex couples can also become mothers this way. This option, permitted under Spanish law, has been widely accepted and its use has been increasing in recent years.

If the man suffers from a sexually transmitted disease such as HIV (Human Immunodeficiency Virus), Hepatitis B, etc., would the use of donor sperm always be necessary?

No, HIV infection, Hepatitis B, etc. is not an absolute indication to resort to the use of donor semen.

From the beginning of the epidemic in 1981 until 1992, male HIV infection was an indication for using donor sperm to avoid infecting the female partner. Currently, sperm washing techniques, which confirm the absence of the virus in the sperm used in assisted reproductive technology (ART), allow the use of the patient's own gametes without resorting to donor sperm. These are scientifically proven techniques and a highly safe alternative. The same applies when the man has hepatitis B, etc. 

If in seropositive patients (HIV, Hepatitis B, etc.), after performing seminal washes, molecular tests identify viral load in the sample to be used in ART, the use of donor sperm should be considered.

In all these cases it is also important to know the treatments the patient is undergoing or has undergone, viral load, the woman's immune status, etc.

When there are no sperm in the semen (azoospermia), should we always use donor sperm?

No, not always, it depends on the cause of the azoospermia.

If the testicle produces sperm, but the sperm do not come out with the seminal fluid due to obstructive causes (obstructive azoospermia) or ejaculation does not occur (anejaculation), sperm can be extracted from the epididymis or testicle using aspiration or open surgical techniques and used in ART (Assisted Reproductive Technology). Sometimes, when ejaculation does occur, the semen is not propelled forward (outward) but instead flows into the bladder (retrograde ejaculation); in these cases, sperm can be retrieved from the urine after orgasm.

When there is no sperm production in the germinal epithelium of the testicle (secretory azoospermia), in more than 40% cases some sperm can be recovered by aspiration or obtaining testicular pulp by biopsy, but there is a majority of men in whom it is impossible to obtain sperm and one option would be to resort to donor sperm (this is the first cause of use of donors in ART).

When a man suffers from a genetic disease that can be transmitted to his children, is donor sperm always used?

No, if a man has a disease that can be inherited by his offspring, and the genetic alteration and its transmission are well-studied and identified, preimplantation genetic diagnosis (PGD) can often be performed on the embryos. Once the embryos that do not carry the genetic alteration have been selected, these are the ones that could be implanted in the uterus.

There are diseases in which it is not possible to make the selection explained above, and in these cases the use of donor semen would be indicated.  

If pregnancy is not achieved through insemination and/or IVF/ICSI, can donor sperm be used?

Yes, if after undergoing ART procedures recommended by the professional, fertilization is not achieved or the embryo quality is very poor and it is suspected or confirmed that the cause is male, the use of donor sperm can be considered.

In what other cases might it be necessary to use donor sperm?

• When recurrent miscarriages occur and the cause is suspected or confirmed to be male. 
• When the man has a positive blood type (homozygous state) and his partner has a negative blood type, and despite being isoimmunized, she produces antibodies against the red blood cells of the fetus with a positive blood type, Rh incompatibility is currently an exceptional indication for using donor sperm. This is because administering anti-Rh globulin in the hours following delivery prevents or reduces the risk of Rh sensitization.
• Yes, significant chromosomal abnormalities are detected in sperm.

When using donor sperm, is it always necessary to perform in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)?

No, not always. Donor sperm can be used for IVF/ICSI or artificial insemination (AI), depending on the woman's reproductive health and circumstances. It would also be necessary to consider whether or not preimplantation genetic testing (PGT) is required.

Article reviewed by Carlos Dosouto