Sometimes the journey to parenthood can be a little complicated. It might make sense to use a sperm donor. Justine Witzke, the founder and CEO of Aligneage Fertility, a boutique, human-centered sperm bank and fertility consultancy, has worked with thousands of patients who've used sperm donors in their paths to parenthood. The Prima team and Justine sat down to discuss how you can work with a sperm donor to create the family that is right for you.

What exactly does the term "sperm donor" mean?

A sperm donor can look like a lot of different things nowadays. When they hear the term "sperm donor", many people think of going on a sperm bank's website, searching through online profiles of strangers, adding those profiles to an online shopping cart and then shipping their sperm off to an IVF clinic. In this instance, you'd be working with a non-identified donor (we no longer use the term "anonymous" in the fertility industry, since we can't guarantee anonymity with online genetic testing databases like 23andme).

We're now seeing more people working with someone who they know or who they've met to be a sperm donor for their child. This could look like a situation where a same sex female couple uses the eggs of one partner and the sperm of the other partner's brother. Or, maybe a single woman has a high school friend who is going to serve as a sperm donor, but they're not partners or the intended coparents of the child. We refer to these instances as using a directed or known sperm donor. 

For patients working with a clinic or sperm bank, how can they trust that the sperm they're using is safe?

The FDA and the state level departments of health have regulations and requirements for the testing and screening of any gamete donors, which includes egg donors and sperm donors. So, the potential donor needs to go through rounds of screening that includes genetic testing, psychological counseling, infectious disease testing, physical exams, and a review of their health, family, and medical history.

Sometimes, a known donor might not pass some of the screening processes, but the intended parents (the person or couple who is planning to raise the child) still want to proceed with the donation. For example, maybe the donor lived in the United Kingdom for a year and could have (in theory) been exposed to Mad Cow Disease. In these cases, the couple would discuss the risk with their provider and may continue to work with the donor anyway.

How would you recommend a patient go about finding a non-identified sperm donor?

The first thing I recommend patients consider is their genetic carrier status. Your fertility clinic will go through genetic testing for the egg provider (who is either the intended parent or an egg donor), and through genetic counseling they will determine whether the egg provider and the sperm donor could have a child with a genetic disorder based on their genetic carrier statuses.

Beyond genetic carrier status, patients will often care about finding a donor with certain physical attributes, such as height, hair color, and eye color. Many sperm banks will provide short essay answers from the donor, information about their personality, and adult or childhood photos. These things can help you decide if you feel aligned with this donor. Our approach at Aligneage Fertility is to do a more hands on approach to matching our donors with intended parents. We try to help the patients narrow down which donor profiles might be a good fit based on what's really important to them. This might include soft skills that we've picked up having met the donor, like determination and aptitude for achievement. So, we're able to make a more nuanced match for the intended parent.

How might using a known sperm donor unexpectedly impact a patient's relationship with the donor?

Using a known donor can definitely impact your existing relationship, which is why we recommend having a conversation that is facilitated by a professional. It's important that everyone understands their expectations of the relationship and the donor's future involvement with the child. There's no right answer, other than that the group should be aligned. It's also important that this relationship be formalized in a legal contract. A legal contract ensures that everyone is protected- that the intended parents have parental rights and responsibilities in the way that it's meant to be, and that the donor doesn't have parental responsibility from a financial standpoint. 

What are the different roles that a sperm donor could play in the child's life? 

Nowadays, almost everyone in the fertility industry agrees that using donor sperm or eggs should be disclosed to the child as soon as possible in an age appropriate, supportive way. We hear cases of known donor relationships where the donor is a friend of the family, or the donor has an uncle-like role. There are even situations closer to co-parenting arrangements. It's also important to keep in mind that these arrangements may change over time. Nobody can perfectly predict how their feelings may change over time. That's why having open discussions and resources such as mental health professionals and lawyers available matters.

We've discussed how people in your life might have an opinion about your fertility treatment. How do you recommend navigating unsolicited advice?

Some communities and families are very open and honest, and people feel comfortable being fully transparent. And then there are other communities and families where fertility treatment is not a topic that is ever discussed. That's where having a supportive network of providers and fertility experts can really make a difference in your life. We help patients navigate these tough questions, whether it's about how to tell your mom you're doing IVF, or if you want to have a baby as a single parent, or whatever your dilemma is. We've seen many different scenarios and have experience in how to approach some of these subjects.

There have been tremendous improvements in reducing taboo and being open about accessing fertility treatments over the last decade or two. Yet, there are still stigmas associated with fertility treatment. If you broke your arm, you'd go to the doctor and have them help fix it- why is fertility treatment any different?

What are some misconceptions patients have about using a sperm donor?

It's unfortunate that there are some cases where there are many, many, families from the same sperm donor. Sometimes neither the families nor the sperm donors were aware that this might be the case. In the industry, we are now trying to be more conscious of keeping the number of families created with a specific sperm donor smaller. At Aligneage, we will keep in touch with the families and the donors so we can share medical information back and forth as is appropriate and take a more connected approach to creating a certain number of families using the same sperm donor.

How can Aligneage Fertility help you start a family?

We're specialized in the andrology space for fertility preservation for young men with cancer, transgender women, patients with sickle cell disease, or patients with other medical indications where they should freeze sperm prior to treatment that might impact their future fertility. We're building out a sperm bank for families looking for a more personalized approach to working with a non-identified donor. We're also working with known donor and intended parent testing and screening.