Fertility for Lesbian Women Becoming Moms

Whether a person elects for an at-home insemination, an intrauterine insemination or some version of in-vitro fertilization, she will need to use sperm to conceive.

The person who provides the sperm is referred to as a “donor” though, counter-intuitively, they are usually paid. We characterize donors into three buckets:

While there are many decisions to be made here, we think of there being a few primary ones, namely:

• Will you procure sperm from someone you know or from a sperm bank?
• If using a bank, will you elect for an open identity (or "open") or nonidentified (or "anonymous") donor?

A directed (or "known") sperm donor is typically someone who is a part of the future parents' lives. This could be a friend, an acquaintance, or, frequently, a brother or relative of the woman who will not be using her eggs.

Positives

There are lots of positives to using a directed (or "known") donor. First, if the donor is a relative, it gives both parents a chance to have a genetic connection to the child.

Second, you’ll have a good sense of who this person is—they’ve been personally vetted by you. This matters because, as you’ll see with donors from sperm banks, many women feel they’re given limited information and can’t formulate a sense for what kind of person the donor is.

Third, you can also take extra steps that make you feel more comfortable with this donor, like doing any specific genetic screening that you want performed. Alternatively, many patients wonder whether sperm banks do a thorough job medically vetting donors (more on this to come).

Fourth, using a directed (or "known") donor also minimizes the risk of surprises later, like learning this same donor has fathered 50+ children who are genetic siblings to your child.

Fifth, you can create a unique family structure, whereby a directed (or "known") donor can also be a part of a child’s life from early on if that’s what the parents want.

Sixth, it’s typical to need more sperm than expected. That’s because fertility treatments seldom work the first time and because many parents want more than one child. Many lesbian couples who acquire sperm from a bank come to learn it’s hard to get ongoing specimens from a donor they like. A directed (or "known") donor is more likely to be able to provide additional samples when needed.

Seventh, presumably the sperm from a directed (or "known") donor can be acquired more cheaply than through a sperm bank; however, this will likely be counterbalanced with additional costs.

Eighth, unlike sperm sourced from a sperm bank, a directed (or "known") donor can contribute fresh samples (compared with sperm banks which only offer frozen samples). In treatments like IUI, this delivers better results.

Negatives

Of course, there are also drawbacks to using a directed (or "known") donor.

Most importantly, there can be legal risks, especially if the donor has involvement with the child. Some of these risks can be mitigated through legal agreements and making sure to do the insemination at a clinic so that it’s well documented that they’re a donor not a father.

Second, there can be complications if, down the road, you and the donor don’t see eye-to-eye on what the relationship should be between the child and the donor.

Next, you will likely need to contend with a number of logistical hurdles that can delay treatment. These include psychological counseling and evaluation for you and the donor, and clinics requiring that such sperm be quarantined for a period of time to protect moms from communicable diseases like STDs.

Additionally, not all clinics and sperm banks are prepared to accommodate directed (or "known") donor situations.

Lastly, you’ll likely need to cover the costs to have the donor’s sperm tested and his physical and mental health assessed, and possibly any costs he accrues for attorneys to review documents relinquishing any claims of parentage to the child. These costs may supercede the cost of having simply purchased sperm from a sperm bank.

The alternative to using sperm from someone in your life is to procure sperm from a sperm bank. Here we’ll try and clarify how this process works as well as the tradeoffs in comparison to using a directed (or "known") donor.

How Sperm Banks Find Donors

There are 3–5 large sperm banks (200–500 donor’s sperm available at any one time) in the United States and a handful of smaller sperm banks.

Often, banks operate as a network, establishing recruitment centers near large, state universities where they screen candidates (medically and psychologically) before collecting their sperm.

If selected, donors waive their paternal rights, agree to testing, provide several samples, and create an online profile for customers of the bank to review.

The Costs of Using a Sperm Bank

The costs of using a sperm bank vary, and prices between the major banks range by 10%–15%. There are really two costs: the cost of information and the cost of sperm itself.

Information: You should assume you will pay for varying tiers of information on donors on the sperm bank’s portal, with top tier access running around $250 every three months.

Sperm: The costs to acquire a vial of sperm range from $1,000–$1,500, and rise if:

• The donor is willing to have their identity known by the offspring when they turn 18 (this is known as an open identity (or “open”) donor)
• The sample has been washed and treated before it is shipped out

For context, each IUI requires a vial of donor sperm. Since IUI works about 10 - 20% of the time, most people purchase 3 - 5 vials in total and the costs of sperm rise 4%–10% per year.

For IVF, which we address in more detail below, each round requires a vial of donor sperm and most clinics require a second vial in case something goes wrong when they attempt to unfreeze it.

The costs of a vial of sperm in many countries have shot up to $1,000 to $1,500 per vial post-COVID and have remained at those prices.

If you purchase more than one vial of sperm, the additional vials are often held at the sperm bank until they’re needed. In cases where a patient decides they don't need or want sperm still held at the bank, the bank is often prepared to buy it back at 50% of what people paid for it.

Ultimately, since treatment is inefficient (sperm gets used up quickly) and most parents want more than one child, customers find they need more sperm than they expected. These customers often regret not buying more sperm (from a donor they like) earlier, because donors eventually stop providing samples and other customers may have stepped in and bought all that was left.

Positives of Using a Sperm Bank

First, compared with trying to select a directed (or "known") donor, sperm banks provide a broad selection (though many customers complain they find it hard to find what they’re looking for.) What’s more, you can get access to the sperm almost immediately.

Second, sperm banks handle much of the logistical hassle that falls to those using a directed (or "known") donor: physical, psychological, and medical screening has been handled. The donor has waived all rights and claims to the child.

Third, most sperm banks are highly LGBTQ+ friendly, as lesbian women comprise nearly half of their business.

When purchasing sperm some experts suggest that the partner who will be using the sperm (or using it first) makes the purchase. The reason is that once it is shipped to the clinic, the clinic’s record system will have an easier time matching it to the recipient if it is in their name.

Negatives of Using a Sperm Bank

First, the experience of finding a sperm donor through a bank can be painful. While banks claim to reject 90% of applicants to donate, many customers find the volume of donors to be overwhelming and the quality to be underwhelming.

Second, sperm banks make little information available to customers. Customers want to see adult photos while banks usually just supply younger photos of the donor. Personal essays are penned by 18 and 19 year olds, and leave customers to wonder what this person will be like as a fully-formed adult. Specific schools attended are purposely made vague because they are seldom viewed as “elite” institutions.

Third, many worry that banks often know less about their donors than customers are led to believe. While banks are meant to follow FDA and ASRM screening guidelines, standards vary between banks, and sometimes even within the same bank, depending on the recruitment center.

The headline below profiles a case where a sperm donor was advertised as having a 160 IQ and a PhD but was later revealed to have neither—instead, he had been convicted of burglary and diagnosed with schizophrenia before donating. His samples were used to father 23 offspring and were obtained from a large bank that’s generally considered reputable.

Fourth, sperm banks provide frozen sperm. Frozen sperm carries lower rates of success than fresh sperm. Fresh sperm can only be provided by a directed (or "known") donor. When one uses frozen sperm, it’s always wise to have at least two vials available for any given cycle in case the first vial does not thaw successfully.

Finally, some clinics may prefer that the sperm they are provided from a sperm bank is prepared in a certain way (depending upon how it will be used), and it’s important the bank is made aware before it is shipped.