Assisted reproductive technology with donor sperm: national trends and perinatal outcomes

Abstract

Background: Information regarding the use of donor sperm in assisted reproductive technology, as well as subsequent treatment and perinatal outcomes, remains limited. Outcome data would aid patient counseling and clinical decision making.

Objectives: The objectives of the study were to report national trends in donor sperm utilization and live birth rates of donor sperm-assisted reproductive technology cycles in the United States and to compare assisted reproductive technology treatment and perinatal outcomes between cycles using donor and nondonor sperm. We hypothesize these outcomes to be comparable between donor and nondonor sperm cycles.

Study design: This was a retrospective cohort study using data from all US fertility centers reporting to the Centers for Disease Control and Prevention's National Assisted Reproductive Technology Surveillance System, accounting for ∼98% of assisted reproductive technology cycles (definition excludes intrauterine insemination). The number and percentage of assisted reproductive technology cycles using donor sperm and rates of pregnancy, live birth, preterm birth (<37 weeks), and low birthweight (<2500 g) were the primary outcomes measured. Treatments assessed include use of donor vs nondonor sperm. The trends analysis included all banking and fresh assisted reproductive technology cycles using donor and autologous oocytes performed between 1996 and 2014 (n = 1,710,034). The outcomes analysis was restricted to include only fresh autologous cycles performed between 2010 and 2014 (n = 437,569) to focus on cycles with a potential outcome and cycles reflective of current practice, thereby improving the clinical relevance. Cycles canceled prior to retrieval were excluded. Statistical analysis included linear regression to explore polynomial trends and log-binomial regression to estimate relative risk for outcomes among cycles using donor and nondonor sperm.

Results: Of all banking and fresh donor and autologous oocyte assisted reproductive technology cycles performed between 1996 and 2014, 74,892 (4.4%) used donor sperm. In 2014, 7351 assisted reproductive technology cycles using donor sperm were performed, as compared with 1763 in 1996 (6.2% vs 3.8% of all cycles). Among all autologous oocyte cycles performed between 2010 and 2014, the live birth rate was lower for donor sperm (27.9%) than nondonor sperm cycles (32.5%); however, after adjustment for maternal age, donor sperm use was associated with an increased likelihood of live birth (adjusted relative risk, 1.06, 95% confidence interval, 1.01-1.10). Per transfer, there was no significant difference in live birth rates for donor vs nondonor sperm (31.9% vs 36.8%; adjusted relative risk, 1.04, 95% confidence interval, 0.998-1.09). Per singleton live birth, there was no significant difference in preterm birth (11.5% vs 11.8%; adjusted relative risk, 0.98, 95% confidence interval, 0.90-1.06); however, low birthweight delivery was slightly lower in donor sperm cycles (8.8% vs 9.4%; adjusted relative risk, 0.91, 95% confidence interval, 0.83-0.99).

Conclusion: Donor sperm use in assisted reproductive technology has increased in the United States, accounting for approximately 6% of all assisted reproductive technology cycles in 2014. Assisted reproductive technology treatment and perinatal outcomes were clinically similar in donor and nondonor sperm cycles.

Keywords: donor sperm; in vitro fertilization; perinatal outcomes; third party reproduction.

FIGURE 1. Number of fresh cycles using donor sperm

A, Number of fresh autologous and donor oocyte ART cycles^a using donor sperm, United States, 1996–2014. The number of fresh cycles using donor sperm with autologous oocytes has increased over time. The number of fresh cycles using donor oocytes followed a similar pattern except for a decline in recent years peaking in 2012. B, Percentage of all banking and fresh ART cycles^a using donor sperm, United States, 1996–2014. Although there was a slight initial decline between 1996 and 1999, the percentage of cycles using donor sperm has since continued to increase over time, accounting for 4.9–6.2% of all ART cycles between 2010 and 2014. ART, assisted reproductive technology. ^a Cycles in which oocyte retrieval was performed. Gerkowicz et al. ART with donor sperm: national trends and perinatal outcomes. Am J Obstet Gynecol 2018.

FIGURE 2. Cycles resulting in live birth by donor and nondonor sperm

A, Percentage of fresh autologous cycles^a that resulted in a live birth by use of donor and nondonor sperm, United States, 1996–2014. The total live birth rate across all years was 28.5% and 31.9% in fresh autologous cycles using donor and nondonor sperm, respectively. For both groups, the live birth rate has increased and then decreased over time. B, Number of live-born infants from fresh autologous cycles using donor sperm,^a United States, 1996–2014. The number of infants born from fresh autologous cycles using donor sperm has increased over time. C, Number of live-born infants from fresh autologous cycles using nondonor sperm,^a United States, 1996–2014. The number of infants born from fresh autologous cycles using nondonor sperm increased from 15,452 in 1996 to a peak of 40,386 in 2008 before falling to 29,615 in 2014. ^a Cycles in which oocyte retrieval was performed. Gerkowicz et al. ART with donor sperm: national trends and perinatal outcomes. Am J Obstet Gynecol 2018.

FIGURE 3. Average maternal age for cycles by donor or nondonor sperm

Average maternal age for fresh autologous cycles^a by use of donor or nondonor sperm, United States, 1996–2014. The average female age of patients has increased over time with a slight decrease in recent years. Cycles using donor sperm, however, consistently have a higher average female age ^a Cycles in which oocyte retrieval was performed. Gerkowicz et al. ART with donor sperm: national trends and perinatal outcomes. Am J Obstet Gynecol 2018.