Expanded carrier panels and rare donor lookbacks are increasing counseling time and workflow demands
Donor egg and sperm utilization continues to rise, with one leading fertility network reporting approximately 300 fertility treatment cycles using donor gametes in the past year. According to Dr. Deborah Wachs of the Reproductive Science Center of the San Francisco Bay Area (RSC Bay Area), this volume reflects not only a sustained demand, but also an ongoing shift in how donor gametes are accessed – particularly a move away from fresh egg donor cycles toward frozen egg bank programs. This transition is reshaping how genetic screening, counseling, and risk communication are operationalized within routine clinical care.
Behind that volume is a broader industry transformation in genetic screening practices. This shift, combined with changes in how donor gametes are accessed, has accelerated the adoption of expanded carrier screening. While ECS panels have become standard practice, clinical interpretation, counseling time, and workflow infrastructure have not always scaled at the same pace.
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Expanded Carrier Panels Have Replaced Limited Panels, Increasing Interpretation Burden
Earlier in her career, donor genetic screening was far more limited, according to Dr. Deborah Wachs of RSC. “It was not uncommon for egg donors to have completed panels with fewer than 20 diseases, and for sperm donors to have no carrier screening at all,” she noted. Over time, egg donor panels expanded, and sperm banks began routinely screening their donors. Although the professional guidelines that initially defined minimal carrier screening standards have not substantially changed, many donor programs now offer panels more closely aligned with those received by intended parents. This evolution adds complexity when matching donors with recipients, particularly since donors who joined programs earlier may have only undergone earlier-recommended testing, and additional screening for those donors may or may not be available. Today, while this expansion in screening has increased patient confidence in proceeding with donor-assisted reproduction, it has also introduced substantially greater volume and complexity of genetic information. This increases the interpretive burden for providers and the scope of counseling required for recipient patients.
Most donor gamete cycles at RSC Bay Area occur through egg and sperm banks, according to Deborah Wachs. “If we are doing a fresh egg donor cycle, we order the expanded carrier testing as part of the screening process”, she explained. In all cases, the donor’s results are reviewed alongside the patient’s own carrier screening. Whenever possible, the same panels are used to minimize the risk of discovering a positive result for a condition that was not included in the donor’s testing.
Sometimes patients complete their own genetic screening before selecting a donor, using their results to help avoid donors who are carriers of the same condition. At RSC Bay Area, all patients are required to complete a genetic counseling appointment, during which the counselor reviews the carrier states, residual risks, and the likelihood of having an affected child.
As donor utilization as the network has increased, so too have counseling time and documentation review. Clinics now rely on more structured workflows to track donor data, coordinate with external banks and maintain consistent communication across programs, reflecting the growing operational demands and interpretive demands of expanded carrier screening in donor-assisted reproduction.
Rare Donor Lookbacks Expose Limits of Predictive Screening
Comprehensive carrier screening does not eliminate uncertainty. At Reproductive Science Center of the San Francisco Bay Area, Deborah Wachs explained, “We have had cases where new information emerged regarding an egg or sperm donor years after a patient had a child resulting from that donor. Sometimes the donor learned of a new condition themselves, and sometimes another family using the same donor reported a newly diagnosed potentially genetic finding. In these cases, we have had to contact our patients and share this information.”
These lookbacks are uncommon and often unrelated to screening gaps, but they underscore the evolving nature of genetic knowledge. Dr. Deborah Wachs added, “Just like with our own health, we never know all the possible outcomes, and as genetics continues to advance, new diagnoses are possible. The best that we can do for our patients using their own gametes or donor gametes, is offer the most up to date, comprehensive screening that is available at the time of treatment and to provide counseling that explains the limitations of testing.”
Reflecting on donor program practices, she emphasized, “The only constant in life is change. Panels continue to expand, and new donors can complete the currently accepted standards, but donors in any egg or sperm bank will have completed varying levels of testing. Our patients can complete the most expansive testing themselves and use those results to make informed decisions when selecting a donor. Genetic counseling is key to understanding what can be known with confidence and the inherent limitations of genetic screening. As our knowledge grows genetic screening is increasing treated as a continuous clinical function rather than a single discrete step”
As donor gamete use and genetic screening complexity continue to grow, standardized counseling ensures patients understand the capabilities and limitations of testing and can make informed decisions throughout the process.
A Genetic Counseling Partner You Can Trust
Expert support for donor programs and recipient matching.
Inviting a genetic counseling partner into your practice means trusting someone with your patients. GeneScreen supports internal donor programs, independent donor agencies, and recipient matching—helping identify and communicate genetic risk with clarity. Our expert counseling aligns with your standards, supporting confident decision-making while delivering patient-centered care.
Get started with seamless genetic counseling that aligns with your standards.