Abstract Purpose <p>Immunological response to paternal antigens in semen and sperm has been implicated in the aetiology of preeclampsia. Although donor sperm conception has been associated with increased preeclampsia risk, evidence specifically regarding IVF with donor sperm remains limited. We aimed to assess whether pregnancies achieved via IVF with donor sperm are associated with a higher risk of preeclampsia or perinatal complications compared to IVF pregnancies using partner sperm.</p> Methods <p>This prospective registry-linkage study included women undergoing IVF using donor versus partner sperm between 2009 and 2017 at the Reproductive Clinic of Karolinska University Hospital, Stockholm, Sweden. Data on demographics and IVF treatments were collected from the clinic’s database, while obstetric data were obtained from the Swedish Medical Birth Register by linking individual records across the two databases.</p> Results <p>Compared with partner sperm, donor sperm was not associated with increased risk of preeclampsia. However, donor sperm was associated with an increased risk of 5-min Apgar score &lt; 7 (OR 2.13, 1.21–3.78), but lower risks of preterm birth (OR 0.55, 0.35–0.86), preterm premature rupture of membranes (OR 0.35, 0.18–0.67), and low birth weight (OR 0.54, 0.33–0.88). Body mass index &gt; 25&#xa0;kg/m² was associated with a higher rate of preeclampsia (aOR 2.20, 1.32–3.68).</p> Conclusions <p>Our study does not support the hypothesis that sperm donation in IVF increases preeclampsia risk. However, donor sperm was associated with differences in obstetric and neonatal outcomes, suggesting that sperm source or related treatment characteristics may influence pregnancy outcomes beyond preeclampsia.</p>