About Donor Sperm Insemination
Donor
Sperm Insemination is a way of resolving male
infertility if the male partner does not wish to
undergo technologically complex procedures such as
PESA, TESA or ICSI or if his testicles have been
surgically removed or damaged by radiotherapy or
chemotherapy for cancer. Some fathers may also not
wish to use their own sperm for genetic or
chromosomal reasons. In these situations Donor Sperm
Insemination may be of great assistance. Unlike most
of the reproductive technologies described here,
Donor Sperm Insemination is a very old form of
treatment dating back over one hundred years. Prior
to the late 1980’s, this was done using fresh semen
samples. Now, all sperm samples are frozen and
quarantined for a six-month period of time prior to
use. According to the American Society for
Reproductive Medicine (ASRM), men providing sperm
for donation must be screened for all infections,
including Hepatitis B and C, HIV (AIDS), syphilis,
gonorrhea and chlamydia.
The
Center for Reproductive Health obtains donor sperm
from recognized and licensed sperm donor banks.
Sperm donors have been carefully screened for
infectious diseases, HIV, Hepatitis B & C, and other
conditions. They have had full medical consultation
as well as counseling. They come from all walks of
life.
It is possible for
prospective parents to chose the appropriate
physical characteristics from the panel of donors so
that skin color, racial origin, height, eye and hair
color can be matched up.
Donors are not allowed
to 'father' more than 10 pregnancies. This means
that the chance of consanguinity (the risk of a boy
and girl from different families both fathered by
the same donor meeting, marrying and having
children) are extraordinarily remote - probably
rather less than winning the lottery!
However parents may use
the same donor to provide a brother or sister
following a successful pregnancy.
Donated sperm may be used in
an
Intrauterine Insemination IUI
cycle if there are no problems on the female side
and if the fallopian tubes are patent. If there are
female problems as well the donated sperm may be
used as part of an
IVF or
GIFT cycle.
Naturally sperm donors
should ideally have 'fathered' their own children
and have a very good sperm count. However there can
be no guarantee of fertility and on rare occasions
the thawed sperm sample is sub-optimal in quality.
ICSI may sometimes be a way of resolving this if the
donated sperm is being used in an IVF cycle.
Intra-cytoplasmic sperm
injection (ICSI) has lowered the need for donor
insemination. However, for couples that present with
total azoospermia (complete absence of sperm), donor
insemination is an alternative option. Men with a
high DNA fragmentation rate (sperm chromatin
structure assay) may also require donor
insemination.
Donor insemination is
still widely used for couples that do not wish to
proceed with an ICSI, or if ICSI attempts have
failed. Donor insemination is extremely safe, and
offers a viable option to achieve a pregnancy. Over
the years, it has proven to be a very successful
program and parent satisfaction is extremely high.
The
combined problems of male infertility and decreased
availability of adoptable babies have increased the
interest in, and the demand for, therapeutic donor
inseminations (TDI). The procedure raises emotional,
ethical, and legal questions that must be considered
and discussed. The clinician must never do
inseminations without the consent of both partners.
Increasingly, single women are seeking TDI. Studies
have reported that children in single head of
household families are as psychologically adjusted
as those from two-parent households and that TDI
should not be denied to single women solely on the
basis of their lack of a male partner.
Donor
inseminations do not guarantee pregnancy. In past
studies, the success rate with fresh semen was about
70% over 5--6 cycles. The fecundability (chance of
getting pregnant per cycle) has been reported to be
18.9% with fresh semen and only 5.0% with frozen
semen. However, with exceptionally good frozen
specimens, success can approach that achieved with
fresh specimens. In a summary of nearly 3000
treatment cycles with frozen sperm, the cumulative
pregnancy rates were 21% at 3 months, 40% at 6
months, and 62% at 12 months for women less than 30
years old.
As a rule the donor should be unknown to the
couple. Use of friends or relatives as donors
raises the potential for emotional problems in the
future. If you are considering a known donor, the
health and fertility of the donor must be
unimpeachable, and there should be no family history
of genetic diseases. The donor will be tested for;
HIV 1 & 2, Hepatitis B, Hepatitis C, ABO & RH, RPR,
CMV and cultures for GC, Chlamydia, Ureaplasma and
Mycoplasma. If negative, the donor will be retested
for HIV 1 & 2, Hepatitis B, Hepatitis C, RPR and CMV
after 6 months. If both results are negative, the
cryopreserved sample, which has been quarantined for
the 6 months, can be used. Screening for
Thalassemia in Mediterranean races, Tay-Sachs
heterozygosity in Jews, and sickle cell disease in
blacks is a wise precaution. Donors can also be
tested for cystic fibrosis.
The donor
may not be a mirror image of the male partner, but
an attempt should be made to match physical
characteristics. Most individuals undergoing TDI
consider it a private matter and not subject to
discussion with family and friends. If successful in
achieving pregnancy, some individuals discuss the
origins of the conception with their children, but
most people prefer to leave it unsaid.
Donor
inseminations are useful in azoospermia, severe
oligospermia, or asthenospermia refractory to
treatment. They also are useful for the rare woman
who has a history of fetal loss due to Rh
sensitization. In that case an Rh-negative donor
would be used. Genetic diseases may, on occasion, be
an indication for donor insemination.
The basal
body temperature (BBT) change, the woman's
perception of vaginal wetness, and ovulatory pain,
if present, are useful guides for timing of
inseminations. More precise timing can be
accomplished by monitoring of the day of the LH
surge with measurements of LH in urine with any of a
number of commercially available kits. In our
experience approximately 75% of women can
successfully use the kits at home to identify their
LH surge. Insemination is performed the day after
the LH surge is identified. In more difficult cases,
monitoring and treatment approaches utilize
ultrasound to monitor preovulatory follicle growth
and an injection of 5000 or 10,000 IU human
chorionic gonadotropin when the dominant follicle
reaches 18 mm or greater in diameter.
If the BBT
alone is used, an attempt is made to inseminate on
the date just before or two days before the
temperature rise with the timing based on reviewing
2 months of charts and/or the day of maximal vaginal
wetness.
IUI with
donor inseminations produces higher pregnancy rates
compared to intracervical insemination. However, the
multiple pregnancy rates may be slightly higher. One
IUI per cycle should be performed for two cycles.
IUI should be performed the day after a positive
test with the urinary LH kit, or approximately 36
hours after HCG administration. Some practitioners
have suggested that double inseminations in a donor
program increase the pregnancy rate and shorten the
time required to achieve pregnancy. When two IUIs
are performed, they should be timed the day of and
the day after the LH kit tests positive, or
approximately 18 and 42 hours after HCG
administration.
Follow-up studies show that
children born after donor insemination have outcomes
comparable to the general population. Interestingly,
approximately half of couples do and half do not
tell their children of their origins. The divorce
rate in families with children conceived with donor
insemination is lower than the general rate.
