CRH Infertility Specialists

Donor Inseminations

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.