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.
To make an
appointment, please call us TODAY at
615-321-8899.
