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Using Donor Sperm
Many infants are conceived each year using this method. Couples use donor sperm (DI) when the husband has no sperm or a very poor semen analysis (azoospermia, oligospermia, poor motility), or when there is a genetic problem which could be inherited from the male. Single women who want a biological child also use DI.
One must be psychologically ready to proceed with DI. Most doctors recommend that any patients considering DI see a counselor who is skilled at clarifying feelings about infertility, and about trying DI. It is essential that both partners feel comfortable with the decision and that all fears and questions be openly discussed. For some, it may mean dealing with various moral and ethical questions; for others, exploring questions about donor selection and whether to be open about the decision to do DI and whether to tell a child conceived by DI how they were conceived.
Most clinics will not allow couples to mix the donor’s and husband’s sperm in an insemination because clinics feel if a couple requests this they may not have done the necessary psychological work involved in deciding to do DI.
Donor Selection
Couples or individuals usually have the right to decide which sperm bank and which donor to use. Information about a donor’s physical characteristics, race, ethnic background, educational background, career history, and general health should be available. Many banks provide written profiles about the donors they have available. Some sperm banks are open to providing non-identifiable information about the donor (even photographs) as well as providing a service for adult offspring to obtain information about the donor.
The American Society for Reproductive Medicine recommends that physicians use only frozen semen and that the specimen be frozen and stored for at least 180 days. The donor should have an initial HIV blood test (the test for the AIDS virus), and should then be retested and have a negative result on the HIV test before the frozen specimen is used.
All donors should have tests for certain infections such as syphilis, hepatitis B, cytomegalovirus (CMV), gonorrhea, chlamydia, streptococcal species and trichomonas. All these organisms can be transmitted via semen to woman. Some can have grave effects on the fetus; others principally affect the woman. The donor’s semen should also be checked for the presence of white blood cells which can indicate an infection within the reproductive tract.
Donors are excluded from a donor program if he or his sexual partner have experienced any of the following: a blood transfusion within one year, a history of homosexual activity, multiple sexual partners, a history of IV drug use, or a history of genital herpes.
Before starting DI, a careful medical and reproductive history should be taken on the woman and a rubella titer, blood type, and antibody test for CMV should be done. If the woman tests negative for CMV, only a CMV-negative donor should be used. Some practices want to document normal ovulation patterns and many doctors order a hysterosalpingogram to document that the woman’s fallopian tubes are open.
The DI procedure involves inseminating the woman as close to the time of ovulation as possible. Many women monitor their ovulatory cycles by testing their urine for an LH surge which indicates that ovulation will soon take place. Inseminations are usually done about 24 hours after a surge of LH is noted on the urine test. Clinics do one or two inseminations per cycle.
Cervical insemination is a simple procedure. A soft catheter is passed through the speculum to the cervical opening and the semen is released from the catheter. The woman may be instructed to stay lying down for 15-20 minutes and then a small plastic covered sponge with a string attached may be inserted to keep the semen as close to the cervix as possible. The woman is instructed to remove the sponge in 2-3 hours. With cervical insemination, the nurse can take a cervical swab several hours after the insemination which will reveal how well the sperm are surviving in the cervical mucus.
Intrauterine insemination is often used to increase success rates with frozen sperm. Some sperm banks process the sperm for intrauterine insemination before shipping. If not, the thawed specimen is processed to remove the seminal plasma from around the sperm cells (Intrauterine insemination without doing this process would cause uterine cramping and possible allergic response.) After the sperm is processed, it is injected, using a syringe and thin catheter, into the uterus via the cervix. The insemination is usually painless; some women who have a tight cervical opening experience cramping if an instrument (tenaculum) is used to open the cervix.
Many women find it helpful to have their husbands with them, especially the first time DI is done. This helps affirm that choosing DI was a mutual decision and a potential beginning to their parenting experiences. Other women bring along a favorite book, music, or a relaxation tape to help make the insemination more pleasant.
Success Rates
The highest success rates for DI are reported in women who have no infertility problems, are under 35 years old and whose husbands have azoospermia (no sperm). Lower success rates are reported where there is a female factor (ovulation problem, endometriosis, DES, etc.) or the woman is over 35. Success rates vary from 60-80% but achieving pregnancy may take many cycles. In one study the overall cumulative pregnancy was 86% in the IUI patients and 49.5% in pericervical insemination group (Matorras, et al, Fertility and Sterility, vol. 65, no. 3, March 1996). Success rates for insemination may increase with two inseminations per cycle and correct timing.
If no pregnancy occurs after several cycles, the doctor will continue an evaluation of the woman. This involves a hysterosalpingogram, a laparoscopy and hysteroscopy to be sure there are no adhesions or endometriosis, and an evaluation of the luteal (post-ovulatory) part of the cycle by endometrial biopsy and/or checking progesterone levels in the blood. Other hormonal tests as well as ultrasound monitoring of follicular development may be indicated.
Ovulatory stimulating drugs such as clomiphene or injectable gonadotropins can be given to the woman. Closely tracked ovulation monitoring as well as IUI can help increase the likelihood of success for some women.
A good resource for obtaining a list of sperm banks is the American Association of Tissue Banks, 1350 Beverly Road, Suite 220-A, McLean, VA 22101, 703-827-9582 or the American Society for Reproductive Medicine, 1209 Montgomery Hwy., Birmingham, AL 35216.