Treatment: Donor Insemination (DI)
Most women seeking donor insemination are doing so because they are single, are lesbian, or their husband has no sperm production at all.
Donor insemination is usually performed in natural cycles without the use of any fertility medications. If a woman has already attempted donor insemination in natural cycles and has been unsuccessful, a fertility evaluation may be warranted and fertility medications may be recommended.
The Donor Insemination Process
Once a woman has decided that she would like to undergo donor insemination, she must select a sperm donor from one of several sperm banks. A woman may choose to work with most any certified sperm bank of her choice. Sperm banks vary widely in the number of donors available, ethnic diversity of donors, information available on the donor including family medical history and availability of donor identification. Certified sperm banks must meet specific requirements for infectious disease testing of their donors. In order to virtually eliminate the risk of transmission of infectious disease through donation, sperm is "quarantined." The sperm donor is tested for infectious diseases, donates the sperm and the sperm is frozen and held at the sperm bank for six months. The donor is then re-tested for HIV before sperm is released to clinics and patients.
Some women prefer to perform inseminations at home in which case they will usually be performing an intra-vaginal insemination. If a woman seeks insemination with a physician, the sperm is shipped directly to our office from the bank and it is stored here until the appropriate time in the cycle for insemination.
Intrauterine insemination is usually recommended because studies have shown that the chances of successful conception are higher if timing of exposure to sperm is controlled, and if sperm is placed in higher numbers closer to the egg or eggs. As we usually perform intrauterine inseminations (at Pacific Fertility Center, San Francisco), we request that the selected sperm be prepared at the sperm bank for intrauterine insemination. It is possible to process sperm that has not been prepared at the bank for intrauterine insemination but there is an additional fee at the clinic for this processing.
The patient is responsible for contacting the sperm bank, selecting the donor from the bank's profiles, and paying the sperm bank directly for the sperm and shipping. The sperm is shipped to the Center as a vial of frozen sperm and we immediately transfer the frozen sperm to our liquid nitrogen storage tanks. The sperm is held in this frozen state until the day of the insemination when the laboratory thaws the vial or vials of sperm for insemination. We will always perform a sperm count and evaluate the percent of motile sperm in the specimen prior to insemination.
Using Sperm from a Known Sperm Donor
In some cases, a woman may know a friend who is willing to donate sperm to her for purposes of conception. Obviously, this raises some social issues concerning the role that the donor may play in the parenting of any child that may be conceived from known donor sperm insemination. Also, if the sperm to be used is to be freshly donated on the day of insemination (no freezing or quarantine), there are issues of potential for infectious disease transmission which must be addressed.
Because of the potential issues involved with parental rights and responsibilities, we at Pacific Fertility Center strongly recommend that the woman being inseminated and the sperm donor have a legal contract established outlining these rights and responsibilities (or lack thereof) prior to the insemination. We can refer patients to appropriate sources for preparation of these contracts. In addition, Pacific Fertility Center requires at least one session of counseling with a family counselor or psychologist familiar with issues which may arise from this arrangement. We have a family counselor on site or we can refer you to other counselors in the Bay Area. The counselor must meet or speak by phone with both the donor and the recipient of the donor sperm.
Infectious disease testing is required for sperm donation, as at any sperm bank. If the woman is using fresh sperm from a known donor, he must also undergo a blood test known as polymerase chain reaction (PCR) for the HIV virus just prior to the insemination cycle (within two weeks of the insemination). Although this testing significantly reduces the risk that the sperm donor is carrying the virus that causes AIDS, it does not completely eliminate this possibility and the recipient of the donated sperm must sign a consent form acknowledging this risk.
Sperm donors are also tested for Hepatitis B and C, syphilis, and another HIV-like virus, HTLV-1. Known sperm donors must also have either a urine sample or urethral swab culture for gonorrhea and chlamydia to reduce the risk that the recipient of the donor sperm may become infected with these sexually transmitted diseases from the insemination.
If the sperm is to be donated fresh on the day of the insemination, the sperm can be collected at home and brought within one hour to the office or can be produced in a clinic's sperm collection rooms. The laboratory will then perform a sperm count and motility evaluation and prepare the sperm. The usual preparation procedure takes about two hours. After preparation, the sperm concentrate is placed into the uterus, through the cervix, using a small catheter. Some of the sperm will also be placed directly into the cervix. The actual insemination process takes approximately 5 to 10 minutes. It is optimal for men to abstain from ejaculation for 1 to 3 days prior to the anticipated insemination. Abstaining for more than 5 days can result in decreased motility.
Studies have been done demonstrating that one well-timed insemination per cycle is as effective as two inseminations per cycle so most clinics, including Pacific Fertility Center, perform a single insemination per cycle.
Preparing for an Donor Insemination Cycle
After consultation with your fertility physician, a treatment plan is usually made between you and your physician. Some women will need some testing to be performed in order to make sure that she is in good reproductive health and has no specific barriers to conception with donor insemination. All women who have regular menstrual cycles should have an early cycle FSH and estradiol blood level tested. She should also be tested for Rubella (German measles) and Varicella (Chicken pox) immunity. We require documentation of the blood type as well.