DONOR INSEMINATION - a patient's guide
Dr Richard Fisher - Fertility Associates

What is donor insemination?

Insemination with donor semen offers the only means of achieving pregnancy for some infertile couples. It may also be an option for some single women, or women in lesbian relationships.

Until recently donor insemination was commonly known as AID, "artificial insemination by donor", but this term has fallen out of favour because of its similarity to "AIDS".

In the past donor insemination was generally subject to disapproval or ignorance, but with the liberalisation of attitudes to sexual matters, it is now acceptable to almost all sectors of society.

The widespread introduction of freezing of semen in the early 1970s made the practice of donor insemination more manageable, and there has been a dramatic increase in the growth of, and the demand for, donor insemination. Because medical science has not yet been able to offer "cures" for most of the types of infertility treated by donor insemination, it seems likely that the use of donor insemination will continue for many years to come.

Why donor insemination?

Donor insemination is offered to people of sound physical and mental health who agree that they want children, but for a variety of reasons, find they cannot.

For a couple, it may be that the man does not produce sperm, or that the quality of sperm production is very low. Rarely, it may be that the use of the man's sperm carries a very high risk of the child having a serious congenital abnormality.

Before you start treatment, we would strongly encourage you to use the information services that are available through the counsellors associated with your fertility specialists.

This is the time to ask questions, consider any reservations, and think about the special issues that are associated with donor insemination as a treatment. Counselling is usually included in the cost of donor insemination treatment.

Sperm Donation:

Who becomes a sperm donor?

Sperm donors come from all walks of life and are typically just ordinary people willing to donate sperm to help infertile couples or others achieve a pregnancy.

Donors must be be aged between 18 and 50 years, with a good semen analysis and good recovery of sperm after it is frozen.

Screening of sperm donors:

All sperm donors are required to undergo screening to minimise the risk of passing on contagious diseases and genetic disorders to patients receiving their semen.

Routine tests include tests for syphilis, gonorrhoea, chlamydia, hepatitis B and C, and HIV (AIDS) antibody.

Sperm donors are blood typed, and have routine blood tests to screen for general health. A doctor physically examines the donor to make sure he is fit and healthy. The donor's family history and medical history is taken using a comprehensive checklist to screen for inheritable diseases.

Once the donor has passed all the screening tests, he is asked to give up to 15 samples. Each sample is frozen within 90 minutes of collection. Donation is often over a period of six months, so it is a major commitment.

A lifestyle declaration form, similar to the one completed by blood donors, is completed for each donation. This is designed to eliminate anyone at risk of exposure to HIV (AIDS).

Each donation is quarantined for a minimum of six months, after which time the donor must repeat the screening tests.

What information is available about the sperm donor?

All sperm donors complete a non-identifying information questionnaire. This information is made available at any time. A simple profile is made up from this for you to look at when choosing a donor.

Recently, all sperm donors must be potentially identifiable, which means the donor agrees to be contacted by the clinic on behalf of the parents or any children that may result from his donations, and to then consider giving more information about himself. Howeveer, this is not a guarantee that the donor will agree to divulge his identity.

Donors are at liberty to place restriction on the use of their semen. For example, donors could request that only married couples be treated with their sperm. However, most sperm donors do not choose to place restrictions.

What information can the sperm donor receive?

At present a sperm donor can request and be given information on the number of pregnancies resulting from his donations and the sex of those children. It is anticipated that donors and parents of donor insemination children may one day want to swap information, but no information should be shared without the consent of both parties.

Which sperm donor?

When you are ready, you can choose a donor from profiles you will be given. The non-identifying information about donors should help you make a final decision.

Some people recruit a donor known to them and ask their fertility team to process this donor for them to use. Many fertility clinics will be happy to help if you choose this approach. However, this practice does carry its own complications, and we strongly encourage you to discuss the matter with a fertility specialist before you approach your prospective donor.

Screening of Recipients

The fertility clinic will usually screen recipients of donor sperm for the same diseases as it does for donors, in case any recipient should ever develop a sexually transmitted disease that might otherwise be attributed to the donor. Your doctor will discuss the implications of this testing, including testing for HIV/AIDS.

Legal Aspects

In some countries, sperm donors are required by law to allow their identity to be revealed to their children once their offspring reaches a certain age. In others, though, including the United States, most sperm donors are still anonymous.

Telling Your Child

Whether you tell your child of the manner of its conception is entirely up to you. The consensus of those working in the field would be that it is better to do so.

Donor Insemination Treatment

Treatment essentially consists of insemination at the most fertile time of the menstrual cycle. The correct timing of insemination is essential, since sperm that have been frozen have a shorter lifespan than that of unstored sperm.

Ovulation can be detected by daily blood tests done at the fertility clinic, or by twice daily urine tests you can do yourself at home.

Insemination is carried out in the same manner as a routine vaginal examination; it is straightforward and painless. It will usually be done by a nurse, who will insert the speculum into the vagina, and place sperm into the mucus in the cervix, or into the uterus. You will be asked to rest for 5-10 minutes after the insemination.

Donor Insemination Pregnancy

The chance of becoming pregnant from any one cycle of donor insemination treatment is about 15-20%; couples without infertility have about a 20% chance, so donor insemination is almost as efficient as nature.

Overall about 70% will have a baby within six cycles. Donor insemination can be combined with IVF or GIFT, if donor insemination itself does not achieve a pregnancy.

Donor insemination will not affect your chances of having a normal pregnancy, a normal delivery, or a normal baby. However, every pregnancy carries risks, and donor insemination does not protect against these risks; you could still miscarry, or the baby could be born with a defect - but the chances of these happening are no greater than normal.