What is Donor Insemination?
Donor insemination (DI) is the injection of donated sperm into the womb of women whose partners are unable to produce or have no sperm. Approximately 10,000 cycles of DI are performed in the UK every year. The treatment is regulated by the Human Fertilisation and Embryology Authority (HFEA) in the UK and is strictly monitored.
Who can donate sperm?
Any healthy man that is free of genetic or transmittable diseases can potentially be a sperm donor. Potential donors undergo a screening process that includes a detailed history and examination. Investigations include blood tests to check their chromosomes and exclude infections like HIV, hepatitis, syphilis and cytomegalovirus, and urethral swabs to check for sexually transmitted diseases like gonorrhoea and chlamydia. The maximum number of children that any particular sperm donor is allowed to father varies around the world and is currently 10 in the UK.
Who needs donated sperm?
In a small proportion of couples that have difficulty conceiving, the man may not be producing any sperm at all. This may be due to problems the man is born with or it may develop for no reason, or following infection, medical treatment or surgery. Some men may have a genetic abnormality that makes them infertile or that they do not wish to pass on to their children.
How is it performed?
Both the sperm donor and receiving couple will usually need to undergo detailed assessment and counseling before undergoing treatment. The female partner will need some tests to determine her fertility, as she will need to have regular ovulation and open fallopian tubes.
The donated sperm is washed in a special medium and frozen in little tubes for a period of six months. At the end of this period the donor has to undergo a further series of screening blood tests for infections before the sperm can be used for treatment. The characteristics (including height, weight, eye and hair colour, skin tone and blood group) of the sperm donor and couple receiving the treatment are matched as closely as possible.
Donor insemination is usually performed around the time of ovulation in natural cycles of the woman receiving the donated sperm. The woman may be monitored by blood or urine tests to detect when ovulation occurs and the insemination performed one or two days later. Some units do not monitor women in this way but instead perform two or three inseminations at two-day intervals around the mid-point of the cycle. Some other units use medicines to stimulate the ovaries to produce up to three eggs before the insemination.
The defrosted sperm is sucked into a syringe that is attached to a small soft tube. With the woman lying on her back, the tube is passed into the womb through its neck and the sperm injected into the womb. The woman continues to lie down for another half-hour after the insemination.
How successful is it?
The chance of achieving a pregnancy varies widely between units. The average chance of a couple in the UK achieving a child from each cycle of DI treatment is 1 in 10. This can vary from 1 in 5 in some units to 1 in 20 in others. The use of medicines to further stimulate the ovaries in these women does not appear to greatly increase the chance of achieving a child. The HFEA publishes a guide to UK clinics that offer DI treatment every year and interested couples may obtain a copy of this by telephoning 0207 377 5077.
Donor insemination has some ethical implications that all who decide to have the treatment need to be aware of.
- Payment of donors – this is a contentious issue and the law varies from country to country. The family doctor, gynaecologist or infertility specialist will usually be able to advise couples of the current legislation governing this form of treatment in their different localities. The current legislation in the UK holds that sperm (indeed any body tissue) donation should be performed altruistically and not attract any form of payment, except where this is to cover reasonable expenses incurred by the donor in the process of the donation. UK sperm donors have thus traditionally received £15 at the time of each donation to cover their expenses (travel etc.).
- Anonymity – the regulations governing this again vary according to country. Legislation in the UK has recently changed to give offspring of donor insemination cycles the right to find out the identity of their genetic parents once they reach their eighteenth birthday.
- Legal parents – the legislation governing this may again vary from country to country and couples need to seek guidance from their healthcare providers about local regulations. Current legislation in the UK holds that the man and woman receiving the treatment are the legal parents of any child that results. For unmarried couples, the man is not automatically awarded legal parent status and has to apply for this through the courts, as does any man who has a child outside wedlock.
- Informing the child – there is no legal requirement for couples that have been successful with this treatment to inform the children of their origin. However, most clinics now recognize that children have rights to know about their conception. Some units arrange some sort of yearly reunion for children born from this and other forms of assisted conception treatment (including DI, IVF and ICSI) to reinforce the normality of such children. Counselling is available at all licensed clinics to discuss the implications of using donated eggs and embryos.
- Donor Network, P.O. Box 265, Sheffield S3 7XY. Tel. 020 8245 4369
- British Infertility Counsellors Association (BICA), 69 Division Street, Sheffield. Tel. 01342 843 880
- Human Fertilisation and Embryology Authority (HFEA), 30 Artillery Lane, London E1 7LS. Tel. 020 7377 5077