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About donor insemination

About donor insemination

Thinking about getting infertility treatment?

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Fertility treatment through Artificial insemination with husband's (AIH) or donor sperm (DI) involves injecting the semen into the cervical canal (neck of the womb) at the time of optimum cervical mucus, which occurs immediately prior to ovulation.

Donor insemination

Donor Insemination (DI) is not a new technique. The earliest reports of this type of fertility treatment date back to the late 19th century when doctors performed the procedure in the greatest of secrecy!  The Human Fertilisation and Embryology Act of 1990 made it a legal requirement for all DI treatments to be documented at a central office.  
 
Donor insemination can help those who are fertile, under the age of 46 years, in good health and with no medical contraindications for pregnancy. Your FSH levels and body weight also need to be within normal range. The patient groups who seek donor insemination include:

  • Single women

  • Heterosexual couples where the male partner is infertile or has other problems with his semen
  • Heterosexual couples where the male partner is a carrier of hereditary disease that may be passed on to a child
  • Women in lesbian relationships

Counselling

The HFEA has determined that implication counselling is compulsory for patients undergoing treatment involving donated gametes.  Counselling gives patients a chance to explore the many complex issues involved in using donor sperm. Counselling can be broadly categorised as follows:

  • Implication counselling aims to enable you to understand the implications of the proposed course of action for you, your family and for any children born as a result of treatment.
  • Support counselling aims to give emotional support during times of particular stress.
  • Therapeutic counselling aims to help people cope with the consequences of infertility and treatment and to resolve the associated problems.  It includes helping people to adjust their expectations and to accept their situations.

The Welfare of the Child

The Human Fertilisation and Embryology Act 1990 states that before carrying out fertility treatment a clinic must “take account of the welfare of any child who may be born as a result of that treatment, (including the need of that child for a father), and of any child who may be affected by the birth”.

This means that before starting fertility treatment the clinic will ask you a number of personal questions, including your age, proof of identity and the medical histories of you and your immediate family.  In situations where the child will have no legal father, the clinic will pay particular attention to the prospective mother’s ability to meet the child’s needs throughout childhood. If you refuse permission, this will be taken into account by the clinic in considering whether or not to offer treatment.

Telling your child

You will be encouraged to consider telling your child about his or her origin as a result of donor insemination. He or she will have the legal right at the age of 18, upon application to the HFEA and after the opportunity for the appropriate counselling to find out whether he or she has a genetic parent different from his or her legal parents.

The treatment

Prior to starting treatment you should be given a full explanation of your programme and provided with a written protocol to which you can refer during treatment. Donor Insemination can either be used in natural cycles or stimulated cycles.  You must have a full bladder at the time of insemination.

Intrauterine insemination (IUI) – natural cycle

An ovulation predictor kit and/or ultrasound are used to monitor ovulation and gauge the time of insemination in a natural cycle.  No medications are required.  Ultrasound, if used, measures the growth of the follicles and is performed internally by placing a slim probe into the vagina.  The scan lasts less than five minutes and it is necessary to empty your bladder prior to the scan.

At the time of insemination, washed and prepared sperm is placed into the uterus by passing a very fine catheter through the cervical canal.  Bypassing the cervical canal decreases the dependency on mucus conditions and increases the success rate.

Sperm donors are screened for sexually transmittable agents (including HIV) and genetically inherited diseases. Sperm are frozen and quarantined for a minimum of six months, at which point the test for HIV is repeated prior to use.

Characteristics that can be matched, if required, to a male partner are eye and hair colour, ethnic background and blood group. In all cases using donor sperm, the patient can receive a brief physical profile listing such characteristics.

IUI with superovulation – stimulated cycles

This treatment offers a higher success rate than ‘natural cycle IUI’.  Patients are scanned and medication is given, either orally or by injection, to stimulate the cycle.  Deciding factors when choosing a treatment option will depend on the age of the patient, clinical history and previous treatment responses.

Either Clomid tablets, 50 - 100 mgs from days 2 - 6, or FSH/ hMG injections are used to simulate the ovaries.  FSH/hMG subcutaneous injections (into fatty tissue) are given, daily or on alternate days.  The aim is to allow the ovaries to produce up to a maximum of three large follicles.  Several vaginal scans are performed to monitor follicular growth.  Insemination is performed at around the time of ovulation, which is triggered by giving an injection 40 hours prior to IUI.

The risk of multiple pregnancies increases when undertaking stimulated cycles of treatment.

Pregnancy following Donor Insemination 

The progress and outcome of a pregnancy resulting from donor sperm carries no greater or lesser risk than a pregnancy resulting from unassisted conception.  Donor insemination does not protect you from miscarriage, an ectopic pregnancy or the possibility of a birth defect, but the chances of these are no greater than usual.

If you wish to purchase sibling stock (sperm from the donor used for your successful cycle) for use in future pregnancies, it may be possible to arrange this following a successful twelfth week scan.

Some donors provide further written information – a pen sketch - about themselves (further information from what is required on the HFEA forms).  You can apply for this information on behalf of your child once you have delivered your baby.

Disadvantages

Legal Aspects / Parental Responsibilities

The donor has no legal claim on any child resulting from treatment with his semen.

For married heterosexual couples, any child born to a woman following donor insemination will be legally the child of the male partner who is treated with her, unless at the time of treatment:
The man and woman are judicially separated.
It is proven that the husband did not consent to his wife undergoing the procedure of intrauterine insemination using donor sperm, and he was not receiving treatment services with the woman.

For unmarried heterosexual couples, or couples who have undergone a judicial separation, the male partner will be the legal father if he gives written acknowledgement agreeing to treatment as a couple.

However, where an unmarried couple is being treated, the male partner will not have “parental responsibility”.  Parental responsibility can be defined as all the rights, duties, powers, responsibilities and authority, which by law a parent of a child has in relation to the child and his property, (Section 3(1) Children’s Act 1989). In order to obtain parental responsibility, the father may apply to court for these rights, or the father and mother may make ‘a parental responsibility agreement’ to allow for the father’s parental responsibility to the child.

The clinic must document the presence of the male partner at each appointment.

Donor sperm

All donors are carefully selected according to the rules laid down by the British Andrology Society and the Human Fertilisation and Embryology Authority (HFEA), which licences and regulates all centres that practice donor insemination.

All donors must comply with the following criteria:

  • Have good sperm counts
  • Aged between 18 & 45 years
  • Be in good health
  • No personal or familial history of inherited disorders
  • No current infection of a sexually transmitted disease

All donors are interviewed and a detailed medical history obtained before they are taken onto the donation programme.  Donors are initially screened for sexually transmitted diseases and the common genetic disorders.  Furthermore, every donor is regularly screened, including tests at three months for chlamydia and bloods every six months.  Every sample produced must be quarantined for 6 months and the donor screened again before the original sample can be used.

You should be provided with a donor characteristic request form at your nurse consultation and a donor with your chosen ethnic origin can be selected.  Attempts will normally be made  to match physical characteristics where possible.  At the start of a treatment cycle you will normally be provided with two choices of donors from which you may indicate your first preference.  A donor choice is normally provided as back up in order to avoid disappointment.

If your first preference of donor is unavailable at the time of transfer, the second choice will be used.  It is possible for donors to become unavailable for the following reasons:

  • Donor decides to leave the programme
  • Donor fails screening
  • Donor’s sperm has achieved 5-6 ‘birth events’ (twins and triplets count as one) and the outcome of other treatments is awaited, so the donor is ‘on hold’
  • Donor has reached his ten live ‘birth events’ limit
  • CMV negative donors might not always be available (please check with staff before starting your treatment).  Acceptance of CMV sperm (by disclaimer) increases a patient’s choice.
  • A particular donor’s sperm is not effective on a number of cycles
  • Donor dies and posthumous consent is unavailable

The limit of live birth events may be exceeded only in exceptional cases when a recipient wishes to have a subsequent child from the same donor.

Patient and donor confidentiality

The HFEA keeps a confidential register of information about donors, patients and treatments. This register was set up on 1st August 1991 and therefore contains information concerning children conceived from licensed treatments from that date onwards.

As from the year 2008, people aged 16+ (if contemplating marriage) or 18 who ask the HFEA will be told whether or not they were born as a result of licensed assisted conception treatment, and if so, whether they are related to the person they want to marry.  As the law now stands for children conceived before April 1, 2005, that is the only information that will be disclosed by the HFEA.

From 1st April 2005, the Human Fertilisation & Embryology Authority (HFEA) requires all gamete donors to provide identifying information. This information will enable the HFEA to inform a donor in the future of any enquiries made by a child that has been born following a donation when that child reaches the age of 18.  The enquiries can be made by the offspring only, not by the sperm donor recipient.  The HFEA will not disclose any information without first contacting the donor.  A donor is made aware of births resulting from his donation.  

Thinking about getting infertility treatment?

Download our free PDF guide

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