Donor insemination (DI) treatment involves the use of sperm from an anonymous donor. Donor sperm may be recommended where the male partner’s semen is unsuitable for treatment, for the following reasons:

  • Complete absence of sperm – known as azoospermia
  • Very low sperm count/or motility
  • Ejaculatory failure (including paraplegia)
  • Genetic factors e.g. cystic fibrosis

DI may also be recommended if you are a single woman or you are in a same sex relationship (lesbian). The law requires that everyone has to undergo an assessment at a licensed fertility clinic before treatment may be offered.

What does DI treatment involve?

DI involves the use of sperm from a donor. A technique known as intrauterine insemination (IUI) is used. This is the placing of a prepared sample of donor sperm into the cavity of the uterus (the womb), using a fine tube which is passed through the cervix (the neck of the womb). The procedure is usually straightforward and painless, requiring neither anaesthetic nor hospital stay, other than perhaps resting for 15 – 20 minutes following the insemination.

DI is performed during the fertile period each month. This is likely to be the middle of the woman’s menstrual cycle. Whilst the woman may observe a change during this fertile period, blood or urine hormone tests, or ultrasound scans are usually used to establish the most suitable time for insemination.

So far, the treatment discussed above assumes that the woman has a regular monthly menstrual cycle, suggesting regular monthly ovulation. For women with irregular or infrequent menstrual periods, ovulation may be unpredictable and infrequent. It may therefore be appropriate for these women to have drug treatment to stimulate the ovaries to produce one or more eggs.

In order to ensure accurate timing of insemination, and to reduce the risks of ovarian stimulation, ultrasound scans are required to monitor the development of ovarian follicles (within which eggs mature) in women receiving stimulatory drugs. The number of scans required will depend on the woman’s response to the various drugs. The details of the treatment regime will be fully discussed and explained at the time of the clinic appointment.

About the donors

Sperm donors are men aged between 18 and 41 with a relatively high sperm count. Each donor is carefully selected and has to undergo health screening, which includes obtaining a personal and family medical history. All reasonable steps are taken to prevent passing-on of serious genetic disorders. In most situations, this is served by taking a thorough family history. In this respect, blood tests are also carried out for chromosome patterns and for carrier status for cystic fibrosis.

All donors also have blood tests to check for infections such as Hepatitis B and C, and another for HIV, the virus that can lead to Acquired Immune Deficiency Syndrome (AIDS). Due to the need to exclude HIV infection, all donor semen samples are deep-frozen for a quarantine period of at least 6 months before release for treatment, after the donors have had a repeat negative blood test. This means that you are protected with almost certainty from such infection.

Many patients ask if there is any chance of suffering from any other sexually transmitted infection following donor insemination. Although no guarantee can be given, the chance of this happening is very small. Similarly, despite all reasonable efforts made to exclude the possibility of heritable conditions, DI treatment does not protect the baby from having some form of congenital defects. The risk of this developing is no greater than if donor sperm were not used. It should also be borne in mind that every pregnancy carries some risks, regardless of whether donor sperm is used or not.

All sperm donors are informed of the possibility that a child born disabled as a result of a donor’s failure to disclose defects, about which he knew or ought to have known, may be liable to damages in a court of law.

We aim to have a wide range of donors to match physical characteristics as closely as possible with the recipient. These characteristics include skin colour, eye colour, hair colour and body build. Apart from physical characteristics, blood type and cytomegalovirus status are also taken into consideration. However, this matching requires a large and constant source of donors and it may, therefore, be difficult to provide a perfect match.

The number of families resulting from the use of sperm of each donor is restricted by law to no more than 10. Once this number is reached, the donor sperm will no longer be available for use for couples outside of these families. This is largely to reduce the likelihood of marriage between two people conceived by the same donor. As donors are allowed to be responsible for siblings within one family unit, it is advisable for couples wishing to have further pregnancies by DI after a successful outcome, and who would prefer to use the same donor, to let the Fertility Centre know of their interest (as soon as possible once the first pregnancy is well established) so that sperm may be reserved for future use.

It should be borne in mind that donors are allowed to withdraw or vary their consent regarding the use of their sperm. This can be done at any time before the insemination procedure (in the case of IUI treatment) or before embryo transfer (in the case of IVF treatment). Couples or women who have reserved sperm in storage will no longer be able to use the designated sperm once the consent of the donor has been withdrawn. These couples will be offered sperm from another donor.

There is also a statutory maximum storage period of 10 years, after which the stored sperm must be destroyed. Donors may also stipulate any period of storage up to a maximum of 10 years. In addition, the storage facility could fail. For these reasons, no guarantee could be given to provide full siblings.

Anonymity of sperm donors

Sperm donors give their characteristics (hair, skin and eye colour; blood group, etc) which will be provided to the recipient couple. Any further voluntary information they choose to provide (e.g. occupation, hobbies, religion, hand-drawn profile) may also be given to the recipient couple. All donors are required to provide this information as well as their names, addresses at the time of birth and at the time of the donation. They will also be required to keep the HFEA updated as to changes of address. Their names and addresses will not be available for the recipient patient but will be held on record by the HFEA and may be released to any child born as a result of their donation if they request it when they reach the age of 18. This does not entitle the child to have any legal claim on the donor’s estate, nor does it allow the donor to have any legal, material or emotional claim on the couple or the child.

Chances of success

Pregnancy is most likely to occur within the first 6 months of treatment and becomes less likely in subsequent cycles.

It is important to realise that it is not unusual to have to wait 6 months or more because of the chance nature of fertility. The treatment will be reviewed periodically to identify ways of improving the chance of success. If pregnancy does not occur within a reasonable time, it will be necessary to consider whether any additional factors are present. Further investigations or more technical treatments may be required.

Generally speaking, women below the age of 30 have a higher success rate and those above the age of 40 significantly lower.

Pregnancies

If you become pregnant it is important to keep the centre fully informed. Not only it is of personal interest to us, it is also a legal requirement. It is necessary to keep a check on the outcome of the use of sperm of each donor, and to ensure that the legal limit on the number of families from each donor has not been exceeded. Please make a special effort to give us all the necessary information including the outcome, even if a pregnancy ends in miscarriage.

Once you have conceived through DI, your pregnancy should follow a normal course. Having DI will not affect your chance of having a normal pregnancy, a normal delivery and a normal baby. However, every pregnancy carries some risks. Routine antenatal care is needed:

  • For any licensed treatment (including the use of donor sperm) the patient’s/recipient’s name must be registered with the Human Fertilisation and Embryology Authority (HFEA).
  • The identities of sperm donors must be registered (see above)
  • Each cycle of treatment started must be registered, and a fee is charged by the HFEA. The fee applies at the time of insemination
  • The Clinic is not allowed to pass on information about your treatment directly to any doctor, except in another licensed centre or in an emergency, without your written permission. You will be given a form to complete, so that the clinic has your consent to disclose information to named person(s). Otherwise, you will be asked to pass on copies of correspondence to your doctors in person. It should be appreciated that keeping your doctors informed of your treatment is a very important part of your care
  • The Act recognises and emphasises the need to make available an independent counsellor, to help couples consider all possible options they might consider in their lives, not just the pursuit of having a child.

Counselling

Before starting DI treatment, all patients are required to receive counselling, which is provided free of charge. Counselling provides an opportunity to discuss with an impartial person any concerns you may have about your treatment. It is part of your initial consultation and decision-making process. Further counselling is available to you at any stage of your treatment.

The HFEA Code of Practice sets out the types of counselling that should be available through all licensed clinics. This includes:

  • Implications counselling: to enable the people concerned to understand the implications of the proposed course of action for themselves, their family and any children born as a result. This may be particularly relevant for people considering treatment with donated sperm. This may also include genetic counselling.
  • Support counselling: to give emotional support at times of particular stress, e.g. when there is a failure to achieve pregnancy.
  • Therapeutic counselling: aims to help people to cope with the consequence of infertility and treatment and resolve the problems these may cause. It includes helping people to adjust their expectations and to come to terms with their situation.

Apart from counselling offered by the clinic, it may also be helpful for you to contact one of the national support groups who may be able to put you in touch with others who have had DI treatment.