Anonymous donor sperm has a largely anonymous genetic heritage
(certain medical information usually is available) so for some
couples this an unrealistic option. The woman inseminated with
donor sperm will carry and deliver the pregnancy so the major
biological difference in the use of donor versus a partner's sperm
appears to be one of carrying on the family's "genetic"
heritage (on the man's side). Despite the relatively straightforward
biological difference with the use of donor sperm many psychological
factors may be involved. A man may feel as though a part of his
manhood is related to his ability to achieve a pregnancy. A woman
may feel that she is carrying someone else's child if pregnant
with donor sperm. The psychological issues should be carefully
examined and discussed by the members of the couple. Open communication
is critically important. In a couple that is comfortable with
using donor sperm, the relatively easy access to donor sperm and
the ease of performing inseminations makes this a valued alternative.
Use of donor sperm does not guarantee a successful pregnancy outcome.
All donor sperm is frozen and quarantined for at least 6 months
to allow for appropriate testing of the male donor for infectious
diseases. The screening process that the donor undergoes should
also be as rigorous as possible to assure the best chance for
a healthy outcome. The Board of Health has guidelines concerning
minimally acceptable testing, yet many sperm banks will test the
donors far in excess of these minimal requirements. The testing
that is performed on donors for any particular sperm bank should
be carefully reviewed before accepting that sperm.
The process of freezing and thawing sperm decreases the fertilization
ability of donor samples when compared to equivalent fresh sperm.
Good quality fresh sperm has about a 15-20% per cycle success
rate of achieving a pregnancy while good quality frozen thawed
sperm has only about a 5-10% chance. In one report of 3000 donor
cycles with IUI the success rates for pregnancy were 21% at 3
months, 40% at 6 months and 62% at 12 months.
It is also important to realize that the chance of having a child
born with a congenital abnormality is not decreased (despite the
extensive testing) over the general population when donor sperm
is used. Therefore, a couple maintains a 4-5% chance of a birth
defect in their child whether donor sperm is used or not.
Donor sperm is generally anonymous. If there is a specific man's
sperm that the couple is interested in, designating a donor is
possible as long as the same stringent criteria are used to screen
the known donor while the sperm is frozen and quarantined. This
testing can be quite expensive since the designated donor is typically
only used by one couple. Determining cost by calling the sperm
bank that would perform the testing and quarantine the sperm is
advised if a designated donor is being considered.
Occasionally a couple will request a family member donate sperm
and suggest that fresh sperm be used to improve the success rate.
The only fresh sperm that is appropriate for IUI is from the patient's
partner. The reason that specific testing is not required is that
this is sperm that would be introduced into the woman's body during
normal relations without testing. Despite a possible close and
trusting relationship with anyone else (say brother, father, friend)
there is a responsibility to assure the safety of the woman being
inseminated since it uses sperm that would normally not be present
in the patient.
The decision of whether to use anonymous or designated known donor
sperm should be discussed carefully by the couple. It may be helpful
to further identify and review the important issues with a professional
counselor or psychologist prior to proceeding. If thoroughly considered
and accepted the use of donor sperm is usually rewarding. In fact,
research suggests that there is a decreased divorce rate in donor
families and that about 50% of donor parents are comfortable enough
to tell the child that donor sperm was used.
Intracervical insemination (ICI) can be attempted for 2-3 cycles
and then IUIs if unsuccessful. Since ICI is not significantly
easier or less expensive, I generally prefer to start with the
more direct and successful IUI.
Related Topics: Sperm