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Psychological challenges

Single women

Gay couples

Workup and therapy


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Donor Sperm Insemination
Therapeutic Donor Insemination

The use of donor sperm to achieve pregnancy in the setting of no sperm or poor sperm in the male partner is a very old technology. Prior to the 1980's almost all donor insemination programs utilized fresh sperm. However, because of concern about transmitting AID's and hepatitis almost all sperm used for donor insemination today has been cryopreserved.

For more than a decade, there have been well established standards for evaluating and testing donors who are willing to provide sperm for this use. A few years ago, the FDA codified these standards as part of their objective of making all donor products safer for the recipient. Today all sperm available for donor insemination has been collected by a small number of commercial sperm banks. Donor sperm from these sources is safer than it has ever been before. It is still a human product and there will always be "unknowns" associated with it. Sperm is obtained from well evaluated and well tested donors and it is cryopreserved. Prior to release of that sperm for use in patients, the donors are again retested for AIDS and Hepatitis (as well as other infectious diseases).

One unintended effect of the need to cryopreserve sperm prior to use in donor insemination is that it is more difficult to achieve pregnancy with sperm that has been cryopreserved as opposed high quality fresh sperm. We feel that this problem can be overcome by utilizing intrauterine insemination as a component of the donor insemination program and by actively managing ovulation. Our approach is based on our experience, some of which has been published. [ bibliographical reference ] When donor insemination utilizes intrauterine insemination as opposed to cervical insemination our pregnancy rate was two and one-half to three times higher. Intrauterine insemination with actively managed ovulation also makes a cycle less expensive in that it suffices to use a single insemination. Older methods utilizing cervical or vaginal insemination usually required multiple sperm inseminations to work. Since donor defrosted sperm does not survive as long in a woman's cervical mucous as does fresh sperm, poorly timed donor insemination is likely a waste of time and money.

Psychological challenges of using donor sperm

The primary issues related to donor insemination are psychological. Is the couple comfortable with this form of therapy? In our experience many couples are initially not comfortable with the idea of donor insemination. The process of coming to terms with the need for donor insemination can sometimes take a long time. I have taken care of many male factor couples who were not ready for donor insemination when the issue was first raised, but who returned several years later finally ready for this therapy. The availability of IVF with ICSI makes the decision to use donor sperm more difficult since ISI can overcome almost all male factor problems. For couple with the potential to use ICSI, the decision to use donor sperm is a cost related or more practical solution to their problem.

Single women

The psychological issues are different for single women and for gay couples. These individuals usually are ready to begin donor insemination therapy when I see them in my practice. The single woman typically has known for a long time that having a child was an important life objective for her. Usually she is in her mid-thirties, recognizes that her potential fertility is time limited, and has not yet found a suitable partner. She has come to accept this situation and prior to undertaking donor insemination therapy, has worked out plans to provide support for her future child usually including family support to enable her to continue working. Before seeing me, she has come to terms with using donor sperm and has also competently accepted the difficult future tasks of single parent child rearing.

Gay couples

Gay couples have also usually thought through the issue of using donor sperm and are ready to begin. They usually have been discussing the possibility of having a baby for some time and have worked out plans for rearing that child. Sometimes their plans are quite creative and utilize the many options they have available to them. Several of our patient's partners have successfully adopted their children (even in Pennsylvania).

Workup and therapy

Generally, our approach to couples desiring donor insemination is to obtain a complete history and perform a physical examination. Most of the time that evaluation suggests that the couple is normal with the exception of not having sperm. We then undertake four trials, attempting pregnancy using donor sperm. If the couple is not pregnant after four tries, we then move to a more complete infertility work-up. If that work-up is negative, we usually next move to superovulation.

Over the years our pregnancy rate per cycle of donor insemination has been approximately 20%/cycle overall. Gonadotropins were used in those patients who did not achieve pregnancy. The pregnancy rate without gonadotropins was 13%/cycle. With gonadotropins it was 26%/cycle.