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Donor insemination treatment (DI) involves the use of sperm from an anonymous donor.
DI may also be recommended if you are a single woman or you are in a same sex relationship.
The law requires that everyone have to undergo an assessment at a licensed fertility clinic and that counselling is offered before treatment may be offered.
Full medical, family and social history, and physical examination will be performed on the day of the appointment. An ultrasound will also be carried out. It may be appropriate in some women to organise some preliminary investigations before treatment, perhaps via their general practitioner. Alternatively, these investigations can be arranged through the Fertility Centre, which may incur a cost.
It is important for the woman to ensure she is immune to rubella (German measles) before starting a pregnancy – this can be checked by a simple blood test. The woman's ability to ovulate (produce and release an egg) is crucial to the success of DI treatment and can be confirmed by hormonal blood tests, urine test kits, or ultrasound scans, or a combination of these tests. It is also necessary to have blood antibody test for the common infection of cytomegalovirus (CMV). The woman's blood group is also required (mainly for “matching” purposes).
A test of the fallopian tubes is not essential at the start of the treatment, unless there are concerns due to past pelvic infections, appendicitis leading to peritonitis, or past pelvic surgery. It should be arranged, however, if the woman does not conceive within a reasonable time.
It is important to look after yourself before and during treatment. Smoking has a negative effect on your fertility, general health and the health of your baby. Similarly, excessive alcohol drinking is detrimental to fertility and pregnancy. These should therefore be best avoided. It is also advised that all women undergoing fertility treatment should take folic acid supplements before and during the first 12 weeks of pregnancy. This minimises the risk of having a baby with spina bifida (spinal defect).
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. A urine kit is most commonly used to detect the surge of LH hormone that occurs 24 hours before ovulation (release of egg).
So far, the treatment discussed above assumes that the woman has 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.
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). It is because of the need to exclude HIV infection that 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 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. If treatment is successful and you wish to have further pregnancies it is important to let the Fertility Centre know that you wish to purchase further donor sperm (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 consent of the donor has been withdrawn.
There is also a statutory maximum storage period to a maximum of 55 years, after which the stored sperm must be destroyed. It should be bourn in mind that a donor may have chosen to consent to a period of storage which is considerably less than this. You should check the period of consent when purchasing donor sperm.
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.
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.
The HFEA Code of Practice sets out the types of counselling that should be available through all licensed clinics. This includes:
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.
The new Human Fertilisation and Embryology (HFE) Act 2008 clarifies the situation of parenthood in relation to partners in a marriage or civil partnership, and to partners outside of these arrangements.
In a marriage or civil partnership, the partner (male or female respectively) of the woman receiving donor sperm treatment, will be treated as legal parent of any resulting child, unless:
If a couple are not married or in a civil partnership at the time of treatment, the partner (male or female) of the woman receiving donor sperm treatment can be treated as the legal parent of any resulting child if, at the time of treatment:
A partner (husband, civil partner or other partner) who has not provided sperm for the treatment of their wife or female partner can be registered as the father or parent of any child born as a result of treatment after their death, if the following conditions are met:
It should be understood that there is a difference in law between the legal status of “father” or “parent” and having “parental responsibility” for a child. In any case in which people seeking treatment have doubts or concerns about legal parenthood or parental responsibility for a child as a result of treatment services, it is advisable to seek legal advice.