The use of donor sperm is a major decision and absolutely must be discussed by both members of a couple and agreed upon prior to initiating treatment. Indeed, both members of the couple will sign the consent for the donor insemination.
Anonymous donor sperm has a largely anonymous genetic heritage (certain medical information usually is available) so for some couples this an unrealistic option. The major biological difference in the use of donor versus a partnerís sperm appears to be one of carrying on the familyís ďgeneticĒ heritage (on the manís 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 elseís child if pregnant with donor sperm. The psychological issues should be carefully examined and discussed by the couple. Open communication is critically important.
Use of donor sperm does not guarantee a successful pregnancy outcome.
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 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 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.
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 manís 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 one couple typically only uses the designated donor. 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 patientís partner. The reason that specific testing is not required is that this is sperm that would be introduced into the womanís 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.