Therapeutic Donor Insemination (TDI)

The donation of semen for therapeutic insemination has been practiced in this country for many years resulting in the birth of thousands of infants each year.  Its use has steadily increased during the last few years due, in part, to its increasing acceptance as a recognized medical procedure and by a decrease in the availability of infants for adoption.

Medical Indications for Donor Insemination

 The major indications for donor insemination are:

• The husband is irreversibly sterile from any cause.

• The husband has had a vasectomy and does not want a reversal.

• The husband has a low or marginal sperm count, antisperm antibodies, or some other condition where the male factor is thought to be the predominant cause of the infertility and cannot be overcome by other means.

• The husband has or is a carrier of a known hereditary disease.

• The husband has problem with ejaculation that cannot be overcome by current technology.

• The wife is Rh-negative and severely sensitized to Rh-positive blood and husband is Rh-positive.

• Failed fertilization in Assisted Reproductive Technology (ART) procedures in couples with a male factor or unexplained infertility.

Making a Decision  

The decision to utilize donor inseminations is not an easy one.  There are many factors that the couple will need to consider before this decision can be made.  Possibly, the most difficult factor for the couple is the emotional acceptance of having a child with a different biological father than the husband.  Cultural background and religious beliefs will also influence this decision.  The couple can be referred for professional counseling, if necessary, during this decision-making process.

The Next Step

Once the couple has decided to utilize donor insemination, an appointment is made for the couple to meet with the physician or nurse to sign the consent forms, select the donor(s), and give a blood samples for laboratory tests.  The wife will also have a physical examination.

Consent Form

The couple considering the use of donor insemination must be fully informed about all aspects of the process and their consequences.  They then must sign an informed consent statement including the following:

• The husband is treated in law as if he were the natural father of the child and all children born shall be legitimate children and heirs to the couple’s estate.

• The couple will never seek to identify the donor, nor will the donor ever be able to identify the couple.

• There is no guarantee that insemination will result in a pregnancy. 

• A certain percentage of all children are born with physical or mental defects, and the occurrence of such defects is beyond the control of physicians.

• There is a very small risk of infection.

• Any pregnancy carries with it the risk of obstetrical complications of miscarriage.

• Semen from the same donor may not be available for all inseminations.

• Frozen sperm that has been quarantined for a minimum of 6 months will be used.

Husband Evaluation

The husband will have a clinical evaluation with review of his medical records.   Blood will be drawn to determine blood type and Rh factor and to determine if antibodies to HIV-I and II (AIDS virus) are present. 

Wife Evaluation

Routine medical and reproductive history and complete general physical examination will be performed.  Blood is drawn for standard preconception screening which includes blood type and Rh factor and rubella titer.  Her serum is also tested for cytomegalovirus (CMV), syphilis, hepatitis B & C, and HIV-1&2 antibodies.  A test called a CBC is done to help assess general health.  A cervical culture is taken to determine the presence of gonorrhea and Chlamydia infections.

Donor Selection

The Donor Selection Worksheet allows close matching of the donor(s) with characteristics of the husband and wife.  Then characteristics of both the husband and wife are determined; these include:  race, ethnic origin, blood type, height, weight, body, build, skin tone, eye color, hair color, and hair texture.  Six donors are chosen by the couple from the Cryobanks’ donor selection lists and prioritized 1 through 6 thus allowing alternative donor choices if a donor becomes unavailable.

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Cryobank Semen Donor Screening Procedures

Preliminary Evaluation:  All semen donors complete a medical and genetic history of themselves and family members.

Infectious Agent Evaluation:  Each donor’s semen specimen is tested for Chlamydia, mycoplasma, gonococcus, cytomegalovirus, adenovirus, trichomonas, candida and actinomyces.  Each donor is serologically tested for Hepatitis B surface antigen, Hepatitis C antibody syphilis, alanine aminotransferase, HTLV-I&II and HIV 1&2.

Medical and Genetic Evaluation:  Each donor has a complete physical examination by a physician.  The medical and genetic history is evaluated by staff physician including a clinical geneticist.  Jewish, Mediterranean and Black applicants are tested for tay-sachs, thalassemia and sickle cell anemia respectively.  All applicants are tested for cystic fibrosis.  In addition, all donors have a full karyotypic (chromosome) analysis.

Semen Analysis:  Each semen specimen submitted for analysis is measured for volume, pH, count, motility, progression, viability, abnormality, and white blood cells.  The specimens are frozen and small portion is subsequently thawed for post-thaw analysis. 

Post-Acceptance Testing:  Each Cryobank has its own standards for post-thaw analysis.  Each semen specimen is evaluated, individually, both pre-freeze and post-thaw.  Any specimen not meeting the minimum standard requirements is discarded.  Any semen specimen that does not meet the minimum post-thaw criteria of individual Cryobanks is discarded.    All specimens are quarantined six months for donor retest before release.  Donors are re-tested for HIV-1&2, and HTLV-I&II at 6-month intervals.

How the Insemination is Done:  The timing of the insemination is usually determined by means of an LH-surge kit, but may also include a blood test for estradiol level, and follicular ultrasound.  This insures accuracy and allows use of only one insemination, which is more convenient and cost-effective for the patient.  The frozen donor specimen is washed with a special medium, unless a “pre-washed specimen” is used, and intrauterine insemination (IUI) is performed.  Frozen donor semen may also be used during in vitro fertilization (IVF) and is prepared in a similar manner to fresh specimens.

Results:  The monthly conception rate, or chance of conceiving in one cycle, is 10% for unstimulated IUI cycles, and 20% for FSH-stimulated cycles using IUI and a donor specimen containing at least 10 million cryopreserved thawed motile sperm.  This compares well with the average conception rate of the “normal” population who are attempting pregnancy, which is between 20 and 25 percent.   The cumulative conception rate is the number of patients conceiving after a number of attempted cycles.  Assuming an average of 15% monthly conception rate for donor insemination, the cumulative conception rate would be 63 percent (or 63 out of 100 patients) conceiving after 6 months (6 attempts).

Resources: 

www.asrm.org/Patients/patientbooklets/thirdparty.pdf