Donor insemination treatment (DI)

Prior to treatment with donor sperm, all patients are seen for a consultation. An appointment for counselling is also arranged.

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 involves the use of sperm from a donor. A technique known as “intrauterine insemination (IUI)” is used. This is the placing of a prepared sample of donor sperm into the cavity of the uterus (the womb), using a fine tube which is passed through the cervix (the neck of the womb). The procedure is usually straightforward and painless, requiring neither anaesthetic nor hospital stay, other than perhaps resting for 15 – 20 minutes following the insemination.

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.

Sperm donors are men aged between 18 and 41 with a relatively high sperm count. Each donor is carefully selected and has to undergo health screening, which includes obtaining a personal and family medical history. All reasonable steps are taken to prevent passing-on of serious genetic disorders. In most situations, this is served by taking a thorough family history. In this respect, blood tests are also carried out for chromosome patterns, and for carrier status for cystic fibrosis.

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.

Sperm donors give their characteristics (hair, skin and eye colour; blood group, etc) which will be provided to the patient(s). Any further voluntary information they choose to provide (e.g., occupation, hobbies, religion, hand-drawn profile) may also be given available. All donors are required to provide this information as well as their names, addresses at the time of birth and at the time of the donation. They will also be required to keep the HFEA updated as to changes of address. Their names and addresses will not be available for the patient, but will be held on record by the HFEA and may be released to any child born as a result of their donation if they request it when they reach the age of 18.  This does not entitle the child to have any legal claim on the donor's estate, nor does it allow the donor to have any legal, material or emotional claim on the couple or the child.

Pregnancy is most likely to occur within the first 6 months of treatment, and becomes less likely in subsequent cycles.

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.

• For any licensed treatment (including the use of donor sperm) the patient's/recipient's name must be registered with the Human Fertilisation and Embryology Authority (HFEA)
• The identities of sperm donors must be registered (see above)
• Each cycle of treatment started must be registered, and a fee is charged by the HFEA. The fee applies at the time of insemination
• The Clinic is not allowed to pass on information about your treatment directly to any doctor, except in another licensed centre or in an emergency, without your written permission. You will be given a form to complete, so that the clinic has your consent to disclose information to named person(s). Otherwise, you will be asked to pass on copies of correspondence to your doctors in person. It should be appreciated that keeping your doctors informed of your treatment is a very important part of your care
• The Act recognises and emphasises the need to make available an independent counsellor, to help couples consider all possible options they might consider in their lives, not just the pursuit of having a child

Before starting DI treatment, all patients are required to receive counselling, which is provided free of charge. Counselling provides an opportunity to discuss with an impartial person any concerns you may have about your treatment. It is part of your initial consultation and decision-making process. Further counselling is available to you at any stage of your treatment.

The HFEA Code of Practice sets out the types of counselling that should be available through all licensed clinics. This includes:

• Implications counselling: to enable the people concerned to understand the implications of the proposed course of action for themselves, their family and any children born as a result. This may be particularly relevant for people considering treatment with donated sperm. This may also include genetic counselling
• Support counselling: to give emotional support at times of particular stress, e.g., when there is a failure to achieve pregnancy
• Therapeutic counselling: aims to help people to cope with the consequence of infertility and treatment and resolve the problems these may cause. It includes helping people to adjust their expectations and to come to terms with their situation.

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 Family Law Reform Act 1987 reflects the Warnock Committee's recommendations that a married woman gives birth to a child following DI treatment – and both she and her husband have consented to the treatment – the child should be treated in Law as their child and the husband registered as its father.

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:

• a separation order was in force, or
• it is shown that the husband or civil partner did not consent to the placing in the woman of sperm and eggs, or embryos, or to her insemination

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:

• both the woman and the partner (male or female) have given written and signed notice to the centre consenting to the partner being treated as the parent of any resulting child. There are specific HFEA consent forms for the woman and her partner (Consent forms PP & WP) which have to be completed prior to treatment; otherwise parenthood of the partner could be questioned in law
• neither of these consents has been withdrawn
• the woman has not given any subsequent consent to any other man or woman being treated as the legal parent of any resulting child, and
• the woman and her partner are not within prohibited degrees of relationship to each other.

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:

• the treatment involved the transfer to the woman of an embryo after the death of the partner
• the embryo was created when the partner was alive
• the partner had given written consent for the embryo to be placed in the woman after their death
• the partner had given written consent to being registered as the father or parent of any resulting child
• the woman elected in writing, within 42 days (21 days in Scotland) after the child's birth, for the partner's details to be entered in the relevant register of births, and
• no one else is to be treated as the father or parent of the child

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.