What is donor insemination?
Donor insemination (DI) is the process of inseminating a woman with sperm obtained from a known or anonymous donor. The procedure is usually performed in natural cycles without the use of any fertility medications. However, fertility medication may be recommended for women in their late 30’s and older, and for those who have been unsuccessful with donor insemination in natural cycles, in order to increase the number of eggs for fertilization.
If insemination with donor sperm is unsuccessful, or if there are other fertility factors that indicate the need, in vitro fertilization (IVF) with donor sperm may be performed.
Using Donor Sperm. Those who may choose to use donor sperm include:
- Single or lesbian women
- Those whose male partner has no recoverable sperm
- Those who may want back up specimens for difficult cases of male factor infertility
Sperm donors may be known or anonymous. The type of donor one chooses is a highly personal decision, and will depend on any number of factors. Regardless of the type of donor chosen, various considerations and requirements apply.
Some women may choose to ask a friend to donate sperm. Because this option may raise sensitive questions and decisions in regards to parenting, a number of actions are required prior to receiving a sperm donation:
- Counseling. Pacific Fertility Center requires that both parties involved in donor insemination attend at least one session of counseling with a family therapist or psychologist familiar with issues that may arise in this type of arrangement.
- Sperm Donor and Intended Parent Legal Agreement. Prior to insemination, the female patient and donor must create a valid and notarized legal agreement or contract outlining parenting rights and responsibilities.
- PFC strongly encourages both donor and recipient to seek legal advice before the insemination process.
State of California legal requirements:
- According to California law (Family Code 7613), if a physician performs an insemination with donor sperm, the provider of that sperm is considered a donor and does not have any parental rights or responsibilities.
- Both sperm donor and recipient are required to sign an acknowledgement of California Family Code 7613, regardless of whether or not the donor is planning to participate in parenting.
- Even in the event that the sperm donor may play some parental role, Family Code 7613 may supersede any such agreement.
- Any other understandings between the donor and recipient of the donor sperm, even when a legal agreement is drafted, may or may not be enforceable in California.
Those patients who use anonymous donor sperm obtain frozen samples from licensed sperm banks, which must be located in the United States. Pacific Fertility Center does not own or run a sperm bank, however we are able to assist you in finding this resource.
Sperm banks can vary widely with regard to donor information, identity, ethnicity and medical history; as well as in the number of available donors. Most banks do not provide a picture of donors. Some sperm banks may have a provision for allowing future contact (release of identification) between adult donor sperm offspring and the donor. Some may allow identification in the case of a medical need.
Sperm Bank Procedure. Certified sperm banks must meet specific requirements for donor screening. In order to virtually eliminate the risk of disease transmission, sperm is quarantined. In this process, the donor is tested for infectious disease. Donated sperm is then frozen and held at the sperm bank for six months. The donor is re-tested for infectious diseases before sperm is provided to clinics and patients.
Our patients may choose most any certified sperm bank. Patients are responsible for selecting the given donor and paying the sperm bank directly for the sperm and shipping.
Women may have to peruse the donor lists at several banks before finding the donor you want. We cannot advise as to which donor to use, as this is a very personal choice.
The blood type of the donor would only matter if the patient were using donor sperm in a case where the intended father has no sperm and you would wish that the future child not know that a donor was used. In this case, it might be wise to use a donor whose blood type matches that of the intended father.
We do recommend that patients pay attention to the sperm quality guaranteed by the bank when choosing. Patients will see a wide variation in the minimum number of motile (swimming) sperm that banks provide. We encourage our patients to work with banks that assure a minimum of 15 million motile sperm per vial after they have been thawed.
Most patients attempting to conceive with donor sperm will begin with intrauterine insemination (IUI). Particularly if the patient is younger and ovulating regularly, we will use a home test kit to detect the LH surge indicating ovulation; and then thaw the sperm and inseminate accordingly.
Other patients may take fertility medications such as clomiphene, letrozole or gonadotropins in conjunction with IUI. The goal in using these medications is to induce ovulation in women that do not ovulate regularly or to recruit multiple eggs (super-ovulation) in order to enhance chances of fertilization.
What to expect from the donor insemination procedure. Intrauterine insemination (IUI) is most commonly done in our clinic, as the chances of successful conception are higher if timing of exposure to sperm is controlled, and if sperm is placed in higher numbers closer to the egg(s).
The donated sperm is delivered directly to our clinic in frozen form, and stored in this state until the day of insemination. On the day of the procedure, the laboratory thaws the vial(s) of sperm, performs a count and evaluates the percentage of motile (normal, forward moving) sperm in the specimen to ensure the best possible results.
Risks associated with donor insemination. Risks of donor insemination are the same as the risks for any type of intrauterine insemination, which include infection, uterine cramping, ectopic pregnancy and miscarriage. The chances of infection are exceedingly low. Cramping is unusual and if present, very mild.
If multiple IUI attempts have not been successful in achieving a pregnancy or if other female factors exist, IVF with sperm donation may be recommended. Although controversial, there are some studies that have suggested that frozen-thawed sperm is much less effective than fresh sperm in achieving fertilization of eggs with IUI.
When a frozen sperm specimen is thawed, the embryologists will analyze the specimen. If the concentration and/or motility of sperm are low, the embryologist may recommend thawing a second vial or may decide to perform ICSI and inject sperm directly into the eggs.
Donor sperm may also be used as a backup in cases of very severe male factor infertility. In such cases, a urologist will first try to recover sperm surgically from the testicle(s) of the male partner. In rare cases where the sperm recovered is insufficient to inseminate the partner’s eggs, we may recommend that donor sperm be available as a back up.
The following documentation is required for all sperm donation:
- Consent Form for the Use of a Known Sperm Donor
- Cryopreservation of Sperm Consent Form
- Cystic Fibrosis Consent Form
- IUI Consent Form
- Acknowledgement of CA Family Code (signed by both recipient and donor)
For Known Donor:
- Known Sperm Donor Consent Form
- Acknowledgement of CA Family Code (both recipient and donor sign this)
Types of Sperm that May be Available from the Sperm Bank. There are 3 ways that sperm banks prepare their sperm.
If a patient has unintentionally purchased ICI sperm but need to have an IUI procedure, the sperm can be prepared for this purpose at our clinic, however this will result in extra cost and loss of some sperm in the preparation process.
Patients should only buy IUI sperm if a medical professional is performing their insemination.
The Physicians at PFC do not advocate that patients buy A.R.T. vials, regardless of the treatment. Because these vials contain fewer sperm than other types of samples, there is a higher risk that there will be insufficient sperm for our needs.
For in vitro fertilization, it is fine to buy ICI-prepared sperm, or if this is not available, IUI prepared sperm. The PFC lab needs to process any sperm that is used for IVF, so there is no need for the patient to pay the sperm bank to do the processing.
- ICI sperm, or sperm for intra cervical insemination. This sperm sample is not processed or prepared before it is frozen. As with ejaculated fresh semen, this sperm is placed in the vagina, close to the cervix, and the sperm swim into the uterus and fallopian tubes themselves. Patients who are doing a home insemination often purchase sperm prepared in this manner.This type of sample cannot be used by a physician to inject directly into the uterus, as the sample contains seminal fluid that can cause uterine contractions. If you are doing a home insemination, we suggest that you purchase ICI-prepared sperm samples that will thaw with at least 15 million live sperm per vial.
- IUI sperm, or sperm for intrauterine insemination. Here, the sperm bank processes the sample by removing seminal fluid and dead sperm prior to freezing. When the sperm is eventually thawed, the sample will have motile sperm and can be injected directly into the uterus. Because IUI sperm requires processing, it is slightly more expensive than ICI sperm. For inseminations at our clinic, PFC suggests that you purchase IUI-prepared sperm samples that will thaw with at least 15 million live sperm per vial.
- A.R.T. sperm (“IVF Prepared”). Offered by a small number of sperm banks, for patient doing in vitro fertilization (IVF). Because it is thought that fewer sperm are needed for use in assisted reproductive technology compared with IUI and ICI, these samples contain significantly fewer sperm and are thus less expensive than insemination vials.
General advice when purchasing from sperm banks. Because sperm banks may overestimate the number of live sperm after thawing, we always recommend that patients purchase more vials than they think you need. This way, we thaw additional sperm if necessary. We suggest patients have a minimum of 2 vials available for any insemination or IVF cycle. PFC will only accept and store up to 4 vials of donor sperm at a time.
Because sperm needs to be shipped to PFC at least 1 week ahead of any procedure, it is important to plan ahead. In this way, we can make other arrangements should any shipping problems occur, and hopefully maintain the patient’s treatment schedule as planned.
Be advised that should a sample vial thaw with fewer sperm than promised by the sperm bank, their liability is limited only to the cost of replacing the vial.
Shipping frozen sperm to PFC. We receive deliveries of frozen sperm from the banks several times a week.
At PFC, our staff will help our patients with the process of shipping sperm; and will put the shipment on our laboratory schedule so we know when to expect the delivery. Our Tissue Bank Manager will also complete paperwork with the patient to ensure that PFC will store their sperm for the length of time needed. Our staff can also assist our patients with sperm transfer and consents. Cryopreservation of Sperm and Transfer of Sperm consents must be completed prior to the shipping of sperm to PFC.
PFC accepts shipments or drop off deliveries Monday – Friday, 9 am – 2 pm. No specimens are accepted on weekends or holidays.
Below is a list of sperm banks that supply anonymous donor sperm. We have worked with all of these sperm banks and have found their sperm quality and customer service to be satisfactory. These banks do a good job in providing a wide variety of donors from all backgrounds.
If a patient is seeking a donor of a non-Caucasian race or a specific ethnicity, one of the larger sperm banks listed below, such as California Cryobank or Fairfax Cryobank, offer a more wide-ranging selection of donors.
The given sperm bank will provide patients with an “authorization” form that must be signed by a physician in order to establish your account. After this point, they may purchase as much sperm as needed.
Please note the following Pacific Fertility Center requirements for those using an anonymous sperm donor:
- We accept sperm only from sperm banks within the United States.
- All donors used in the USA must be screened for infectious diseases according to rules implemented by the FDA.
- All testing of sperm donors must be by FDA approved test methods and by FDA registered labs.
- The sperm banks themselves must be licensed and inspected by the FDA.