ARTIFICIAL INSEMINATION USING DONOR SPERM
Indications for using an anonymous or known donor’s sperm (TDI) to achieve pregnancy include:
- Azoospermia – the absence of sperm
- Oligo-astheno-teratospermia – sperm that are of low supply, having poor quality motion and/or abnormally shaped
- Avoidance of transmission of genetic abnormalities. When the male partner carries a gene for an undesirable inheritable condition, the couple may utilize artificial insemination by donors to avoid the risk of that condition.
- Reproduction by single or lesbian women. A woman without a male partner may elect to utilize donor sperm in order to have a family.
ARTIFICIAL INSEMINATION – THE PROCESS
When a physician places semen into the reproductive tract of the patient, the process is called artificial insemination. The type of insemination and method of sperm processing depends on the details of each case. When sperm is obtained from an anonymous donor, the process is termed therapeutic donor insemination (TDI).
Donor sperm is purchased from a commercial sperm bank. Donors undergo a strict screening process overseen by the Food and Drug Association (FDA). Donor sperm can be selected based on the physical characteristics of the donor (such as skin color, height, eye color and hair color), level of education, and nationality. Donor sperm is frozen for at least 6 months and then the donor is tested again for infectious diseased during this quarantine period. Frozen donor sperm is shipped overnight to the physician’s office in a dryshipper containing liquid nitrogen vapors.
In our office, artificial insemination is most often performed by thawing then depositing a processed sperm specimen into the uterus (womb) of the patient (intrauterine insemination, IUI). In certain cases, sperm can be deposited in the cervix (ICI). Because seminal fluid contains substances that may irritate the uterus, semen is usually processed before intrauterine insemination. Sperm can be “washed” by first diluting the seminal fluid with a modified salt solution (culture fluid) and then centrifuging the specimen so that the sperm cells are concentrated to the bottom of the centrifuge tube. The washed sperm cells are re-suspended in a small volume of culture fluid, loaded into a soft plastic catheter which is threaded through the patient’s cervix into the uterus and deposited within the uterus. Most patients experience mild cramping discomfort during intrauterine insemination. A little bit of vaginal bleeding will often be noted in the hours following insemination.
Proper timing of artificial insemination is important to the success of the process. Once an egg is ovulated, it remains fertilizable for 12-24 hours. Once deposited in the reproductive tract of a woman, sperm retains the ability to fertilize an egg for less than 72 hours. Usually, a single insemination is planned for the expected day of ovulation each cycle. In special situations, when the number of sperm for insemination is low, we will schedule insemination on two consecutive days. The day of insemination(s) may be determined by several means. Often, the woman will utilize a kit that detects the LH surge in her urine. Ovulation is most likely to occur on the day after the LH surge is first appreciated. Accordingly, patients are instructed to run an LH kit and call the office to schedule insemination for 18-30 hours after the LH surge is noted. An alternative means of scheduling insemination is to monitor the LH surge utilizing blood testing.
Ultrasound evaluation of follicle growth on the ovary may be incorporated into cycle monitoring. An injection of human chorionic gonadotropin (hCG) may be administered to some patients (who are usually receiving other fertility drugs) in order to “trigger” ovulation. When we do this, artificial insemination will usually be scheduled for 36-44 hours after the hCG injection when a single insemination is planned or at approximately 24 and 48 hours after the hCG injection when two inseminations are to be done.
The incidence of complications after artificial insemination is very low. Rarely, a patient can develop an infection or allergic reaction to the sperm. Signs of infection include fever, chills, and lower abdominal pain. Such symptoms should be reported to the physician if they occur within four or five days of an insemination.