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Therapeutic donor insemination (TDI) is the process of using an anonymous or known donor's sperm to achieve pregnancy. Indications for TDI include:
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Azoospermia - the absence of sperm |
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Oligo-astheno-teratospermia - sperm that are of low supply, having poor quality motion and/or abnormally shaped |
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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. |
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Reproduction by single or lesbian women. A woman without a male partner may elect to utilize donor sperm in order to have a family. |
Semen is collected and stored by sperm bank facilitates located throughout the United States. In general, donors are men between the ages of 21 and 35 years old who have been recruited through personal contact or media advertisement. An extensive medical history is obtained from potential donors. Men with risk factors for sexually transmitted diseases are excluded. Those with risk factors for hepatitis or acquired immune deficiency syndrome are not used. The presence of a genetically transmittable disease in the donor's family may also disqualify him. Testing for carrier states of genetic conditions are done when appropriate. For example, donors of Jewish ancestry are screened for Tay-Sachs disease. Black donors are screened for sickle cell disease. Unfortunately, it is both physically and financially impossible to screen a donor for each of the 500 or more known genetically transmissible diseases.
The social history of the donor is carefully examined for habits that may damage his sperm. The use of recreational drugs and excessive alcohol will disqualify a donor.
Donors are subjected to rigorous screening for infectious diseases. All donors are checked for hepatitis B, hepatitis C, syphilis, gonorrhea and acquired immune deficiency syndrome. Many banks will check a donor for cytomegalovirus, a common virus that can increase the risk of birth defects should it be contracted by a pregnant woman for the first time in her life during pregnancy. The donors' blood types are determined for the purpose of matching the potential recipient. Specific genetic screens are obtained when ethical or medical history dictates.
The sperm banks must rely to a degree on the integrity and honesty of their donors. As part of his understanding with the bank, the donor pledges to accurately relate historical information and to report any signs of the disease. Donors are screened periodically for venereal disease. Sperm banks will quarantine all semen specimens for at least six months, retesting the donor for HIV before releasing the sample for insemination.
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Despite measures to prospectively identify and prevent sexually transmitted diseases, it is a known risk of therapeutic donor insemination that a recipient (and possibly her offspring or partner) might contract an infection, for example, hepatitis B or HIV, from the donor specimen. |
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The risk that a child will be born with a congenital defect is normally 3%-5%. Collected experience with therapeutic donor insemination suggests that the incidence of abnormalities in the offspring of TDI pregnancies is no different than that seen in the general population. Because of their genetic screening, donors tend to be more free of genetic diseases than the average person. There is no evidence that the processes of sperm collection and preparation damage sperm. |
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The incidence of miscarriage in donor pregnancies appears to be no different from that of the general population. Still, the possibility exists that a donor insemination pregnancy will end in miscarriage, ectopic pregnancy, hydatidiform mole, stillbirth, or some other problem delivery. |
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It has been the general recommendation of physicians and psychologists through the years that offspring remain unaware of their origin by donor insemination. This recommendation has been based on adjustment reactions observed in children who have been adopted and belatedly learn of their biological origin. In more recent years, our society has moved towards an attitude of disclosure. Thus, the final decision as to whether the child is informed of his/her origin rests with the parents. If the parents elect to tell their child or if the child otherwise finds out about the TDI, careful attention should be given to the child's emotional well-being. |
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A donor is likely to establish additional pregnancies either through other patients or by past/future marriage. There is a finite risk that two donor offspring will meet and produce children, unaware that they are half-brother and sister. The incidence of congenital abnormalities in the offspring of half siblings is approximately 35%. Thus, there is a theoretical risk of future unintended incest and resultant abnormality when donor insemination is utilized. Most sperm banks limit the number of pregnancies allowed to each donor in an effort to reduce the incidence of unintended intermarriage. |
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Every effort is made to prevent an anonymous donor from identifying the recipient of his semen. Coding systems are utilized so that the name of a donor will not appear on a patient's chart. We are unaware of any successful legal action by a donor to identify or have access to an offspring. Thus far, it has been the intention of all legislative and judicial action in regard to artificial insemination to protect the recipient from harassment\t or claims by the donor. Such protection does not exist when the donor is known to the recipient. |
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It has been the tendings of legislative and judicial statements that recipient couples have no recourse towards the donor. So long as the donor offers information in a truthful manner, he cannot be held liable for mishaps that result from donor insemination. |
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Artificial Insemination with Donor Sperm (TDI)