Donor Insemination (DI) / Therapeutic Donor Insemination (TDI)
One of the options for treating severe male factor infertility, or for achieving fertility where no male partner is involved, is artificial insemination using donor sperm or, more commonly, donor insemination (“DI”). The acronym “AID” is no longer used since the advent of AIDS, and sometimes the procedure is called “therapeutic donor insemination” or TDI. DI involves placing cryobanked sperm from an anonymous or known donor in the uterus, at the time of ovulation.
When to Use Donor Insemination:
Therapeutic insemination using donor sperm (DI) may be the treatment of choice in the following cases:
- When the sperm count is very poor and there are no treatment options to improve sperm count and quality
- When it is not possible to recover sperm capable of fertilizing an egg – even by ICSI
- As a preference over using IVF and ICSI to achieve a pregnancy
- When the man is a carrier of an undesirable hereditary condition
- For single women or same sex couples
Where Do Donor Sperm come from?
Donor sperm is usually obtained from reputable sperm banks that must meet strict standards imposed by Health Canada. Rigorous screening is performed on each donor before collecting and freezing sperm. The screening process includes a thorough family history, complete medical and social history, blood typing, screening for genetic disorder, sexually transmitted diseases,and screening for hepatitis B and C, HIV, CMV and HTLV. Potential donors are not accepted if there are any abnormalities detected in any of the screening tests. Furthermore, each frozen specimen is quarantined after freezing and only released for use if the donor remains free of any infectious illnesses at least 6 months later. Only sperm and banks that meet the Health Canada standards can be used for donor insemination in Canada.
Donor sperm may also be obtained form "Known sperm donors". However there are strict regulations regarding the processing and distributing of sperm to be used for insemination.
If you have a known donor - and wish to use this person's sperm thorugh a fertility cetnre such as VFC, the male donor will need to prticipate in the "Known donor program" through repromed in Ontario. This means the donor would need have screening done, bank sperm in Toronto at Repromed, then after the requried 6 month quarantine period have the sperm shipped to VFC for use in assisting conception.
How Do I Choose a Sperm Donor?
The sperm banks provide a list of donors available. Brief descriptions will be given of the donor – including racial and ethnic background, blood type, CMV status, certain physical characteristics and/or certain social characteristics that may be important to you. More detailed profiles are normally available from the sperm banks on request, although there is usually a charge for this extra service.
How is Donor Insemination Done?
Before embarking on donor sperm insemination you will be evaluated to rule out any obvious fertility problems. Your menstrual cycles will be monitored with a basal body temperature chart to confirm that you are ovulating. This will give information about the length of your cycle, and at what time of the month you normally ovulate. As part of your work up some baseline investigations will also be performed. These will include some hormone tests, blood tests to rule out infectious illnesses such as hepatitis B and C, HIV,HTLV,CMV as well as genital tract cultures. The exact timing of ovulation will be determined by you checking your urine each day leading up to your fertile period using an ovulation predictor kit. Approximately 24–36 hours prior to ovulation (that's when the egg is released) a hormone called luteinizing hormone (LH) appears in your urine. The ovulation predictor kit allows you to monitor your urine for the presence of this hormone. When the test is positive we will know that your egg will be released the following day.
There are a number of different commercially available Ovulation predictor kits available. Some of these include CLEARPLAN, OVUQUICK, FIRST RESPONSE etc - all of which can be purchased from any pharmacy. Some of these kits may be expensive. On line companies may provide LH kits at more affordable prices. One such company operates out of Vancouver and their products can be purchased thorugh their website www.saveontests.com
When the urine test is positive you will need to contact VFC so that arrangements can be made for the insemination to take place the following day.
Inseminations are performed seven days per week.
If you do not ovulate regularly, or if your cycles are unpredictable, you may be offered a fertility enhancing (ovulation induction agent) such as Clomiphene.
Some women have trouble identifying their LH surge using a urine based test. If this is the case VFC will offer you more sophisticated monitoring in the form of ultrasounds and blood tests.
The actual insemination process is very like having a Pap smear done. A speculum is inserted into the vagina, and the thawed, washed sperm is injected through the cervix into the uterine cavity using a special thin catheter. (called an IUI catheter) Sometimes this might cause a sharp cramp, which usually subsides after a few minutes, although you might also experience some discomfort a few hours later. The actual insemination procedure usually only takes a few minutes.
After the insemination you will be asked to lie quietly on the examination couch for 10-15 minutes, after which you will be free to leave the office and resume normal activities. We do however ask that you do not do any major exercise or go into a hot tub or public swimming pool for 24 hours after the insemination. Other activities such as intercourse are fine to do.
How Successful is Donor Insemination?
This depends on many factors, the most important of which is your age. For women under the age of 35, with no other fertility-related health problems, the success rate is about 20 % per treatment cycle or about 60% after 6 months. Success rates decrease as you get older.
If you are not pregnant after 6 treatment cycles, further investigations might be suggested. If no fertility related problems are identified,you may be offered fertility enancing treatments. There are a variety of different fertility enhancing medications which could be discussed with you.
Is Donor Insemination Safe?
Donor insemination is a very safe procedure, especially when no medications are used. Once a pregnancy occurs, it is no different to one that occurs naturally in a woman of the same age. The risk of miscarriage is not increased, remaining at about 15% for women under the age of 35. The risk of congenital abnormalities is also the same as would be expected for anyone conceiving naturally. However, if fertility-enhancing drugs are used there might be other risks such as multiple pregnancy.
What are the Legal Implications?
A child born through donor insemination is considered to be the legal child of the mother and her spouse or partner. The legal obligations of the mother and her spouse to such a child are no different to that of any other couple.
If you and your partner are not legally married, and there is any concern about your obligations to the child, you should consult your lawyer prior to committing to this treatment.
Is Donor Insemination Confidential?
This is a highly confidential process. It is not necessary for you to disclose your participation to anyone.
Some donors prefer to be ananymous, others may be willing to share their identity. Each donors preferences are explained on the donor website.
You might or might not choose to discuss this process with your family, friends, or the children that result. These are some of the many issues that you should discuss with a counselor before starting treatment.
(We at VFC do encourage disclosure - meaning that the child born through this process is informed).
What Does Counselling Involve?
If you do opt for donor insemination we will ask you to meet with a Counsellor to discuss many of the issues involved. A counselling session is essential before proceeding with donor sperm insemination. It is not a screening test to determine your eligibility, but rather an attempt to help you become emotionally and socially prepared for the whole process. The treatment process will be started only once you and the Counsellor are comfortable that you have considered all the issues associated with donor insemination.
The Provincial Health Services Plan does not cover the consultation with the Counsellor, for which you will be charged a fee - explained under the Fee guide ( http://www.victoriafertility.com/fees )
What Does Donor Insemination cost?
There are several costs associated with having donor insemination treatment.
Counselling: You will be billed by the Counsellor and pay he/her directly.
Sperm Samples: Donor sperm samples must be bought from a donor sperm bank that is approved by Health Canada. Although many donor sperm banks list samples as either washed or unwashed (washing is a process that separates the good sperm from the liquid part of the semen and suspends them in a special culture medium), we recommend that after thawing, all sperm samples are washed to remove the cryoprotectant that was used to protect the sperm during freezing (like antifreeze). This is particularly important because we recommend inseminating the sperm directly into the cavity of the uterus, since this increases the chance of conceiving in each treatment cycle, Therefore - we recommend that unwashed specimens are purchased (since they’re cheaper and contain more sperm), and we will do the washing in our lab after thawing the sample, before the insemination. The cost of each donor semen specimen varies from one bank to another, but is generally around $500-600 per unit
Courier Fees: These are variable and depend on whether you choose a standard or priority service for shipping the semen from the cryobank to the VFC
Storage: Ongoing storage of the frozen donor sperm samples in the VFC cryobank also attracts a fee. There is also a handling fee for processing the paper work and transferring the samples to the VFC Cryotanks (see current price list)
Insemination: The cost for each insemination (see our current price list) includes the thaw, post-thaw sperm count and assessment, washing, and the insemination itself
Fertility Drugs: These may or may not be required. There are different types of fertility drugs and treatment regimens that might eventually be used, and they vary tremendously in cost
Ovulation Predictor Kits: These vary significantly in price.
After everything is said and done, the average cost per insemination ( after paying the sperm bank for the vials, the shipping and handling, the counselling fee, the storage fees, and the cost for preparing the sperm for the insemination) is about $1000.00. This partly depends on how many vials you purchase, and the cost per vial which may vary from company to company)
Please order sperm from one of the following three Health Canada approved sperm banks:
When you are ready, you will need to coordinate the ordering of your donor semen with the VFC. When you have chosen a donor, please call one of our embryologists to make all the necessary arrangements.
Please note: The patient is responsible for placing the order through the Canadian distributor of their choice
(Before choosing a donor and ordering sperm, you need to know your CMV status. Cytomegalovirus (CMV) is a common virus in the community – which causes a flu like illness. Most adults are immune to it. As part of your assessment, you will be having a blood test to check whether or not you have had CMV in the past. If you have – you will have antibodies against CMV – and cannot get the infection again. If you are negative, it means that you have never had CMV – and that you are still susceptible to it. If you do not have antibodies against CMV – you should preferably choose a donor who is also CMV negative.)
The Cycle Itself
Once everything has been organized, and the sperm samples have been received from the donor bank, you will be ready to go. By this time we will have had a chance to review a basal body temperature chart and have an idea approximately what day you ovulate on. YOu can then know to start testing your urine daily, starting at least 3 - 4 days you expect to ovulate.Please notify VFC when you get your period so we are aware that you will be having an insemination
- When your ovulation predictor kit is positive you contact VFC and we make arrangements for the insemination to be done the following day
- You will be given a sheet of instructions on exactly how to use the ovulation predictor kit, as well as the phone numbers to contact me after hours
- Please make sure that you always test your urine at around midday - and inform the clinic ASAP that you will be needing a DI the following day. The laboratory has to prepare and plan for the insemination - and MUST KNOW THE DAY THAT YOU HAVE YOUR SURGE ie. the day before the insemination is to take place
For more information on Ovulation predictor testing and details on how to contact VFC -
What About Future Pregnancies?
Many women who choose donor insemination would like the option to use the same donor for further pregnancies. If this is a consideration, you might wish to purchase extra samples from the donor sperm bank to store in the VFC cryobank. These sperm samples would then be available for you to use whenever you are ready. There is no limit to the number of pregnancies that you can attempt.
The donor sperm banks track how many pregnancies occur in a certain geographical area.
It is very important that you inform the sperm banks when you deliver a baby. We also request that you please contact the clinic - as we assist the sperm banks gathering this information.
Summary of process for proceeding with donor insemination.
- Consultation at VFC. This is best arranged by asking for a referral from your GP, or if you do not have one , through a walk in Clinic.
- At the consultation you should expect a pelvic examination wich will include an updated PAP smear, cervical cultures and a pelvic ultrasound to check your uterus and ovaries.
- Blood tests to check your fertility ( ovarian reserve),hormone levels, blood type, immunity to rubella,chicken pox and CMV, and an infectious disease screen ( RPR,Hepatitis B and C, HIV 1 and 2, HTLV and Chlamydia + gonorrhoea tests)
- Do a hysterosalpingogram - a test to check your tubes ( this is optional but chosen to be done by most women)
- Counselling - this is compulsory, and is to discuss the psychosocial implications of 3rd party parenting. Contact either Dr.Ochs or Jennifer Vining
- Be aware of how to monitor for ovulation using an Ovulation predictor Kit. The link on ovulaiton predictor testing will also advise you regarding the phone numbers to be used when booking your DI
- Order your donor sperm form one of the 3 sperm banks in Canada (www.donorspermohs.com; www.repromedltd.com; www.canamcryo.com) Please be sure you are aware of your CMV status before ordering your sperm
- When you have ordered your sperm samples, contact one of the VFC lab staff.
- Take a prenatal vitamin containing at least 1 mg of folic acid daily
Who to contact if you have any questions.
You may direct your questions to firstname.lastname@example.org