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Pregnancy And Birth

DONOR INSEMINATION

Abstract

A good overview of what is involved and associated issues .

 

What is donor insemination?

Insemination with donor semen (DI) offers the only means of achieving pregnancy for some infertile couples. It may also be an option for some single women, or women in lesbian relationships.

Until recently DI was commonly known as AID, "artificial insemination by donor", but this term has fallen out of favour because of its similarity to "AIDS".

In the past DI was generally subject to disapproval or ignorance, but with the liberalisation of attitudes to sexual matters, it is now acceptable to almost all sectors of society.

The widespread introduction of freezing of semen in the early 1970s made the practice of DI more manageable, and there has been a dramatic increase in the growth of, and the demand for, DI. Because medical science has not yet been able to offer "cures" for most of the types of infertility treated by DI, it seems likely that the use of DI will continue for many years to come.

Why DI?

We offer donor insemination to people of sound physical and mental health who agree that they want children, but for a variety of reasons, find they cannot.

For a couple, it may be that the man does not produce sperm, or that the quality of sperm production is very low. Rarely, it may be that the use of the man's sperm carries a very high risk of the child having a serious congenital abnormality.

For single women, or women in lesbian relationship, it is a way of being able to have children, which is free of risk and complications.

Questions:

Before you start treatment, we would strongly encourage you to use the information services that we have made available through the counsellors associated with our team.

This is the time to ask questions consider any reservations, and think about the special issues that are associated with DI as a treatment. Counselling and information services are included in the cost of treatment with donor insemination.

Counsellors

Being involved with the Donor Insemination programme is an emotional as well as physical experience and can trigger grief related to infertility or other life experiences. Included in the cost of your DI treatment at Fertility Associates is a confidential counselling session, which you may use at any time. Joi Ellis and Robyn Irwin are here to support you through the experience of infertility, decision making and treatment. Please phone reception to make an appointment should you wish to see or talk to one of them.

Donors

Who becomes a donor?

Donors come from all walks of life and are generally just ordinary people willing to donate sperm to help infertile couples or others achieve a pregnancy. Many of our donors have children of their own, but this is not a condition of acceptance. We require that donors be aged between 18 and 50 years, with a good semen analysis and good recovery of sperm after it is frozen.

Screening of donors:

All donors are required to undergo screening to minimise the risk of passing on contagious diseases and genetic disorders to patients receiving their semen. We routinely test for syphilis, gonorrhoea, chlamydia, hepatitis B and C, and HIV (AIDS) antibody. Donors are blood typed, and have routine haematological tests to screen for general health. One of our doctors physically examines the donor to make sure he is fit and healthy. The donor's family and medical history is taken using a comprehensive checklist to screen for inheritable diseases. Once the donor has passed all the screening tests, he is asked to give up to 15 samples. Each sample is frozen within 90 minutes of collection. Donation is often over a period of six months, so it is a major commitment. A lifestyle declaration form, similar to the one completed by blood donors, is completed for each donation. This is designed to eliminate anyone at risk of exposure to HIV (AIDS). Each donation is quarantined for a minimum of six months, after which time the donor must repeat the screening tests.

What information is available about the donor?

All donors complete a non-identifying information questionnaire. This information is made available at any time. A simple profile is made up from this for you to look at when choosing a donor.

In 1987 following passage of the Amendment to the Status of Children Act defining the legal status of the donor, we encouraged donors to be identifiable. In 1993, we decided that all donors must be potentially identifiable, which means the donor agrees to be contacted by the clinic on behalf of the parents or any children that may result from his donations, and to then consider giving more information about himself. This is not a guarantee that the donor will agree to divulge his identity. Although we encourage identifiable donors to keep the clinic informed of any change of address, not all will remember to do so!

Donors can change their consent form if they wish, although few decide to do so. We guarantee to donors that no information beyond the non-identifying information sheet will be given without their consent.

Donors are at liberty to place restriction on the use of their semen. A few donors have requested that only married couples be treated with their sperm, but most donors do not choose to place restrictions.

What information can the donor receive?

At present a donor can request and is given information on the number of pregnancies resulting from his donations and the sex of those children. We anticipate that donors and parents of DI children may one day want to swap information. We emphasise that no information will be given without the consent of both parties.

Which donor?

When you are ready you can choose a donor from the profiles you will be given. The non-identifying information is available to help you make a final decision.

Some people recruit a donor known to them and ask Fertility Associates to process this donor for them to use. We are quite happy to help if you choose this approach. The practice does carry its own complications, and we strongly encourage you to discuss the matter with us before you approach your prospective donor.

Confidentiality

The clinic's notes are only available to staff, and are not removed from the building. If you are referred elsewhere (e.g. if you move, or want obstetric care) and copies of your medical records are requested, we would not provide any information about your DI treatment unless it was quite clear that you had given us authority to do so.

Donors are identified only by a number throughout our records, so that there is no way that you can learn the donor's identity, or vice versa.

Screening of Recipients

Fertility Associates screens recipients of donor sperm for the same diseases as it does for donors, in case any recipient should ever develop a sexually transmitted disease that might otherwise be attributed to the donor. Your doctor will discuss the implications of this testing, including for AIDS.

Legal Aspects

In July 1987, an amendment to the Status of Children Act, was passed by the New Zealand Parliament, which clearly defines the legal status of the donor, a recipient's partner and child when conception occurs as a result of artificial insemination, and she has undergone the procedure with the consent of her partner.

Clause 5, l (a) states that:

"The husband shall, for all purposes, be the father of any child of the pregnancy, whether born or unborn"

Clause 5, l (b) states that:

"Any man, not being her husband, who produced the semen used for the procedure shall, for all purposes, not be the father of any child of the pregnancy, whether born or unborn "

Clauses 5, 2 (a) and (b), cover the situations when a woman is not married, neither the child nor the donor have any rights or liabilities in relationship to each other.

We encourage you to obtain a copy of the Act.

There is no legislation concerning the running of donor insemination programmes. However we have been accredited by the Australian Reproductive Technology Accreditation Committee and abide by their guidelines.

Telling Your Child

Whether you tell your child of the manner of its conception is entirely up to you. The consensus of those working in the field would be that it is better to do so.

The Counsellors are available to help you with this. They periodically run meetings of Dl recipients to discuss this and other issues.

Treatment

Treatment essentially consists of insemination at the most fertile time of the menstrual cycle. The correct timing of insemination is essential, since sperm that have been frozen have a shorter lifespan than that of unstored sperm.

Ovulation can be detected by daily blood tests done at the clinic, or by twice daily urine tests you can do yourself at home.

Insemination is carried out in the same manner as a routine vaginal examination; it is straightforward and painless. It will usually be done by a nurse, who will insert the speculum into the vagina, and place sperm into the mucus in the cervix, or into the uterus. You will be asked to rest for 5-10 minutes after the insemination.

Pregnancy

The chance of becoming pregnant from any one cycle of Dl treatment is about 15-20%; couples without infertility have about a 20% chance, so Dl is almost as efficient as nature.

Overall about 70% will have a baby within six cycles. Dl can be combined with IVF or GIFT, if Dl itself does not achieve a pregnancy.

Dl will not affect your chances of having a normal pregnancy, a normal delivery, or a normal baby. However, every pregnancy carries risks, and having had Dl does not protect against these. You could still miscarry, or the baby could be born with some defect, but the chances of these happening are no greater than normal.

We will confirm pregnancy when it occurs, and discuss arrangements for obstetric care. Once you are pregnant, we can usually reserve more sperm from the same donor in case you wish to try for another child. There is an information sheet on this subject.

Self Help Resources

There are infertility societies in the main centres and support groups in some other areas, which offer information, support and counselling for people experiencing infertility. Pamphlets are available at the Fertility Associates clinic.

Fertility New Zealand is an organisation set up to help provide information, support and advocacy to New Zealanders affected by infertility. For more information please contact Fertility NZ: Phone: 09-913 2496 or 0800 333 306

 Email: [email protected]  

Web: www.fertilitynz.org.nz

Postal Address: PO Box 34151, Birkenhead, Auckland

 


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