Donor insemination (DI)

Donor insemination (DI) involves using sperm from a donor to artificially inseminate a woman at the most fertile part of her cycle, so that she has a chance of getting pregnant. Countries around the world differ in the regulations they apply to donor insemination. Some refuse to allow it, including all those that follow Islamic law, while others agree to its use as an infertility treatment but have rules in place for both sperm donors and recipients.

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Who can benefit from donor insemination (DI)

Donor insemination (DI) is an infertility treatment that can be used to bring about pregnancy in a woman whose partner is at high risk of passing on a genetic disease or who is not able to produce sperm. Men who have had testicular cancer, for example, require chemotherapy and radiotherapy that can affect sperm production in the testes at a young age. Some men have their own sperm frozen before treatment, so this can be used later when they want to have children but this is not always possible. Other men may have a physical illness or injury that prevents them producing sperm.

Donor insemination can also be used by women who are not in a relationship but who want a child, or by lesbian couples who want to have their own family. Women in either of these two groups may need to seek fertility treatment abroad if they live in a country that insists that recipients of donor insemination are married (Germany, Switzerland, Hungary and Hong Kong), or has rules that lesbians are ineligible for sperm donation.

Currently, the only countries that allow donor insemination for lesbian couples include the USA, Mexico, Canada, Venezuela, Trinidad and Tobago, Uganda, New Zealand, Israel, India, South Africa, Jamaica, Iceland, Estonia, Sweden, Belgium, Denmark, Spain and the UK. Donor insemination and donation of eggs and embryos is usually subject to legal requirements or nationally-enforced guidelines, and there is growing international agreement that sperm banks and fertility clinics in all countries should be more highly licensed and regulated.

Donor insemination: the process for the sperm donor

In most countries a sperm donor will only be accepted if they are below a certain age, and their semen and blood will be screened. Donors will be rejected if they have:

  • HIV infection.
  • Hepatitis B or hepatitis C infection.
  • A genetic disorder, or if they are a carrier of a genetic disease such as cystic fibrosis.
  • A sexually transmitted infection such as gonorrhoea or syphilis.
  • Cytomegalovirus infection (CMV infection).

The sperm donor’s blood will also be tested for blood group, and a chromosome analysis will be carried out. A doctor will usually then examine each potential sperm donor for any signs of sexually transmitted infection and the man’s own doctor may be contacted for further information on medical history.

If the screening and medical tests show nothing that rules out sperm donation, the next step is to consider the legal side of what will happen when the sperm are used. Different countries have different rules on sperm donor anonymity; in the UK, for example, all sperm donors were anonymous until 2005, but then the law changed and now, any child born as a result of donor insemination is able to ask for information about their biological father once they reach 18.

If a potential donor is happy to proceed, he signs a consent form, his physical details are put into the database of a sperm bank and a sample of his sperm is obtained and frozen, ready for use in donor insemination.

Donor insemination: the process for the recipient

The actual process of donor insemination is straightforward but the preparation, particularly the emotional side of things, is more complex. If you are in a relationship, embarking on donor insemination must be something that you both want. In legal terms, you will both be parents of a child born as a result of the insemination, and both of you will be named on its birth certificate. Counselling is usually offered to couples, whether male/female or female/female, who are considering donor insemination.

It is also important to find out if the woman who is going to receive the donor sperm has any problems with her fallopian tubes, uterus, or hormone levels that might prevent pregnancy. A thorough examination of the fallopian tubes is required to make sure they are free from blockages; donor insemination is possible in women with mild endometriosis, but it not recommended if the condition is severe.

The woman recipient will also need to be screened for the same infectious and sexually transmitted diseases as the donor, as well as for German measles (rubella). If you are not immune to rubella, you may need to be vaccinated before your cycles of infertility treatment can begin.

Intrauterine insemination – stimulated or unstimulated?

If all the tests are clear and the potential recipient and her partner have decided to go ahead, the next choice to make is the type of intrauterine insemination (IUI) that will be used:

  • Unstimulated intrauterine insemination (IUI): donor insemination takes place at the most fertile time of the woman’s natural menstrual cycle. No hormones or fertility drugs are used to boost egg production, or to prepare the uterus. The sperm are introduced through a thin tube passed into the cervix. You can find out more about unstimulated intrauterine insemination in a separate article in this guide.
  • Stimulated intrauterine insemination (IUI): a woman who has irregular periods or irregular ovulation can be given hormonal treatments and/or fertility drugs to stimulate the ovaries to produce one or more eggs before donor insemination takes place. Find out more about stimulated intrauterine insemination.
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