Treatments and investigations


Artificial insemination by donor has resulted in the birth of many thousands of babies. DI is now widely accepted as an alternative option when a man is unable to father a child himself due to severe male infertility problems. If DI is being considered, very careful counselling of both partners is essential, as it is vital that both of you are absolutely sure that you want to have DI carried out

The main indications for considering DI are:

  • male sterility, whether due to vasectomy, radiotherapy or unexplained causes;
  • severely reduced sperm counts which cannot be improved and where micro-assisted fertilisation (ICSI) is not acceptable as an option;
  • where the man is a carrier of an inheritable disease which could be passed on to his children;
  • rare cases where there is a major blood group incompatibility
  • where a single woman or a lesbian couple are wishing to achieve a pregnancy.

Centres do not insist that couples are married to each other as it is not their role to moralise, but your centre does need to know that your relationship is a stable one.

Screening of Donors

All potential donors are thoroughly screened. There are certain groups of men who should not become sperm donors because of their increased risk of carrying the HIV (AIDS) virus. These include homosexual and bisexual men, drug abusers, haemophiliac men who in the past have been treated with blood products, men who have lived in parts of the world where there is a fairly high risk of HIV infection and lastly anyone who has had sexual contact with any of these groups. Centres cannot accept as donors men who have been adopted as they do not know their past family history and have no knowledge of any hereditary illnesses in the family.

An initial sperm sample is checked to make sure that it is of suitable quality and a test "freeze" and "thaw" is carried out. The sample is also screened for any infection within the seminal fluid. A very detailed personal and medical history is obtained as well as a wider family medical history. With the prospective donor's consent, enquiry is made of his general practitioner as to whether there may be any relevant history which would make him unsuitable to become a sperm donor. In-depth counselling takes place to ensure that he fully appreciates and understands the implications of becoming a donor. All donors are asked to write a short non-identifiable "pen portrait" about themselves and a "goodwill message" (although they need not oblige) and this is held by the Human Fertilisation & Embryology Authority (HFEA).

Tests are taken to screen for HIV antibody, Hepatitis B and C, cytomegalovirus, gonorrhoea and syphilis. His blood group and chromosome make-up or karyotype are also determined. Cystic Fibrosis screening of donors is also important, as 1 in 20 of the population are carriers of this gene. A urine sample is screened for chlamydia infection. He is then examined by a genito-urinary physician to ensure that there are no warts or ulcers in the genital area.

If the tests are clear, he can now start producing sperm samples for freezing and storage. All donors are required to produce their sperm samples on the premises of the sperm bank. Six months later, further HIV testing is carried out and he is rechecked by the genito-urinary physician. During this six month interval, the sperm samples are quarantined and kept apart from the “cleared” samples in the sperm bank. Only if both HIV tests are negative, can stored sperm from six months earlier be taken out of quarantine and be released for use in DI treatment. Only frozen sperm can be used for DI as adequate screening cannot be carried out on fresh sperm. If a donor changes his own sexual partner, he informs the centre so that re-screening can be done before further stored sperm can be used.

How will we be screened and matched to a donor?

Nowadays it is normal practice for your centre to screen both of you for HIV antibodies and Hepatitis B and C, as well as cytomegalovirus, syphilis and blood grouping before accepting you for treatment. You will be fully counselled about this.

As far as possible, donors are matched for skin, hair and eye colouring, body build and blood group. The stored sperm from donors of different ethnic groups are kept apart from each other so that there is no possible chance of a mix up. Sperm are not categorised by the religion of the donor as this is not an inheritable characteristic. However, Asian donors are usually sub grouped into Hindu, Muslim, Sikh and Punjabi, as the recipients generally desire this. Donors will otherwise be classified as being Caucasian, Asian, Persian, Afro-Caribbean and Oriental.

It may very occasionally be possible to use a close relative of your partner (e.g. brother) as a donor. Considerable counselling would be required to avoid future disruption between members of the family.

Legal Aspects

Under the Human Fertilisation & Embryology (HFE) Act (1990), identifiable information about all donors and the recipients of their sperm are registered with the HFEA. As the law stands, no identifying information whatsoever may be given to children about donors following treatment with donor sperm. However, if a child was born with a disability as a result of a donor’s failure to disclose an inherited disease that he could have reasonably been expected to know about, the chid could sue both the donor and the clinic for damages. In order to bring proceedings under the Congenital Disabilities (Civil Liability) Act (1976), a court of law could require the HFEA to disclose the name of the donor.

The purpose of the HFEA Register is to enable people over the age of 18 (or 16 if contemplating marriage) to find out whether they were born as a result of licensed fertility treatment, and if so, whether they are related to someone they intend to marry because of past sperm, egg or embryo donation. However, before any information could be released, the applicant must first have been given a suitable opportunity to receive proper counselling about the implications of the request. No identifiable information about the donor will be given.

At the present time, it is not possible for a sperm recipient to find out who the donor is or vice versa. However, following public consultation, both the HFEA and the government obtained a change in the regulations of the HFE Act (1990). Since 2005, all new sperm donors can only be accepted as donors if they agree that identifying information about themselves will be provided upon request to donor-conceived people after they have reached the age of 18 years. This will only be after attempts have been made to contact the donor before his identity is revealed to a person conceived from the use of his sperm. The donor will then be advised to seek appropriate counselling.

This therefore, raises the whole question of whether or not to tell a child resulting from DI of his or her origins. The law requires that when people seek treatment using donor sperm, they should be given information about the importance of informing any resulting child at an early age that they came from the sperm of a person other than their father. You will learn that there are pros and cons of both telling and not telling which will be discussed with you in depth. REMEMBER that if there is anyone other than your medical advisors who is "in the know" about your DI treatment, it becomes impossible to guarantee that your secret will be kept. If you are going to tell and so avoid the possible stresses of secrecy, the principle is to tell your child when young and not wait until you think the child is "old enough to understand". You will be advised on suitable ways of telling the child this. As long as the “story” is given in an atmosphere of love and security, a very young child can accept any information regarding origins.

Under the Act the donor forgoes any claim on a child resulting from treatment using his sperm. Once 10 live births or so-called "birth events" of one or more children have resulted from his sperm, he is no longer used as a donor. This means that centres will need to change the donor you have selected once his quota of 10 has been reached. This is to minimise the chance of a consanguineous marriage between his children. However, when you do become pregnant by a particular donor, it may be possible to request that some vials of his sperm are set aside for your future use, even after his quota of 10 has been reached, as your children will not be marrying each other!

Although it is not a legal requirement, both you and your partner will be asked to sign the insemination consent form, as this does establish legal parenthood. If your partner has consented to your DI treatment, he is the legal father of the child and it is his name that will appear on the birth certificate. When a child is born to an unmarried couple, the male partner may not have parental responsibility for that child. An unmarried mother has sole responsibility for a child unless the birth of the child is registered together with the child's father, a formal agreement is made with the father of the child or there is a court order in favour of the father. Unmarried couples are therefore recommended to seek their own legal advice about the male partner’s rights and responsibilities towards any chid that may be born as a result of treatment. Under the Human Fertilisation & Embryology Act 2008, if two women are seeking DI together, both the woman receiving treatment and her female partner must consent that the partner is to be treated as a parent of any child resulting from DI treatment. Agreed female parenthood conditions must be met.

The welfare of the child is of paramount importance. For this reason, centres do sometimes need to refuse treatment if it is thought that the needs of the child have not been taken into account.

You are likely to have a lot of questions that will need answering. The centre’s consultants, nurse specialists and counsellor will ensure that all questions are answered so that neither of you have any doubts before undergoing DI. Extensive counselling is given to both of you before embarking upon DI treatment.

How is DI treatment carried out?

DI is carried out during the fertile phase of the cycle, namely around the time of ovulation. While DI can be performed in natural cycles, fertility drugs such as clomifene are often required to make certain that ovulation becomes a regular and predictable event. A few days before ovulation is expected (usually about day 10 of the cycle), a vaginal ultrasound scan is carried out. This is to ensure that no more than two good egg follicles are growing and that the thickness of the endometrium lining of the uterus is developing satisfactorily. In this way very multiple pregnancies can be avoided. The signal that you are about to ovulate (the so-called LH surge) can be detected by blood test or by using a reliable ovulation predictor kit. When you get a positive result indicating that ovulation is likely to occur in the next 24-36 hours, your own LH surge may be given a booster in the form of hCG by injection. DI/IUI is carried out on that day and may be repeated 24-48 hours later.

If your response to clomifene is poor, pure FSH will be used as in IUI (see ovulation induction information). Ultrasound scans are then used to monitor follicle growth and DI/IUI is performed at the time of ovulation.

The DI itself is a painless procedure. It involves a gentle instrumental examination of the cervix just as when a cervical smear test is being carried out. The prepared sperm sample is gently introduced into the uterus itself by passing a fine catheter tube through the canal of the cervix. For the next 10 minutes or so you will be asked to remain lying on your back.

If there is no other factor causing infertility, approximately 45% of women under the age of 35 receiving DI/IUI will eventually become pregnant. The majority of these pregnancies will occur in the first 6 cycles of treatment.

In 2006, the percentage of DI cycles started that resulted in a live birth was:

  • 13.5% for women under 35   (13.4%)
  • 9.2% for women aged 35-39  (9.7%)
  • 5.3% for women aged 40-42  (3.9%)
  • 1.2% for women aged 43-44  (1.7%)
  • 0% for women aged 44+  (0%)

The figure for 2005 is shown in brackets for comparison.

(Figures by courtesy of the HFEA)

One obvious requirement for DI to be successful is that at least one of your fallopian tubes is open and healthy. Centres will usually require you to have a tubal patency test before treatment is commenced (see intrauterine insemination information). This is very much in your interests if the number of NHS funded DI cycles available to you is restricted. For example, if you only have one open tube, there is little point in wasting one of your valuable treatment cycles by having DI when it can be seen on scan that ovulation is going to occur on the side of your blocked tube.

If you are funding your own treatment, centres may feel that if there is no past medical history such as appendicitis or peritonitis that can damage the fallopian tubes, it is reasonable, at least initially, to give your tubes the benefit of the doubt and defer having a tubal patency test. But if a pregnancy does not occur within three treatment cycles, a test must be performed. You should however, be offered the opportunity of having a tubal patency test before you commence DI treatment if you prefer to have the reassurance that your anatomy is trouble-free!

DI will not be carried out indefinitely. If standard DI/IUI fails, it is possible to consider a combination of IVF and DI.

March 2009