Egg, sperm or embryo donation, embryo adoption and gestational surrogacy, frequently referred to as third party reproduction, has opened a new dimension for couples, otherwise labeled as sterile in the past.
Donor sperm insemination may be employed to accomplish conception in a group of patients with the appropriate indication. Some of the indications for using donor sperm include a male partner with low or no sperm, ejaculatory dysfunction, significant male factor infertility (failure of fertilization, male immune disorders or very low count and motility), when intracytoplasmic sperm injection (ICSI) is not feasible or elected, presence of a significant genetic defect or having an affected offspring, presence of an ineradicable sexually transmissible infection, severe Rh-immunized female with Rh positive male and females without partners.
The decision to proceed with donor sperm insemination is complex and requires a thorough discussion with a reproductive endocrinologist (RE) and psychological counseling. The main qualities to look for in selecting a sperm donor are assurance of good health and absence of any genetic diseases. The sperm donor should be younger than age 40 to avoid potential problems with aging. Although establishment of fertility is ideal, it is generally not required. Using sperm from anonymous donors is much more common than non-anonymous donors and both are acceptable as long as both parties agree.
Laboratory testing for sperm donors include serological tests for syphilis, hepatitis B and C, gonorrhea and chlamydia, cytomegalovirus, HTLV and HIV at baseline and repeated at 6 months. Anonymous donor specimens must be quarantined for 180 days for appropriate re-testing to avoid any potential transmission of infection to the recipient. Therefore, the use of fresh anonymous donor semen for insemination is not justifiable and all donor sperm available for use are frozen samples that are collected at least six months prior. If the sperm donor is a known or non-anonymous donor, the 6 month quarantine may be waived with informed consenting of the recipient and the sperm needs to be labeled accordingly.
Donor sperm can be used for intrauterine inseminations (IUI) or for assisted reproduction namely in vitro fertilization (IVF). Typically, donor sperm is ordered by the fertility clinic after the recipient chooses the sperm donor from one of the sperm banks. Donor sperm is then used to achieve a pregnancy based on the treatment protocol.
In some cases, patients may prefer to do a natural cycle insemination, which is the injection of the sperm into the uterine cavity around the time of ovulation without any stimulation of egg growth with medications