Using
Donor Sperm
from
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha
Malpani, MD and Dr. Anjali Malpani, MD.
table
of contents ·
previous page · next page
THERAPEUTIC
INSEMINATION BY DONOR [TID] means using the sperm from an anonymous
donor to achieve a pregnancy, and is a treatment option if the man
is infertile. While TID is a well established method for treating
male infertility, it can be very difficult for the couple to accept.
With the newer options for treating male infertility, such as microinjection,
the need for TID has declined. However, these new techniques can be
very expensive, and because they are out of the reach of many couples,
TID is still a viable option.
Getting
set for TID
Before
a couple choose TID as a treatment, they must remember the taxing
ethical, emotional and psychological repercussions it has for both
of them. The husband may feel threatened, isolated, inferior, insecure
and jealous. He may wonder whether he will be able to play father
to " another man's child ". In fact, with the advent of microinjection,
coming to terms with TID has become even more difficult, since many
men are forced to resort to TID rather than use microinjection with
their own sperm, purely for financial reasons.
The woman
may be resentful that she has to undergo treatment and turmoil for
something that is not actually her "fault". She may also worry about
bearing the baby of a total stranger ; and will often have no support
as this is something which she may not be able to share with anyone
- even her own mother.
Couples
undergoing TID often undergo psychologic reactions which can be difficult
to cope with. The sense of isolation is even more than with other
forms of infertility, since most couples do not tell anyone they are
undergoing AID - so that they miss the social support and sympathy
which other infertile patients receive. The stress can be tremendous
because the sperms of another man are being inseminated into the wife,
and both partners experience many conflicting emotions. The involvement
of a completely unknown third party as a sperm donor can make coping
with the pregnancy especially difficult . Fantasies and nightmares
may occur about the unknown donor - and there are also concerns as
to whether the child will be normal and what the child will look like
. Many men also experience sexual impotency at this time, but this
is only temporary.
Now is
the time to talk, for togetherness. Air out all your apprehensions
with honesty and maturity. Discuss how you will make sure that you
will both be equal partners in parenthood. She will have to reassure
her husband with tact, gentleness and humour of her commitment to
him. Love, patience and understanding are very important - this is
a time when the couple needs each other the most. Seek counselling
from your gynaecologist or fertility expert. Discuss other choices
too. Don't rush into adopting a sperm - explore the alternative options
as well!
Who
are the donors?
The donors
are healthy men between 20 to 40, from a sound background, and usually
graduates. Those who are healthy, with no family history of illness
are requested to provide a sperm sample for testing. This semen is
analyzed, and accepted only if it has superior qualities: a count
over 100 million per millimetre; and motility of 70% to 80%. Blood
is checked to make sure they are negative for AIDS, Hepatitis and
STDs.
After
liquefaction, the semen sample is mixed with an equal quantity of
the cryoprotectant medium ( a chemical which prevents the sperm from
being damaged even at very low temperatures) and is loaded into plastic
straws. These are uniquely coded and sealed; and then placed in steel
tubs of liquid nitrogen where they are frozen to - 196 degree Celsius.
One day later, one straw is removed and thawed to see how the sperms
survived the cold ( cryosurvival). Only samples which contain at least
25 to 40 million motile sperm are accepted.
The sperms
are then kept in cold storage for 3 months, which is how long it takes
for the HIV virus ( which causes AIDS) to become detectable in a person's
blood after infection. The donor's blood is then retested for HIV,
hepatitis and STDs, and the infected donors weeded out.
Donors
are paid a little more than conveyance costs - they are usually philanthropic
men who have experienced fatherhood and want to make another couple
happy. They are not allowed to produce more than 10 babies and the
doctors generally scatter the offspring so that there is no risk of
half siblings unwittingly marrying each other.
Known
Donors
Sometimes
couples wish to use a friend or relative as donor. However, there
are many dangers in doing so. Over time, the donor's psychological
make-up as well as the relationship with the donor may change. This
could create social and legal problems. Furthermore, you will become
dependent upon the donor's discretion to keep the insemination a secret.
This is why using a known donor is not usually a good idea - however
tempting this may seem.
The
Treatment Process
The couple
signs a consent form for TID after appropriate counselling. The doctor
will need to ensure that at least one of the woman's fallopian tubes
is open - and may advise a hysterosalpingogram or laparoscopy to confirm
this.
The woman
may be treated with fertility drugs to ensure ovulation. Daily vaginal
ultrasound scans are done from the 11th day of the cycle to view the
evolution of the egg and discover exactly when the maturing follicle
bursts.
For frozen
sperm , a straw of the appropriate donor ( who best matches the husband's
physical traits) is picked out and rechecked under the microscope
to see that the sperm are actively motile. The doctor matches the
donor and the husband for height, build, hair colour, skin colour,
eye colour, Rh factor and blood group.
Under
sterile conditions, the donor sperm is injected through a plastic
catheter into the cervix. The patient rests for about ten minutes
and that's that. The husband is encouraged to be present at the time
of the insemination - this is one way that both the partners can be
close during the process ; and some clinics will even allow the husband
to do the actual insemination himself, so he feels more "involved".
There is no reason not to make love shortly after TID if this is what
the couple wants to do.
After
each insemination there is than a two weeks waiting period to find
out if it's been successful. It's an emotional roller coaster - anticipation,
insemination, menstruation, desperation, and then, hopefully - elation.
Success
statistics mimic nature. They are 10% in a 25 year old woman in one
cycle ; so that over six treatment cycles the chance of a pregnancy
is about 60% in a 25 year old - and only about 20% in a 38 year old
. It takes nature time to make babies, and patience is needed. The
chances of success are highest if the female partner is young, has
no fertility problem and the husband has no sperm. Irregular menstrual
cycles; or a history of endometriosis or tubal infection decreases
the chance of pregnancy. Interestingly, pregnancy rates with TID are
lower in women whose husbands have a low sperm count, as compared
to those whose husbands have no sperms at all . The reason for this
is not entirely clear.
Once
you get pregnant, your pregnancy is like a normal pregnancy - with
the same risks of miscarriage and birth defects as any other. If you
change your obstetrician , you do not even need to tell your new doctor
that you have conceived by TID. He will never know; and the name on
the birth certificate will be yours and your husband's. With TID strict
confidentiality is maintained, and the identities of the patients
and donors are kept secret. Historically, parents have kept TID a
secret from the child and from friends and relatives. Unlike adoption,
TID is not obvious to those who know the infertile couple. It is entirely
up to the parents to tell the child the circumstances of his or her
birth and most Indian doctors advice against it . However, there is
always the burden of secrecy which the parents have to bear for the
rest of their life.
The
Donor Semen Sample - Fresh or Frozen?
Traditionally,
gynecologists have used fresh semen samples (ejaculated recently}
for TID. However, using fresh semen samples for TID can be hazardous
to the patient’s health. It is best to use frozen cryopreserved, tested
samples from a sperm bank for TID. It used to be felt that pregnancy
rates with frozen samples were poor as compared to fresh samples.
However, recent studies have shown that if the frozen samples contain
a sufficient number of motile sperm, pregnancy rates with fresh and
frozen samples are comparable.
Common
problems
- to
tell or not to tell friends and family
- the
need to explain to employers and co-workers the need to arrive late,
leave early, take time off - without being able to give a reason
why
- to
deal with an erratic ovulation cycle caused by anxiety
- to
keep your sexual relationship on an even keel = to work out a plan
when one partner wants TID and the other does not
Disadvantages
of fresh semen
- There
are no records of the donors and no information as to his medical
and family history.
- It's
impossible to match the physical traits of the donor and the husband.
- Using
known donors can lead to rocky legal , emotional and ego problems.
- The
quality of the sample is always suspect, but beggars can't be choosers.
- It
could be difficult to produce a donor at the critical time and occasionally
a treatment cycle has to run dry.
- The
spectre of transmission of AIDS looms large since fresh semen cannot
be tested for AIDS
Advantages
of frozen sperm
- No
risk of STD and AIDS as the samples are quarantined for three months
and the donors are retested
- Around
the clock availability; no scheduling bottle neck.
- High
quality product since it is tested before and after freezing
- Rh
negative donors can be used for Rh negative women
- Physical
traits of husband and donor can be matched
Sperm
banking
While
the major application of sperm banking today is for donor insemination,
sperm banking is also useful in a number of other areas as well. Thus,
we can store and freeze husband’s sperm samples for treating the wife,
and this is very useful in the following circumstances.
- When
the husband has situational erectile dysfunction, so that he cannot
produce a semen sample by masturbation at the appropriate time of
an IUI or IVF cycle, storing a sample is very useful . This frozen
sample can be used as a backup, in case the man cannot produce a
sample at the required time. However, in many cases, because the
man knows that a frozen sample is available , this helps to take
the pressure off, so that many of them can produce a fresh sample
with little difficulty!
- When
the husband is away (working overseas or traveling), his frozen
sample can be used to treat his wife.
- For
men with very variable sperm counts, it can be helpful to store
the "good samples", so that these can be used. Unfortunately, pooling
many frozen samples together does not help to increase the sperm
quality.
- For
men with cancers, sperm freezing offers them a chance of conserving
their reproductive potential.
previous
page · next
page
|
