At our clinic, when a couple is ready to proceed with inseminations, and has completed the required counseling, we have them select the donor. We do check blood types of both the husband and wife and ask that they choose a donor consistent with those blood types. Other than that, the choice is up to them. They simply look through the information and select the donor who meets their criteria. Samples from this donor are then ordered and kept frozen until needed by the couple.
Some evaluation of the female is indicated before proceeding with donor inseminations. Unless there is some previous documentation of normal fallopian tubes, I like to do a hysterosalpingogram. Donor inseminations are not inexpensive, and it is worthwhile knowing that the tubes are normal before doing inseminations. There may also be some beneficial effect in terms of enhancing conception rates as a result of doing the HSG. It is also worthwhile to be certain that regular and adequate ovulation is occurring through the use of basal body temperature tracking and progesterone levels.
This will allow the physician to decide how the timing of the inseminations will be determined. For women with regular, ovulatory cycles, the easiest means of timing the inseminations is with the use of an ovulation predictor kit (OPK).
The OPK detects the presence of luteinizing hormone (LH) in the urine, which is present just before ovulation occurs. By simply testing her urine each morning, a woman can know when she is about to ovulate. When the OPK indicates, she calls the office and comes in that day for an insemination, and often the following day as well if possible. Inseminations are done in the office.
A speculum is placed in the vagina and the sperm sample, which has been placed in a small syringe, is injected into the uterine cavity through a small plastic catheter that is gently placed through the cervix. This is essentially painless. After lying in the office for 10 to 15 minutes, the woman can return to her normal activities.
As noted, donor sperm samples can be expensive. Enough sperm to do two inseminations per month can cost upwards of $500. The inseminations and sperm processing can add another $100 to $300 to this.
Donor inseminations are done on a completely anonymous basis. The donor has no access to the identity of the couple. The couple will have no access to the identity of the donor.
Whether or not to divulge the information that donor sperm was used is a decision each couple must make for themselves. It is, however, incumbent upon the physician and the staff to preserve the right of the couple to make that decision. In other words, not even the obstetrician to whom they are referred need be informed of the use of donor sperm. Whether or not to tell the child, to tell their family, or to tell their friends is a decision that each couple must carefully consider. Again, counseling is helpful in this regard.
If the female has no fertility problems and is under age 35, her chances of conceiving are excellent. Because the donor sperm has been frozen, the monthly chances of conception with donor sperm may be slightly less than with fresh sperm, but over a period of time, the chances become essentially the same. The chances are, of course, dependent on the woman's age, but in general are in the range of 10 to 15 percent a month. After four to six months of inseminations, about 60 to 80 percent of couples will have conceived. If conception has not occurred by this time, some investigation into other possible problems is warranted and other more aggressive approaches such as superovulation or an assisted reproductive technology (ART) procedure may be indicated.
There are really no more risks associated with conception by donor insemination than by any other means. The risks of miscarriage, birth defects or any other type of pregnancy-related problem are not increased.