Artificial insemination by donor has resulted in the birth of many thousands of babies. DI is now widely accepted as a method of bypassing 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
• 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

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.

We would not normally accept as donors men who have been adopted unless they do know their past family history and have 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 "pen portrait" about themselves and this is held by the HFEA.

Blood tests are taken to screen for HIV antibody, Hepatitis B and C, Cytomegalovirus, and Syphilis.

The donors' blood group and chromosome make-up or karyotype is also determined. Cystic Fibrosis screening of donors is also important, as 1 in 25 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 for any 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. Only if both HIV tests are negative, can stored sperm from six months earlier 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 clinic so that re-screening can be done before further stored sperm can be used.

Nowadays it is normal practice for the clinic to screen both of you for HIV, as well as Cytomegalovirus, Syphilis and blood grouping before accepting you for treatment. The HFEA require clinics to screen all patients requesting treatment for HIV, antibodies and Hepatitis B and C.

You will be fully counselled about this by the clinic.

As far as pssible, donors are matched to your partner 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. Donors will otherwise be classified asaccording to their ethnic group.

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.

It is not possible for you to find out who the donor is or vice versa.

However, following public consultation, both the HFEA and the government have obtained a change in the regulations of the HFE Act (1990). From 1st April 2005, all new sperm, egg or embryo donors will 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 (i.e. from 2023 -- 18 years after 2005).

This will only be after appropriate counselling and notification of the donor. However, the 1990 Act makes it clear that this change in the regulations cannot identify past or existing donors. The new regulations only apply to those who donate after 1st April 2005.

Legal Aspects

Under the HFE Act (1990), identifiable information about all donors and the recipients of their sperm are registered with the HFEA.

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.

This therefore, raises the whole question of whether or not to tell a child resulting from DI of his or her origins. 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". As long as there is 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 we 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 straws 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, we require that both you and your partner 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 which 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 under the Children Act 1989. Unmarried couples are therefore recommended to seek their own legal advice about the male partner's rights and responsibilities towards any chid who may be born as a result of treatment.

The welfare of the child is of paramount importance. For this reason, we do sometimes need to refuse treatment if we feel 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. Our consultants, nurse specialists and counsellor will ensure that all questions are answered so that neither of you have any doubts before undergoing DI.

Treatment

DI is carried out during the fertile phase of the cycle, namely around the time of ovulation. You may be asked to keep a temperature chart on which to record your early morning resting temperature. While DI can be performed in natural cycles, fertility drugs such as clomiphene are usually 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 developing 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) is detected by using a reliable ovulation predictor kit provided by us.

When you get a positive result indicating that ovulation is likely to occur in the next 24-36 hours, your own LH surge is given a booster in the form of hCG by injection.

DI/IUI is carried out on that day and repeated 24-48 hours later (weekends permitting).

If your response to clomiphene is poor, pure FSH will be used as in IUI.

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 receiving DI/IUI will eventually become pregnant. The majority of these pregnancies will occur in the first 6 cycles of treatment.

If there is no past medical history such as appendicitis or peritonitis, which can block 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.

If a pregnancy does not occur within six treatment cycles, a test must be performed. You will 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, or if there is known to be an additional problem such as blocked or damaged fallopian tubes, it is possible to consider a combination of IVF and DI.

Extensive counselling is given to both of you before embarking upon DI treatment.