When Should Donor Sperm Be Used?

Robert Oates, M.D.
Associate Professor Urology
Boston University

Donor sperm insemination, also referred to as TDI (therapeutic donor sperm insemination), involves the use of sperm that has been donated to a sperm bank to help couples achieve pregnancy. The donors are generally young men, often times 20 - 30 years of age who may be attending college or graduate school. They answer a basic health questionnaire and have no obvious genetic diseases in their family. They are often profiled in the bank's catalog in terms of their height, general physical appearance, skin and eye coloring, blood type, heritage, educational level attained, and outside interests such as the arts or sports. The semen is rigorously screened and tested for infectious agents. A quarantine period is now employed to eliminate as best possible the risk of HIV transmission. The semen is released for use only after a 6 month period has passed and a test for HIV is negative at that time. The use of donor sperm is a very safe procedure. Generally, 1 - 2 intrauterine inseminations during the ovulatory period are carried out using the thawed donor sperm sample.

The frequency of donor sperm use has declined in recent years as technology has improved to the point where small numbers of sperm that would never have been able to be used in the past, are now more than enough to generate pregnancy. However, TDI is still a reasonable option for many couples. Couples should not feel compelled to use the very fancy technology available, they should not feel guilty if they elect TDI instead of trying in-vitro technologies, they should not feel pressured by friends or family if they choose an alternative route such as TDI. After a couple has been fully educated about their options, the decision they make is necessarily the right one because they made it.

TDI is probably not necessary or helpful when the semen profile is normal and a male factor is not suspected to be the root cause of a couple's infertility. If the sperm parameters are abnormal and the sperm are believed to be the limitation to conception, intrauterine insemination, in vitro-fertilization with or without intracytoplasmic sperm injection (ICSI), TDI and adoption are all alternatives for a couple. The choice depends upon financial concerns, ethical and moral issues, logistical matters, etc. What the couple decides upon has a great deal to do with "non-Medical questions of which only the couple knows the answers.

If there are small numbers of sperm in the ejaculate, ICSI may be the only viable option for the couple in terms of the use of husband sperm. Here again, TDI is a perfectly reasonable option for the couple to think about.

If there is no sperm in the ejaculate due to a blockage of sperm flow, reconstructive microsurgery may be possible with the end result being sperm in the semen and a natural pregnancy. If reconstructive microsurgery is not possible, sperm that are aspirated from the system may be used in conjunction with ICSI to achieve pregnancy. In these cases, the couple also has the choice of moving straight to TDI. Financial constraints are typically the driving force behind the decision to move to TDI in circumstances like these.

If there is a severe reduction in sperm production to the point where there is no sperm in the ejaculate, approximately 45-50% of men will have a tiny number of individual spermatozoa that can be harvested from a piece of the testicular tissue. This process is termed TESE. These may be used as the source of sperm for ICSI and pregnancy can result. If the plan is to retrieve the tissue for the first time on the day of egg retrieval, there is a 50-55%chance that spermatozoa will not be able to be found. After all that went into getting to that point, couples will often have donor sperm available as a back up so that the cycle might be "salvaged" to some degree.

There are a number of genetic conditions that may be transmitted by the male partner to his offspring. The use of donor sperm may be chosen so that these disorders are not propagated into the next generation. A Geneticist is able to help couples understand the chances that this will happen given the nature and genetic basis of the disease in question.

The theme of the preceding paragraphs is that while there have been great advances made to help couples with even the most severe male factor infertility, these technologies are just another option that couples need to think about. They should feel comfortable in not using them if that is the plan they have devised for themselves. Every clinician helping couples with their infertility will be able to educate them and direct them to TDI if that is the choice made. The end result of TDI is a happy, healthy baby with loving, contented parents.