| from the book How to Have a Baby: Overcoming
Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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ART
Next page: Surrogate
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Table of Contents
What
is donor insemination ( TID) ?
What
are the psychological issues raised by donor insemination
treatment ?
Who
are the sperm donors ?
How
is the sperm frozen and stored in a sperm bank ?
How
is donor insemination treatment performed ?
Why
is it safer to use frozen sperm samples for donor insemination
?
What is donor insemination
( TID) ?
THERAPEUTIC INSEMINATION BY DONOR [TID]
means using the sperm ( Sperm Video ) 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.
What
are the psychological issues raised by donor insemination
treatment ?
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 ( Sperm Video ) ,
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 ( Sperm
Video ) - explore the alternative options as well!
Who
are the sperm 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.
How is the
sperm frozen and stored in a sperm bank ?
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 6 months, which is how long it takes for the HIV
virus ( which causes AIDS) to become detectable in a
person's blood after infection. This is called the quarantine
period. The donor's blood is then retested for HIV,
hepatitis and STDs, and the infected donors weeded out.
Fig 1. Sperm being frozen in liquid nitrogen
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.
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.
How is donor
insemination treatment performed ?
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.
Why
is it safer to use frozen sperm samples for donor insemination
?
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.
- 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
- 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
- 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
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.
Next page: Surrogate
Mothering
Previous page:
PGD - Preimplantation Genetic Diagnosis – The Newest
ART
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|
