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Fertility Treatment using Donor Sperm Introduction This section introduces the subject of Artificial Insemination with Donor Sperm (DI) and should be read carefully by couples and individuals who believe that this may be a necessary course for them to take. In 30 - 40% of couples who complain of infertility, the cause of the problem lies with the male partner. This may be due to a total absence of sperm in the ejaculate or to low numbers or poor quality of the sperm. There is often no medical or surgical treatment for these conditions. In cases where In vitro Fertilisation (IVF) with Intracytoplasmic Sperm Injection (ICSI) is not appropriate, one way of achieving a pregnancy is by insemination of the female partner with donor sperm. The decision to go ahead with DI treatment is often a difficult one for the couples involved. There are many medical, ethical, religious and legal aspects that need to be considered. Patients require thorough counselling to discuss the implications of DI and any reservations they may have about the treatment. Patient support groups and contact with patients who have achieved pregnancies using DI are often helpful. As the number of babies available for adoption is limited, DI often offers the only chance of a family. Donor Screening A number of different sources have been used for donor recruitment including medical schools, local colleges and businesses. The most important criteria are that the donors should be healthy with a good sperm count and donate their samples anonymously. It is ideal if the prospective donor has had children of his own. Each donor is screened for sexually transmittable agents including HIV, hepatitis B & C, chlamydia, gonorrhoea, syphilis & cytomegalovirus as well as genetic defects through chromosome analysis and cystic fibrosis screening as recommended by the British Andrology Society. Screening for Sickle Cell disease, Thalassaemia and Tay Sachs disease is performed where necessary. In addition, all Centres now freeze donated samples and quarantine them for six months prior to use. This is a requirement laid down in the Human Fertilisation and Embryology Authority's (HFEA) code of practice and allows time for all the test results to be collected, and HIV testing to be repeated, prior to using the samples. Donor Selection Clinics offering donor insemination take great care to match the physical characteristics of the male partner to those of the donor. Characteristics usually matched are ethnic background, eye, skin, hair colouring, height of the male partner, and blood group if required. Donor's Consent Donors giving consent to storage and use of their sperm can vary or withdraw their consent at any time up until their genetic material has been introduced into the patient. Medical Aspects of DI The vast majority of couples are referred due to the male partner's lack of sperm or low sperm count. Other indications for treatment include genetic disease, paraplegia or rhesus incompatibility. Male infertility needs to be fully investigated and all treatment options considered before DI is recommended. As the female partner is usually of normal fertility, tests on her side are kept to a minimum. However, it is important to know that she is ovulating regularly. This can be checked with temperature charts, serum progesterone estimations, kits that monitor urinary LH or serial ultrasound scans. Some doctors check tubal patency prior to commencing treatment, whilst others only recommend this after a number of unsuccessful cycles of treatment. Suitability for DI The Bridge Centre treats married couples and patients who have a long-standing stable relationship. It is important that couples are interviewed together to ensure they have both come to terms with the medical and legal implications of DI. The male partner (when present) should have come to terms with his sub-fertility and realise that he will be the social rather than the biological father of any resulting offspring. Requests for treatment from single women or lesbians have to be considered carefully. Independent counselling is required and consideration of the case by the Centre's ethics committee is sometimes requested. If the male partner is seriously ill or very much older than the woman, the possibility of her bringing up her family alone has to be considered. The use of known semen donors introduces a number of difficulties and can be time consuming and costly. However each case is assessed on an individual basis - the welfare of the child being the most important issue. Performing the Treatment The treatment itself is straight-forward and painless. It requires a speculum examination in order to place the donor sperm into the uterus. This should be done at the fertile period each month - as close to the day of ovulation as possible. Sometimes fertility drugs are used to try and increase the chances of conceiving in a single month. The pregnancy rates are approximately 10% per cycle. It is not surprising therefore that some women have to try several times before achieving a pregnancy with DI. Once conception has occurred the pregnancy should follow a normal course. However, the same risks of miscarriage and fetal abnormalities apply as those in the general population. In addition a higher rate of pre-eclampsia has been reported than that seen in the general population. DI has been practised in this country for many years. Each year over a thousand children are born as a result of this procedure, bringing a great deal of happiness to people who would otherwise have remained childless. Laws governing DI DI is legal in this country and provided it is carried out with the husband's consent, cannot provide grounds for divorce on the basis of unreasonable conduct. Any woman carrying a baby is obviously the legal mother. Her husband (or partner if unmarried) is the legal father as long as he consents to the treatment. If a single woman is treated without a partner, the resulting offspring will have no legal father. The sperm donor has no parental rights or legal obligation toward the child. There is no legal requirement to tell the child how he/she was conceived. However, we always encourage patients to be open and honest with a child regarding his/her mode of conception, in order to avoid a secret within the family. It is obviously important, where DI is performed for a genetic reason that the child should know he/she is not at risk from inherited disease. Parental Responsibility Where an unmarried couple is being treated, the male partner will not automatically have 'parental responsibility'. Parental responsibility is defined by the Children Act 1989 in England and Wales and the Children (Northern Ireland) Order 1985 as 'all the rights, duties, powers, responsibilities and authority which by law a parent of the child has in relation to the child and his property'. *Section two of the Children Act 1989 states :
Similar provisions apply in Scotland by virtue of Section 3 & 4 of the Children (Scotland) Act 1995 and in Northern Ireland by virtue of Article 3 of the Children (Northern Ireland) Order 1995. Unmarried couples are therefore recommended to seek their own advice about the male partner's rights and responsibilities in relation to the potential child who may be born as a result of the treatment. We understand that the Government intend to amend the Children Act 1989 so that an unmarried father who registers his child's birth jointly with the mother will acquire parental responsibility without further formality. See also - |
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