Before committing yourself emotionally to the process of getting pregnant through donor sperm, we recommend that you have your basic medical screening in place.
I also strongly recommend emotional counselling before selecting a donor. After all, this is a decision that will affect not only yourself, but your wider family…and most critically, your child. You should have as deep an understanding as possible regarding the concerns and pressures that people sometimes face. Your clinic should be able to set you up with a local counsellor.
Choosing a donor
Choosing a donor can feel a little like shopping for sperm; it can feel rather surreal.
Canadians have access to three Health Canada accredited sperm banks. Repromed collects sperm from men located in Toronto; Outreach and Can Am are Canadian offices that import sperm from American and international suppliers. There is no “safest” source. I have worked successfully with all three banks. I believe that Outreach is the largest supplier in Canada, but all will ship to accredited partnering physicians across the country.
As you look through your options, you will quickly see that sperm can be stored in two different ways.
The sperm bank can sell “washed” sperm (the ejaculatory fluid is washed away, and the sperm stored in synthetic fluids). This means it is ready to be thawed and used for intrauterine insemination (IUI) right away.
Unwashed sperm is frozen within the ejaculate. Though it can be used for intracervical inseminatin (ICI; the sperm is placed in and around the cervix) I always recommend washing the sperm for IUI. A number of studies have demonstrated that the success rates with IUI are greater than ICI when frozen donor sperm is used.
Is it better to buy washed or unwashed? I continue to suspect that unwashed is better: when we have the opportunity to wash the sperm ourselves, greater sperm motility results (usually 80% swimming) than the pre-washed samples (not uncommonly less than 50%). However, we cannot prove that this better motility is associated with better pregnancy rates. Careful review of my data from 2006 to April 2009 could not prove a benefit.
Bottom line: we can suspect all we want, but whether you purchase sperm washed or unwashed, the evidence says that it doesn’t seem to matter too much. And pre-washed sperm will be less expensive for you than letting your clinic wash it.
How much sperm to buy?
IUI will be done around the time of ovulation; your clinic may encourage you to do one insemination, or two over two days. There is weak evidence (here is a recent study and here an older review) that two may be better. I always suggest two. That means two vials of donor sperm per cycle. You may wish to purchase 4 vials, enough for two cycles.
You may wish to purchase more (if you want to preserve the opportunity for a second child, for example, from the same donor) or fewer. It is a personal choice.
The Xytex website faq states that donor frozen-thawed donor sperm may be associated with better success rates than fresh sperm. Unfortunately, I don’t think that is true.
According to the ASRM, the monthly chance for pregnancy with frozen-thawed sperm ranges from 8% to 15%..and that is for “all ages”, the mean usually being around 36y of age. In other words, your personal chances may be higher or lower than that number depending on a variety of factors including age.
At our clinic, when using fertility medications (see below) rates are just over 21%. Yes, the number is better than ASRM averages, but it doesn’t compare to fresh cycles. A fertile couple trying naturally at home (assuming she is 36y old) can expect success rates of around 25% per cycle for the first three cycles…and that is without the fertility drugs.
The good news is that the risk of birth defects as a result of conceiving with donor insemination is no different than from conceiving naturally, and is in the range of 2% to 4%. This is likely because, while freezing may affect the ability of the sperm to enter eggs, the DNA that they carry is unaffected. At the end of the day, sperm is just a vector for DNA. Once that sperm is in your egg, it probably doesn’t matter how he got there.
Improving your success rates
The first way to improve success rates, as mentioned above, is to access the advantages of controlled ovarian hyperstimulation with fertility medications. When you release 2-4 eggs on a medicated cycle, rather than just 1 on a natural cycle, you will double your pregnancy rates, while taking only a 2.8%ch for multiple pregnancy (reference).
If you are still not having any luck after 2-4 cycles, you may also wish to change donors, especially if your donor has never had proven success from other donor sperm cycles.
By far the biggest success rates increase occur when you move from IUI to IVF with ICSI. Frozen/thawed sperm simply don’t attach to and penetrate eggs as easily as fresh sperm. The jump in success rates is dramatic when you move to IVF/ICSI because we can then place the sperm inside the eggs (you no longer have to worry about motility, “hard egg shells”, etc). Our last posted average success rates for women 36y are about 56%, based on the transfer of two day-5 embryos, with 25% of the pregnancies twins. (Note: the data set includes fresh and donor sperm cycles combined…it is likely that donor sperm cycles are higher than average for a few reasons).
In my opinion, after two or three failed cycles, it is always worth reconsidering your assumptions. Multiple failed cycles are emotionally (and financially) trying. You need to make sure that your Care Plan fits your current needs.
A final word
I am most grateful to the men who choose to donate sperm. Look at the Repromed site: at this time there are 33 donors…a respectable number, but strikingly limited for our country’s only sperm bank. For a variey of reasons, the political and regulatory hurdles for men who choose to donate are immense. There is little (or no) personal or financial recognition. It is a miraculous gift that these men provide to the women and couples who want to build a family. Thank you.