• Couples use donor sperm (Donor Insemination) when the husband has no sperm
• Or very poor semen analysis (azoospermia, very severe oligospermia, extremely poor motility),
• Couples with severe, untreatable male factor infertility,
• Male carries a hereditary disease

• Donor insemination (DI) is the process of inseminating a woman with sperm obtained from a known or anonymous donor.
• The procedure is usually performed in natural cycles without the use of any fertility medications or ovulation induction in the women.
• However, fertility medication in the form of ovulation induction may be recommended for women in their late 30's and older, and for those who have been unsuccessful with donor insemination in natural cycles, in order to increase the number of eggs for fertilization.
• If insemination with donor sperm is unsuccessful, or if there are other fertility factors that indicate the need, in vitro fertilization (IVF) with donor sperm may be performed.

• You will have the opportunity to select your own donor through government approved cryobanks (ART banks).
• Donor choice can be based on racial or ethnic background, physical or social characteristics, or previous history.
• As part of the donor insemination process, all women or couples considering this option are encouraged to meet with a reproductive counselor. This is an important step in the process as it allows for discussion of the decision making process as well as consideration of the impact the choice may make on the individual or couple.
• Couples or individuals usually have the right to decide which sperm bank and which donor to use.
• Information about a donor’s physical characteristics, race, ethnic background, educational background, career history, and general health is available with these banks.
• It is recommended to use only frozen semen and that the specimen be frozen and stored for at least 3-6months.
• The donor should have an initial HIV blood test, and should then be retested and have a negative result on the HIV test before the frozen specimen is used.
• All donors should have tests for certain infections such as syphilis, hepatitis B, Hepatitis C.
• Donors are excluded from a donor program if he or his sexual partner have experienced blood transfusion within one year, a history of homosexual activity, multiple sexual partners, a history of IV drug use, or a history of genital herpes.

• Government certified sperm banks (ART banks) must meet specific requirements for donor screening. In order to virtually eliminate the risk of disease transmission, semen samples are quarantined. In this process, the donor is tested for infectious disease. Donated sperm is then frozen and held at the sperm bank for 3-6 months. The donor is re-tested for infectious diseases before sperm is provided to clinics and patients.
• Patients may choose from any certified sperm bank. Patients are responsible for selecting the given donor and paying the sperm bank directly.
• We cannot advise as to which donor to use, as this is a very personal choice.
• The blood type of the donor can be matched with the intended father.
• We do recommend that patients pay attention to the sperm quality guaranteed by the bank when choosing. We encourage our patients to select a sample with minimum of 15 million motile sperm per vial after they have been thawed.

• Women considering the use of donor sperm should know that thorough screening is carried out and documented on all donor sperm samples available according to ICMR guidelines.
• This screening is performed by the cryobank (ART bank) providing your donor sperm and typically involves a thorough family history, complete medical, social and sometimes psychological history, blood group information, genetic screening and screening for transmissible diseases.
• As part of the regulated guidelines, all donated sperm must be quarantined for a period of 3-6 months to ensure that the donor still screens negative for infectious diseases such as HIV after initial testing.

• The intrauterine insemination process is simple and quick.
• Once you arrive in the clinic the day of the insemination, the lab will start to thaw the sperm.
• When it is ready, you will be asked to come into the exam room.
• Just as with a routine Pap test, a speculum is placed into the vagina to clearly see the cervix.
• The semen sample is labeled with your identity which you verify for us with a signature.
• Written consent from the intending parents (both husband and wife) is taken.
• The sperm is then loaded into a small syringe with a soft plastic-tipped catheter.
• The catheter is passed through the cervix and into the cavity of the uterus, where the sperm is injected slowly.
• Once the insemination is completed, you will be asked to rest for 10-15 minutes and then you carry on with your usual daily activities.

• It is very important that the couple or individual be psychologically ready to move forward with using donor sperm.
• Most doctors recommend that any patients considering Donor Insemination (DI) see a counselor who is skilled at clarifying feelings about infertility, and about trying DI.
• It is crucial that both partners feel comfortable with the decision and that all fears and questions be openly discussed.
• For some, it may mean dealing with various moral and ethical questions; for others, exploring questions about donor selection and whether to be open about the decision to do DI and whether to tell a child conceived by DI how they were conceived.

• The DI procedure involves inseminating the woman as close to the time of ovulation as possible.
• Inseminations are usually done about 24 hours after a surge of LH is noted on the urine test.
• In stimulated cycles it’s done around the time of ovulation which is confirmed by doing a USG.
• Clinics do one or two inseminations per cycle.

• Most patients attempting to conceive with donor sperm will begin with intrauterine insemination (IUI). Particularly if the patient is younger and ovulating regularly, we will use a home test kit to detect the LH surge indicating ovulation; and then thaw the sperm and inseminate accordingly.
• Other patients may take fertility medications such as clomiphene, letrozole or gonadotropins in conjunction with IUI. The goal in using these medications is to induce ovulation in women that do not ovulate regularly or to recruit multiple eggs (super-ovulation) in order to enhance chances of fertilization.

• Intrauterine insemination (IUI) is most commonly done, as the chances of successful conception are higher if timing of exposure to sperm is controlled, and if sperm is placed in higher numbers closer to the egg(s).
• The donated sperm is delivered directly to the clinic in frozen form. On the day of the procedure, the laboratory thaws the vial(s) of sperm, performs a count and evaluates the percentage of motile (normal, forward moving) sperm in the specimen to ensure the best possible results.

• Success rate in women under 35 years is around 10-15% per cycle.
• After 6 cycles of inseminations, about 50% of women are pregnant.
• After 3-6 cycles with no success, it may be important to consider some fertility treatments to maximize your chances in a shorter time period.
• Your doctor will discuss this with you during the course of your treatment if necessary.
• Once a pregnancy occurs, it is no different than one that occurs naturally in any other woman of the same age.
• The risk of miscarriage, or congenital abnormalities is also the same as others in the same age group.
• You will be asked to sign consent forms which include acknowledgement that a child born through donor semen insemination is considered to be the legal child of the mother, and her husband.
• Success rates vary from 60-80% but achieving pregnancy may take many cycles. In one study the overall cumulative pregnancy was 86% in the IUI patients.

Donor insemination is generally safe. The primary medical risks of donor insemination are:

• Risk of infection.
• Risks of donor insemination are the same as the risks for any type of intrauterine insemination, which include infection, uterine cramping, ectopic pregnancy and miscarriage.
• Risk of the family medical history shared by the donor being incorrect. Sperm banks and fertility clinics are careful to screen donors and verify information that donors share. Still, there have been cases where donors have not shared vital family history information.

• AS per the ICMR, the provider of that sperm is considered a donor and does not have any parental rights or responsibilities.
• The sperm donor needs to sign a consent stating that he is donating his semen on his free will and has no legal rights on the child born through this.
• Both, the recipient and her husband, are required to sign consent for the donor insemination stating that they agree for the same and the child born through this will be their legal child.

• If multiple IUI attempts have not been successful in achieving a pregnancy or if other female factors exist, IVF with sperm donation may be recommended.
• Donor sperm may also be used as a backup in cases of very severe male factor infertility. In such cases, a urologist will first try to recover sperm surgically from the testicle(s) of the male partner. In rare cases where the sperm recovered is insufficient to inseminate the partner's eggs, we may recommend that donor sperm be available as a back up.

Your alternative options to donor insemination depend on why you’re considering using a sperm donor.

With that said, some possible alternatives include:

• IVF with an embryo donor
• IVF with ICSI and TESE/TESA (testicular sperm extraction, if that’s a possibility in your particular case)
• Adoption
• Living a child-free life