You and your SRM physician
may decide that donor sperm is best for your medical
situation. We can assist you and your partner in obtaining
sperm and proceeding with the appropriate workup. Please
find below, details regarding sperm donation, often
referred to as therapeutic donor insemination (TDI,
for short).
Known sperm donors
[i.e., who are known to the patient but are not her
intimate partner or an intended parent of the resulting
child(ren)] will be required to undergo screening, sperm
cryopreservation and quarantine for at least 6 months
at an established third-party sperm bank before their
samples may be used for insemination at SRM. SRM is
not a sperm bank.
The 10 Step Therapeutic Donor
Sperm (TDI) Process
Step 1 TDI Consultation Appointment
The first
step is to contact Seattle Reproductive Medicine (SRM)
and schedule a comprehensive consultation with one of
our providers. Tamara Tobias and Lindsay Wood, our nurse
practitioners, will be able to perform the initial visit.
Any follow-up appointment can then be made to review
your results with the SRM physician of your choice.
Your medical and genetic history, as well as the records
from any previous fertility evaluations will be reviewed.
The details
of the TDI program will also be discussed. To
make an appointment with Tamara
Tobias, please call 206-301-5000 or apply online.
Step
2 Recipient Psychosocial Education
There are
many complex issues surrounding the use of donor sperm
for both couples and single women. Our fertility
counselors understand the complex and delicate nature
of sperm donation as a means to starting a family. The
appointment with our fertility counselors will enable
you to discuss the unique legal, psychological, and
social implications of using donor sperm. Please call
206-301-5000 to schedule an appointment at SRM’s
main office. This is a requirement of the American Society
of Reproductive Medicine (ASRM).
Step
3 Screening
Requirements
All potential TDI patients and partners
are thoroughly evaluated before receiving donor insemination.
The female TDI recipient should generally be of normal
fertility potential. The US Food and Drug Administration
(FDA) has implemented new mandatory regulations for
patients utilizing donor sperm. The purpose of this
regulation is to increase safety by minimizing any risk
of transmission and spread of communicable diseases,
as well as providing high quality care to the recipients
of donated tissue.
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Step
4 Determining
CMV Status
Cytomegalovirus
(CMV) is a member of the very large family of viruses
known as herpes. It is important to determine the CMV
status of the recipient mother before selecting the
donor sperm sample. Please see the CMV
handout.
Step
5 Sperm Bank Selection
It is the
policy of SRM for all patients who are using donor sperm
to utilize sperm banks that have been registered and
contracted with SRM and for all known or directed sperm
donors to have the evaluation, testing and quarantine
of the specimens be completed at a registered and accredited
sperm bank recommended by SRM. Only banks which conform
to ASRM, AATB, FDA guidelines and regulations, are certified
by CLIA, and registered with the FDA can be used. SRM
reserves the right to not permit utilization of a given
bank. These sperm banks provide semen samples that have
been frozen and quarantined for 6 months and then the
donor is retested prior to releasing the sample, thereby
reducing the risk of infectious disease transmission.
For more information on these banks, click
here.
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Step
6 Ordering and Shipment of the Semen Specimen
- Sperm Bank Account Set Up
- Complete the Semen Authorization for your selected
bank (pre-authorized form signed by Tamara Tobias,
ARNP)
- Set up an account with your selected bank
- Ordering Your Specimen
- Purchase specimen from your selected sperm
bank
- Complete SRM’s Donated Sperm Acquisition
form and fax to 206-301-5096 Attention, Lab Administrator.
Samples are ordered from the sperm
bank by the patient. Many patients order 3-4 samples
for more than one cycle at a time to save on shipping
costs. Usually one sample is sufficient for one insemination.
Occasionally, your provider may recommend using two
samples per insemination. SRM’s initial shipping
cost of approximately $300 includes up to 3 months storage.
Donor sperm specimens may be stored at SRM for an additional
year for approximately $480.00. Patients requesting
longer storage (i.e. wishing to use same sperm donor
for another child) will be referred to ReproTech, Ltd,
a long term storage cryobank at 1-888-489-8944.
Donor semen samples used for TDI must be processed,
or “washed”, in order to separate the seminal
plasma from the sperm. Washed (or IUI) samples are processed
by the sperm bank and contain no semen. Unwashed samples,
also called Intracervical Insemination (ICI) samples,
contain semen and must be washed by our SRM Laboratory
on the day of your insemination in order for placement
into the uterus. ART samples are now being offered by
some sperm banks. These samples have lower total motile
sperm and may only be used with IVF (in-vitro fertilization).
Unwashed IUI, ICI, or ART vials may be used with IVF.
- Shipping Your Specimen to SRM, Seattle
Please call our Lab Administrator at 206-301-5034 or
email
to inform them of when your samples will be arriving.
This is imperative so that someone will be available
to receive your samples upon arrival. You will need
to leave your name and telephone number so the lab can
verify with you that the samples have arrived.
Samples need to arrive at the SRM Laboratory between
8:00am and 4:00pm Monday through Friday, excluding holidays.
There can be no weekend or holiday deliveries.
*SRM will not receive or store frozen sperm without
a signed consent (Receipt of Cryopreserved Sperm, Testicular
Tissue and/or Epididymal Aspirate From Another Institution).
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Step
7 Consent Signing and Risks
Patients who
use donor sperm samples for their infertility treatment
at SRM must sign consents related to the storage and
use of donor sperm. In addition, for married couples,
state law requires a physician to file the husband's
written consent and date of insemination with the State
of Washington if a child is born to a married woman
as a result of donor insemination. The State maintains
this record in a sealed file that can only be opened
by a court order. The child of a donor insemination
conception obtains a legal birth certificate listing
the recipient’s husband as the legal father.
The chance of obstetrical complications, spontaneous
abortion (miscarriage), and having a child with physical
or mental defects is the same with TDI as with a pregnancy
conceived after intercourse. Donors’ family histories
have been reviewed by medical geneticists to eliminate
those with a higher than average risk of passing known
major genetic defects to their offspring. This screening,
however, in no way entirely eliminates all risk to the
offspring of genetic defect(s).
Although extensive precautions have been taken to minimize
the chance of infection, there remains some risk, although
very slight, of contracting an infection from TDI. Included
are such sexually transmitted infections as hepatitis,
herpes, Chlamydia, gonorrhea, acquired immune deficiency
syndrome (AIDS), and others. The use of frozen semen
from an approved bank carries a theoretically minimal
risk of transmitting infection since the frozen samples
are held in quarantine while donors are re-tested for
infection.
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Step
8 Determining your Treatment Plan
In most cases,
women will time their inseminations by using a home
kit designed to predict ovulation. The kit detects the
rapid rise of luteininzing hormone (LH) in the urine.
This is known as the “LH surge”. The LH
surge occurs at the middle of the menstrual cycle and
triggers ovulation. One insemination is performed each
month a day after a LH surge is detected in the urine.
The insemination itself is a relatively simple procedure.
It is done with the insertion of speculum much like
a PAP smear and takes only a few minutes to perform.
A very small insemination catheter is passed through
the cervical opening into the uterus. The donor sperm
sample is then delivered in a small volume directly
into the uterine cavity. The woman rests in the clinic
for 15-20 minutes after the insemination and then may
resume normal activity. Risks of the procedure include
mild cramping and rare potential for infection.
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Step
9 Pregnancy Test
If your period
is delayed after an insemination cycle, you may perform
a home pregnancy test. If it is positive, please call
SRM to schedule a blood pregnancy test the following
day. We usually repeat a blood level in 2-3 days to
see if it is rising normally.
If so, we will recommend scheduling an obstetrical
ultrasound to confirm a fetal heartbeat when you are
about 7 weeks pregnant. Once everything looks positive,
we send you back to your obstetrician or give you a
referral. Please note that your OB/GYN provider will
be informed that your conception was by donor sperm
ONLY if you reveal this information yourself. However,
if you request copies of your SRM record for an outside
physician, references to the use of donor sperm may
be contained in the SRM record.
Step
10 Follow-Up
You should
schedule a follow-up appointment with your TDI practitioner
after 3 months of inseminations to review your cycles
and discuss any needed changes. If your menstrual cycle
is delayed after an insemination cycle, you may call
SRM to schedule a pregnancy test, or have the test done
by any lab that you choose. We ask that you notify us
if pregnancy occurs or if you decide to discontinue
treatment. It is vital that we learn the outcome of
your insemination(s) so that we may assess the effectiveness
of the TDI program. More importantly, we greatly appreciate
the encouragement of knowing that TDI worked for you,
or being able to support you if you do not become pregnant.
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Success
Rates
The success
rate of TDI varies depending on patient age. In
general, the TDI pregnancy rate is around 10% with each
cycle. It is recommended that most patients undergo
at least 3-6 TDI cycles to give the treatment an adequate
opportunity to be successful, depending on your medical
situation.
Revised
March 19, 2007
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