12 - Therapeutic donor insemination: screening, indications and technique

Summary

Introduction

Despite significant advances in both the diagnosis and treatment of male infertility, for some there is still the possibility of unsuccessful medical or surgical therapy. In these situations, and others where no therapy can be offered, when it is refused, or when therapy fails to result in conception, therapeutic donor insemination (TDI) may be the only chance for pregnancy.

Demand for TDI and human semen cryobanking has been increasing world-wide. The number of patients requesting TDI increased four-fold in the United States between 1971 and 1976 (Jacobson, 1976). The process is certainly not new, with observations of the effects of low temperature on spermatozoa being reported by Spallanzani in the eighteenth century. Human semen cryobanking and resulting in vivo fertilization were then reported by Bunge and Sherman in their landmark articles appearing in 1953 and 1954 (Bunge & Sherman, 1953; Bunge et al., 1954). Thirty years later, data compiled by the United States Congress Office of Technology Assessment (US Congress OTA, 1988) estimated that approximately 30 000 births occurred annually as a result of donor insemination. While several factors may account for this tremendous increase in the utilization of donor insemination services (such as increased incidence and prevalence of infertility, greater willingness to utilize TDI by clinicians and fewer adoptive infants), much can be attributed to the established safety and efficacy of cryopreserved donor semen for therapeutic insemination (Table 12.1).

Ten years ago most donor inseminations used fresh semen specimens. Because of concern regarding the transmission of sexually transmitted diseases (STDs), including acquired immune deficiency syndrome (AIDS), practice shifted in the mid-1980s to the exclusive use of cryopreserved semen.