Some men will be termed sub-fertile, which means that though their semen contains
sperm, there are fewer present than thought ideal to cause a pregnancy. Sub-fertile
can also be used to describe a man who, though he produces plenty of sperm,
they may not move very well (low motility) or may not be properly formed (low
or poor morphology).
Treatments offered to couples in this situation include ICSI (Intracellular
spermatozoa injection) which is similar to IVF.
IUIH (Intrauterine insemination using husband's sperm) is a low technological
treatment and is used by many couples where there is a less than optimum sperm
count, or where the motility is poor. Couples often try IUIH before they go
on to have more 'high-tech' treatments. The success rate is about 10%.
Azoospermia is the medical term for absence of sperm in the semen. A man with
azoospermia will not cause his partner to become pregnant.
Men suffering from azoospermia, or subfertility, should be investigated by
a urologist or at a fertility unit in a hospital. Often the cause is not found
and successful reversal of male infertility is rare. It is important to receive
the most appropriate advice in each individual case.
In cases where couples have had failed treatments due to poor sperm quality,
or where there is an absence of sperm, they may use donor sperm.
Using donor sperm is not a modern idea, there are reports of donor sperm being
used for women experiencing difficulties becoming pregnant in Egypt over 2,000
Doctors in America used donor sperm as a medical treatment for couples in the
1920s. Many hospitals and clinics in Britain have been using donor insemination
for the last 40 years. The first sperm bank was brought into Ireland in 1980.
Since then many Irish couples who once thought that having a baby was not to
be an option for them have had their greatest dreams realised.
While successful treatment with donor sperm can bring a great deal of happiness,
it is a big decision for a couple to make. For this reason, a couple must always
have counselling with one of the clinic's trained counsellors, prior to having
treatment. There are many issues that need to be looked at. The couple's confidentiality
will always be maintained. Everyone makes their own decision about whether they
will tell the child or not, but it is wise to give this and other matters a
great deal of thought in advance. We endeavour to discuss what is relevant to
each person attending us - what might be a moral or ethical issue for one person
may not be for another.
Unfortunately treatments are not always successful and one of the aims of counselling
is to help people to prepare themselves to cope with disappointment.
Donor sperm used at our clinic is brought in from England and Denmark. These
countries of origin are used because legislation is such in each country as
to ensure that the donors are thoroughly screened. Tests done on the donors
include those for HIV, hepatitis B and C and many others. All donor sperm is
required by law to be frozen and guaranteed for a minimum of six months, after
which time the donor must have all his tests repeated. This is to ensure that
the donor has been clear of all infections before, during and after donating.
Donors are generally young, usually under 25 years of age. They are mostly
students, with a majority being medical students. They are very well counselled
to ascertain their suitability and motivation. They are given no information
as to what country their sperm will be sent to and no information as to the
It is impossible for a donor or recipient couple to trace each other. Both
have their confidentiality respected. A child conceived using donor sperm, who
has been told of his origins, may, if the donor was English, go to a central
register in England when they have reached 18 years of age and acquire some
non identifiable information about the donor. This is not possible with Danish
The physical characteristics of the donor are matched to that of the couple,
eg. race, eye colour, blood group, hair and skin colour, height and build.
There are two treatments with donor sperm available at the Morehampton Clinic.
The first of these is termed DI (donor insemination). This is a relatively simple,
painless procedure. The matched donor sperm is taken from the bank and defrosted
in an incubator and then placed at the opening in the cervix (neck of the womb).
The woman remains on the couch for about five minutes and may then get dressed
and return home. This treatment costs £95.00 and the success rate is about 8%
The other treatment where donor sperm is used is called IUID (Intra uterine
insemination using donor sperm). This treatment has been available to us for
about five years. The basic principle is the same as that of DI, but a larger
sample of sperm is used. A procedure called a 'wash and swim up' is done on
the sample initially. This is to render the sample suitable for insertion directly
into the womb. This treatment costs £270 and the success rate is 11%-12% per
cycle. The fact that the sample is going directly into the womb, means that
the sperm are in an ideal atmosphere for survival. If there is any delay on
the estimated timing of ovulation, there should be a reservoir of sperm in the
fallopian tubes, awaiting the arrival of an egg.
Donor sperm is increasingly being used by couples who know that they are at
risk of having a baby with a serious genetic problem. In most cases, it is possible
to get the donors' agreement to be genetically screened.
Since 1980, I have counselled over 3,000 couples with a view to pursuing donor
insemination, Over 2,000 have been treated, with over six hundred babies being