Using a sperm bank...

About one couple in six may experience difficulty conceiving. About a third of affected couples will have infertility resulting from male factor problems.

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.

Donor sperm

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 years ago.

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 outcome.

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 donors.

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% per cycle.

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 born.

Written by Mary McEneaney, a counsellor at the Morehampton Clinic, Donnybrook, Dublin.

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