Donor insemination is an assisted reproductive technology that uses sperm specimens provided by a sperm bank to artificially inseminate the female partner. In China, the sperm bank providing sperm donor must be a legal unit approved by the State Ministry of Health. The sperm bank at Jiangsu Provincial People’s Hospital was the first and only legal sperm donor in the province to be approved in November 2001. Each sperm donor is strictly screened according to the standards issued by the Ministry of Health, and a thorough management system is in place to ensure the health and safety of the recipient and the legal rights of the offspring as much as possible.
Donor insemination includes cervical insemination, intravaginal insemination and intrauterine insemination. Currently, intrauterine insemination is most commonly used in clinical practice. Frozen sperm specimens are first processed in the laboratory and then injected into the uterine cavity of the female partner through a special insemination tube.
Infertile couples receiving artificial insemination by sperm donation mainly have the following reasons: ① irreversible azoospermia, non-obstructive azoospermia such as Creutzfeldt-Jakob syndrome, obstructive azoospermia such as congenital vas deferens, failed recanalization after vasectomy; ② severe oligozoospermia, very rare active sperm in semen, teratospermia such as round-headed spermatozoospermia; ④ serious genetic diseases in the male partner and or family that are not suitable for fertility, such as hemophilia, Huntington’s chorea; ⑤ maternal and child blood group incompatibility cannot obtain a viable newborn.
In severe oligospermia, a small number of motile sperm can sometimes be seen in the semen. In obstructive azoospermia and some non-obstructive azoospermia, sperm can be obtained through surgical epididymal or testicular sperm retrieval, which can then be used to help conceive a child through “IVF” techniques using single sperm intracytoplasmic injection. These techniques are, of course, expensive and time-consuming, with a pregnancy rate of about 50%. It is your couple’s choice whether to undergo IVF treatment with hermaphroditic monosperm plasmapheresis.
If your doctor determines that your couple has an indication for donor insemination and you are seriously considering donor insemination, please follow the steps below.
Step 1: Outpatient consultation and medical examination for both men and women
The male partner should go to the general and specialist urology or reproductive male clinic for semen analysis and other necessary tests, and blood typing; the female partner should go to the specialist or specialist clinic of the fertility center for blood typing and routine gynecological examination, and also for uterine tubal patency examination, mainly iodine oil imaging of the uterine tubes.
Step 2: Apply for a sperm donor specimen
The treatment plan is selected based on the female partner’s tubal patency test or other causes of infertility. If the fallopian tubes are patent, apply for donor insemination; if the fallopian tubes are not patent, or if a condition is determined to be inappropriate for IUI, apply for donor IVF. Applications can be registered in either the general or specialist clinics. Fill out the application form and leave your contact information for future contact.
Step 3: Pre-operative Preparation
After a waiting period, we will call you to inform you that the couple will come to the hospital for treatment. Both couples need to bring their medical records and previous examinations to the general or specialist clinic of the fertility center for pre-operative consultation and examination. The male clinic will review the indications and exclude contraindications for sperm donation and write the male medical record. The female clinic will make a preliminary decision on whether to implement a natural cycle or an ovulation promotion cycle treatment plan. Both men and women will undergo the eight pre-transfusion tests (hepatitis B and half, hepatitis C antibody, syphilis antibody, HIV antibody), liver function and vaginal cleanliness of the female partner.
Your couple should prepare an original certificate of not having children that meets the requirements of the regulations (a valid certificate of re-birth is required for the birth of a second child), an original and copy of the marriage certificate, and an original and copy of the ID card.
If the preoperative examination and preparation meet the requirements of the regulations, the couple can undergo artificial insemination treatment, and the staff will establish a medical record of assisted reproduction with artificial insemination and sign the relevant informed consent form.
Step 4: Implementation of treatment
After the treatment plan is formulated (natural cycle or medically induced ovulation cycle), the female partner will notify the department staff on the first day of menstruation to verify the sperm donor specimen, usually from the 12th day of menstruation for ultrasound dynamic monitoring of follicle development and daily monitoring of basal body temperature. After 24 hours, the laboratory will check your ID card and fingerprints again, and check the number of your selected sperm donor specimen for frozen sperm recovery and processing; the surgeon is responsible for injecting the processed sperm into the woman’s uterine cavity.
After surgery, intercourse should be avoided to prevent infection. Some women may have a small amount of vaginal bleeding and mild abdominal pain 1-2 days after surgery, which is usually related to cervical factors and uterine cramps, and there is no need to be alarmed. If you have any special discomfort, please contact the medical staff of the fertility center promptly.
Forty-eight hours after HCG or GnRH-a injection, you need to go to the fertility center for ultrasound examination. If the follicle has ruptured, apply progesterone orally or intravaginally as prescribed by the doctor, and go to the hospital 12-14 days after progesterone treatment to test blood in the morning on an empty stomach? -HCG to determine if pregnancy is confirmed. If pregnancy is confirmed in this cycle and progesterone is continued as prescribed, ultrasound should be performed on days 45-50 and 70 of menopause to check fetal development.
If there is no pregnancy in the current cycle, you can register to the clinic to develop a treatment plan for the next cycle, and the woman will notify the department staff on the first day of menstruation to make another appointment for a new cycle of sperm donor specimens.
Step 5: Treatment Outcome and Follow-Up
The success rate of donor insemination is about 20-25% per cycle and is usually scheduled for 3-4 treatment cycles. Depending on the woman’s ovulation, the first 2 cycles are usually done spontaneously; if unsuccessful, the second 2 cycles are done with medically induced ovulation cycles. To try to avoid multiple pregnancies, the doctor will terminate the IUI treatment for this cycle when the number of dominant follicles is ≥4. If after 3 to 4 cycles of treatment you are still unsuccessful, you should follow up with a specialist or specialist clinic to determine the next step in your examination and treatment plan, and sometimes you may need to apply for IVF treatment.
According to the regulations of the Ministry of Health, 100% follow-up visits are required for sperm donor treatment cycles, please cooperate with the medical staff for follow-up visits.