Artificial Insemination by Donor (AID)

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There are a number of reasons why artificial insemination by donor has become quite common in recent years: it has become more socially acceptable; it is more difficult to find children for adoption; older people and a growing number of unmarried women want to have children. The artificial insemination by donor (AID) procedure was first performed in 1884, but did not become an acceptable option until this century. In the 1950s it was discovered that sperm could be frozen and used later. In the following years the legal and moral aspects of the procedure were studied and criteria for donors were established. Only in 1979 were directives established by which the possibility of hereditary and sexual diseases among donors could be discounted. These criteria were reevaluated in 1986, and an AIDS test was included.

Today the most common reasons to use artificial insemination by donor is male infertility and the prevention of hereditary diseases such as cystic fibrosis, hemophilia, Rh disease, muscular dystrophy, and Tay-Sachs disease. The criteria for male infertility according to which the use of artificial insemination by donor would be justified are: irreversible lack of sperm from childhood or as a result of disease, radiation, chemotherapy, or sterilization; insufficient quantities of sperm or severe sperm malformation; or other forms of incorrectable impotence.

For most couples, impotence is often accompanied by feelings of anger, frustration, and guilt. Even when artificial insemination is offered as a possible solution, the husband may have difficulties facing his sense of failure and a crisis may emerge that can lead to the break-up of the marriage. Therefore, when tests show that there is no alternative, the doctor must present these findings with considerable caution. Treatment should not begin immediately. The couple needs time to confront their problem and deal with it. Women too may sometimes feel disgusted by the injection of foreign sperm into their bodies, Some women even develop physical problems expressed in menstrual and ovulation disorders and even cessation of ovulation. Obviously, not all couples can be considered suitable candidates for artificial insemination. Any couple that applies for it must be carefully studied and it must be ascertained that no other solution to their problem is available. Both partners must agree in writing to receiving sperm from a donor and the man must also sign that he undertakes to recognize the resultant child as his own. So as to prevent any regrets, the husband should participate in all parts of the process, from the determination of ovulation until the completion of the AID process. Another way of reducing tension is to provide a thorough explanation to both partners about all stages of the procedure, including how donors are chosen and the tests they undergo so that their sperm is considered suitable, the chances of impregnation, possible complications of pregnancy, and the chance of birth defects.

Donors are chosen with great caution so as to avoid those with faulty health, hereditary diseases, and poor potential for fertility. Sperm counts must show a volume of over 1.5 milliliters, a concentration of 20 million sperm per milliliter, motility of over 40 percent, and proper morphology in at least 50 percent of the sperm. Donors are generally chosen from quality populations (many are students); they undergo considerable physical and mental evaluation. A comprehensive interview is made to determine whether there are any problems in the donor’s past or family history, with particular emphasis placed on hereditary diseases and the mental health of the donor’s family. Comprehensive testing is done to determine if the sperm carry sexually transmitted diseases, particularly AIDS. These tests are repeated every six months: the sperm sample is then frozen until similar responses six months later indicate that the sperm may be used.

A listing of physical factors (blood type, Rh factor, body structure, and color of skin, eyes, and hair) is made. The psychological and social backgrounds of the donor are also recorded to facilitate the child’s absorption by the family and surroundings. At the same time the couple must be informed that although every effort will be made, there is no way to ensure that the donor will be similar in every way to the father. The identities of the donor and couple receiving AID treatment remain anonymous in most countries. The information is kept in a hospital safe and is not handed to anyone.

The AID procedure includes tracking ovulation by various methods, including measuring the basal body temperature and ultrasound tracking of the follicle’s development. Sperm is injected around the time of ovulation. Prior to the injection a speculum is inserted into the vagina to expose the cervix, and a sperm sample is placed inside by means of a narrow tube. In some cases, sperm is also injected directly into the uterus. The patients lies down for several minutes but can then get up and go home. When an injection is made, it is considered that the ovum is ready in the fallopian tube up to three days after ovulation, but sperm remains functional in the female sex organs for seven days.

One injection is usually sufficient during ovulation, but often two or more injections are given, particularly when the precise time of ovulation is uncertain. When the time of ovulation is certain, especially when ovulation has been brought about by drugs, there is no advantage to additional injections. Because of the sperm’s lifespan, it is preferable to inject it before the follicle is shed. When multiple injections are used, it is best that they all be from the same donor to ascertain the father’s identity.

If no other problems are involved, the chances for pregnancy are good—about 90 percent after a year of intensive treatment. Pregnancy and birth are no different from other pregnancies and births. In fact, children born from artificial insemination by donor have been found to have a higher intelligence than average.

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