Making the Decision to Undergo Donor Insemination
We strongly recommend patients be counseled regarding the decision to undergo Therapeutic Donor Insemination or TDI. We hope the following information is helpful in making this decision.
There are over 5,000 babies born each year in United States conceived by artificial insemination with donor sperm or TDI. The procedure was first performed in the United States in 1884 surrounded by much secrecy. Over 100 years later, TDI is still poorly understood. There are medical, psychological, religious and legal issues, which need to be considered; yet many couples thinking about TDI don't have the necessary information in order to make a well-informed decision.
People decide to choose Therapeutic Donor Insemination for many reasons. The primary reason is male infertility, due to either the total absence of sperm (Azoospermia) or severe problems with sperm count, motility, or morphology (shape). In addition, a man may have chosen sterilization through vasectomy and not wish to undergo the reversal surgery, which isn't always successful. He may have been exposed to radiation or chemotherapy for an illness such as cancer. Some men may choose TDI to avoid transmitting a genetic disease such as Huntington's Chorea or Tay-Sachs. Finally, the decision to go with TDI may come when a woman is concerned about "her biological time clock" or she may desire a child but not a relationship with the biological father.
There are distinct advantages to Therapeutic Donor Insemination. A couple can go through a pregnancy together knowing that they are providing the kind of prenatal care and protection that they want for their baby. They have the opportunity to prepare for childbirth and participate in labor and delivery together. They can be with the baby from the moment of birth. They know the genetic background of the mother and the donor, and there is a good likelihood of family resemblance.
Questions about the health of babies conceived through donor insemination reveal yet another advantage to this choice: the rate of congenital birth defects in our nation is about 6% (half of these are considered "minor"). Studies have shown the incidence of birth defects in TDI babies to be less than 1%.
The secrecy aspect of donor insemination can be another difficult decision to make. Do you tell your friends and family that you are considering inseminations or that you conceived your pregnancy through donor inseminations? If you don't plan to tell your child that he or she was conceived through donor insemination, we recommend not telling anyone. This is not something that you want your child to accidentally hear from someone else. Whether to tell the child they were conceived through TDI is a very personal and sometimes difficult decision to make. Unlike adoption the biological father's identity would never be released to the recipient or the offspring.
Making one of the most difficult decisions of your life without the help of relatives and friends increases the anxiety of deciding to go the route of donor insemination. One solution that we have found to be helpful is for patients to seek a psychologist or counselor that is trained in this area. Patients can then have open discussions about their concerns and feelings regarding donor insemination.
Patients should be counseled about the completeness of the fertility evaluation, the prognosis, and deciding a reasonable time frame to keep trying. How long is realistic for you as a couple to keep trying to conceive? Generally it is thought that if a pregnancy has not occurred after 6 months to 1 year of well timed artificial inseminations with the husband's specimens, and in the absence of severe female infertility problems, it may be time to make a decision about what to do next. If the woman's age is a factor it may be advisable to shorten that time period, so that the option of invitro fertilization or donor inseminations can be explored.
Many couples have gone to a number of different doctors, endured numerous tests and assisted reproductive procedures such as sperm washing and intrauterine inseminations and IVF with the husband's sperm without success. It seems like there is no end in sight as more time, effort and money are invested. The greater the vested interest, the harder it is to let go of your goal, even though you begin to feel maybe it would be a relief if you were told to stop.
When a couple is told they have little to no chance of conceiving a child without the aid of TDI it is a very emotional time. Do you accept the prognosis that there is little if any possibility of a pregnancy occurring with the husband's sperm specimen? It is even more difficult when the semen analysis is classified as sub-fertile which makes pregnancy unlikely, but not impossible, especially with the reproductive technology available today. If you are waiting to be told that a pregnancy with the husband's specimen is not possible, it may never happen. Waiting for such absolute terms can be a trap, because in medicine these terms are rarely used, as the human body can be very unpredictable.
A couple should not begin TDI immediately after learning that the husband has either an untreatable infertility problem or that treatment appears to be unsuccessful. Both husband and wife need time to absorb the shock and accept the fact that he will not be able to have a biological child. Grief can be expressed in many ways. Feelings of intense sadness, anger and loss of self-esteem are common. The wife is also struggling to deal with her reactions. She is feeling many of the same emotions and may feel guilty that she still has the possibility of conceiving and that she still wants a pregnancy. Infertility and the feelings that accompany it can be one of the most difficult times your marriage will endure.
TDI should not be consented to out of a sense of guilt caused by a spouse's pressure. It is advisable to consider all possible options of assisted reproduction prior to making a decision to go with TDI. Both partners need to be totally resolved that all options of conceiving as a couple have been exhausted. Acceptance does come. There will come a point when despite your doubts and fears, other ways of becoming a parent will begin to be acceptable to you. In order to accept the idea of fatherhood through TDI (as well as adoption) you need to separate the desire for a joint biological pregnancy from the desire for parenthood. How important is it for you to have a genetic link in order to love your baby? How do you define fatherhood? Is it planting the seed, or is a father someone that raises the child with daily love, support and nurturing.
In some cases the second child born to these couples will be the biological offspring of both husband and wife. This can be due to improved fertility in both the wife (full term pregnancy often improves fertility) and husband (sperm factors can improve over time for many reasons). When both husband and wife have impaired fertility, it makes obtaining a pregnancy very difficult. Often just improving on either male or female fertility factors makes the difference in obtaining a pregnancy.