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Conception using Donor Sperm March 2003 Welcome The first recorded use of donor insemination was in 1909. After the process of cryopreservation of sperm was developed in the 1950s, sperm banks were established thus increasing access. Since this time there have been significant changes which have coloured the provision of donor insemination services. Male factors contributing to infertility are better understood, debunking the myth that infertility is a female condition and enabling more open discussion of men's feelings about their infertility. The offspring of donor conceptions have questioned the secrecy surrounding their conception and argued convincingly for disclosure of their biological beginnings and for access to identifying information about their donors. Initial Presentation Tom 31, and Angela 29, have been married for four years and trying to conceive for 18 months. Following investigations for infertility, it is discovered that Tom has azoospermia. Angela is shown to be ovulating regularly. Further investigations show that Tom has reduced testicular volume (5 ml) and a serum FSH of 22iu/l (RR<10), suggesting major disruption to spermatogenesis rather than obstruction. Following discussion it is decided that aspiration of the testes is unlikely to recover viable sperm and that insemination using a donors sperm would be the most likely path to achieve a successful pregnancy. Tom and Angela are referred for counselling because they feel they need some support, both in coming to terms with this very unexpected position and in considering their options with respect to having children. Counsellor Comment Information about the diagnosis may need to be given more than once before it can be fully understood. The couple may experience feelings of shock and disbelief. Initially therefore, they may not be able to address the implications of this news for their lives. Decision making should be delayed until they have had time to accommodate their immediate emotional responses to this crisis. Follow Up Tom follows up the initial appointment by coming to see the counsellor alone. He has been profoundly surprised by the intensity of his feelings. He had assumed that a fertility problem, if it existed, would reside with his partner and that it would be treatable and fixable. He describes feelings of sadness and powerlessness and expresses guilt that he is contributing to his partners sense of loss that they have not conceived. Angela also seeks time to talk alone with the counsellor. She does not feel able yet to talk freely to Tom of her feelings, recognising that he is shouldering blame and not wishing to add to this. Tom has not wanted their situation discussed with anyone else and Angela feels she cannot use her usual supports to talk over and clarify her feelings. Counsellor Comment Each partner is likely to have very different responses from the other and therefore different issues to deal with. They may feel that these differences threaten their relationship and at first feel safer talking with the counsellor separately. Other facets of the relationship may be affected. It is not unusual for people's sexual functioning to be disrupted, with men experiencing temporary erectile dysfunction and women, loss of libido. Each may be experiencing grief that they will not parent a genetically shared child. People may feel isolated from their friends and family, particularly those with children. Their usual supports are therefore not available. Follow up Tom and Angela take time to further consider their options which include donor insemination, adoption or child free living. They decide that they wish to use donor sperm to build a family. They make arrangements to see the counsellor to discuss the implications of receiving donor genetic material. They are given written material to consider before attending the meeting with the counsellor. Counsellor Comment In South Australia, counselling of both donors and recipients is mandatory under the Reproductive Technology Act 1988. Issues which would be explored with the couple are: Their emotional readiness to embark on this course. If either is still overwhelmed by feelings of distress, they may experience difficulties engaging with this process of becoming a parent. The meaning they each ascribe to genetic and non genetic links. What has been their experience in their own lives? How has cultural and family background contributed to this? How then do they consider the genetic inequity that results from having a child through donor insemination. Their feelings about disclosure of their beginnings to their potential child. The positives of openness as distinct from secrecy are discussed while respecting the individuals' circumstances. The possible exchange of non identifying information relevant to the donor and offspring. In SA, when a child conceived through donor insemination reaches sixteen, they may apply for non identifying information about the donor. This may be extended in the future to include identifying information by the establishment of a central register of donors, recipients and offspring. The legal status of a child born using donor gametes. In SA the Family Relationships Act clarifies that the legal parents of a child born using donor gametes are the woman bearing the child and her spouse. Follow up Tom and Angela are given time to consider their responses to the issues which have been raised. They are offered ongoing support and given the contact details of consumer support groups and other relevant community services. After a period of consideration, Tom and Angela wish to proceed with donor insemination and make appointments with the fertility nurse and doctor to discuss logistics, cost and choice of donor. References Boivin,J and Kentenich, H, (Editors), "Guidelines for Counselling in Infertility"ESHRE Monographs 2002 Daniels, K and Haimes, E (Editors) "Donor Insemination" CUP 1998 Donor Conception Support Group, "Let the Offspring Speak" DCSG 1997 Hammer Burns, L and Covington,SN "Infertility Counselling"Parthenon Publishing Group NY 1999 SA Reproductive Technology Act 1988 SA Family Relationships Act  PRINT THIS PAGE
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