Insemination with donor sperm

Questions from the couples.

Sperm donation is the only possibility for a couple where the male partner is permanently sterile, to conceive. The section 4 of the Law on Medically Assisted Procreation (LPMA), which came into effect on 1st. January 2001, stipulates the conditions under which the sperm donation should be carried out.

At the moment, in Switzerland, very few Centres practice sperm donation. UMR and CPMA are the only Centres in the French speaking part of Switzerland, offering this technique to couples suffering infertility.  Other Swiss Centres are located in the Schaffouse & Tessin Cantons.

Sperm donation is anonymous.  However, the child to come may, upon adult age, know his origin.  Most European countries do not propose this option to children conceived with donor sperm, except northern European countries.  However, this tendency seems to be reversing.  For instance in the UK and The Netherlands the decision has been taken to release the donor’s coordinates.  Remember, in Italy as well, legislation is very constraining for that matter since even sperm donation is prohibited.  Finally, the female equivalent, the egg donation, is not allowed in Switzerland through the law on medically assisted procreation (LPMA).

The development of ICSI has resulted in a reducing of the number of couples I need for IAD.  However, several indicators remain in sperm donation:

• Secretory azoospermia (absence of spermatozoa in the testicles)
• When the couple decides to give up ICSI due to several failures or for personal reasons (financial. ethical, etc)
• When the father is carrying a genetic decease transmissible to the child to come (pre-implant diagnosis is not allowed in Switzerland)
• When the father has a sexually transmissible decease, such as HIV, which could infect both mother and child
• Why sperm donation?
• Sperm donation is the only possibility for a couple where the male partner is permanently sterile, to conceive, to live pregnancy, birth giving, to transmit part of the genetic patrimonial.  It enables the legal father to live the pregnancy with his spouse as well as birth giving.  The parents participates right from the child’s birth to its development and education.  It is quite clear that insemination with donor sperm (IAD) is not an easy move and certain couples will prefer, no matter how many difficulties this entails, to choose for adoption.
• This PMA technique offers maximum security as well as for sexually transmissible deceases as for the child’s protection.
• Who can benefit from donor sperm?
• In Switzerland, only married couples can benefit from sperm donation (Art 3 Al.3, LPMA).  The well being of the child is the key factor on which this law has been focussed.  In case of death or divorce, the child’s security is ensured.
• The members of the couple must be capable of understanding, women should be older than 18 years and less than 42 (exceptionally till 45 years) and men should be older than 18 and less than 60 years.

Which procedure to follow?

Once the decision has been taken, you need to contact your gynaecologist or UMR directly.  Your doctor may already perform the basic exams in order to establish your file in the light if IAD.  A doctor of UMR will then evaluate your results.  When all conditions are fulfilled, a last meeting with the doctor in charge of UMR will take place.  You will be given the answers to your eventual questions.  A “contract” is to be signed by both members of the couple.  Your signature is the caution that you are aware of the LPMA and that you accept its modalities.  The donor will be attributed and inseminations can start.

What medical examinations should be performed?

For the future mother

• ·Rubella, hepatitis B and C, HIV and CMV screenings
• ·TSH and prolactine levels
• ·Blood group identification
• ·Hysterosalpingography (evaluation of Fallopian tubes and uterus by X-rays)

For the future father

• ·Blood group identification
• HIV Serology
• ·Sperm analysis

For the couple

Psychological counselling is compulsory. This counselling aims at evaluating the personal resources, making the patients ponder about the notion of secrecy and answering questions. It is also possible for the patients to participate to gatherings concerning DI and secrecy.

How is the donor attributed to a couple?

The donor is attributed according to his physical features, which are the weight, the height and the colour of the skin, of the hair and of the eyes. The blood group of the donor is also chosen according to the blood groups of the patients.

What is the cost for IAD?

The basic insurance accepts the cost for 3 inseminations (franchise and participation cost excluded).  Twelve stimulation cycles are theoretically at the insurance’s expense.  However, in order to avoid misunderstanding, the UMR’s doctor will write a letter to medical advisor of your insurance and ask for confirmation though respecting the secret vis-à-vis the origin of the sperm.

For confidentiality sake, you will receive an invoice at home covering the sperm expense and which you will have to settle without transmitting it to your sickness insurance.  Estimated cost is 360 CHF.  As from the 4th insemination onwards, a flat fee of 735 CHF covering expenses inherent to the insemination and sperm will be charged.

What are the chances for success?

The success rate per insemination lies between 10 – 15% per cycle depending whether the latter has been stimulated or not.  Obviously an additional female infertility factor might reduce the chances.

What does the insemination with donor involve?

The insemination consists in placing the sperm preparation inside the uterus a few hours before the ovulation. The patient's doctor will establish the time of ovulation and subsequently evaluate the day when the insemination will take place. To do so, three methods are used: vaginal ultrasound, blood test and urine test. Stimulation with oral medicine or daily sub-coetaneous injections can be prescribed. The insemination takes only a few minutes and is practiced like a gynaecological examination. It is totally painless and already after a few minutes rest, the patient can go back to her normal activities.

How can we be sure that the used sperm does not present risks for sexually transmittable diseases?

All necessary precautions are taken to limit, to the extent possible, the risk of contamination by sexually transmittable diseases. The federal regulation on the control of transplants specifies which medical tests are to be performed.

In practice, once the sample has been given, the sperm is washed and cryopreserved. It is frozen inside straws. The donor is controlled every three months (for details of tests performed, please refer to the section "donor"). It is only after having been tested twice with negative result each time, which the sperm can be used for treatment of unfertile patients.

Donors' questions

Who can be a donor?

All men aged between 18 and 50 (exceptionally 55) and able to understand can give their sperm. The donor should not be a carry any sexually transmittable disease (HIV, Hepatitis, Syphilis, etc...) nor present any genetic disease. In Switzerland, donors do not need to have had children or be married. The donor must have read the articles of section 4 of the LPMA and accept the modalities. The sperm should be given to one Centre only.

Is sperm donation anonymous?

In Switzerland, the LPMA (Article 27) states that the child can, if he wishes, ask for the donor identity and his physical characteristics (eye and hair colour, weight, height, origin). However, the recourse in paternity against the donor is illegal. The legal father of the child is the spouse of the child's mother (Article 23). This means that the child does not have any right with respect to the donor. The latter has no duty towards the child. In several European countries, legislation is about to change and is going in the same direction as the Swiss law (England, Holland).

How many children can be conceived with one donor?

A sperm donor can help to conceive a maximum of 8 children.

What is the procedure?

You can contact directly the Maternity of CHUV, the secretariat of Drsse Dorothea Wunder (+41 21 314 32 88) from 8 to 12 am. The future donor can also call the laboratory (LABR) of UMR (+41 21 314 31 61) or eventually send an e-mail to: umr@chuv.ch

How is the interview held for a potential donor?

The potential donor will have an interview of 30 to60 minutes with the doctor, who will explain in detail, the terms and conditions for sperm donation. He will also answer all questions asked. If the person decides to carry on with the donation procedure, he will be asked for his medical history record. The doctor will make sure the candidate-donor matches to the required criteria.

The donor will be given a copy of section 4, which is the chapter on sperm donation, of the LPMA, Law on Medically Assisted Procreation. Given all conditions are met, the donor will sign a contract certifying that he is aware of the LPMA and particularly of the article 27 related to the eventual transmission of the donor's identity to the child. Once the contract is signed, some of the donor's personal details will be registered such as name, surname, birth date, address, education, physical criteria (weight, height, skin, eye and hair colours). The donor will be asked to choose a code name for himself that will enable him to stay anonymous with respect to laboratory personnel he might come across. A sequence will be associated to that name since the couples will only have access to that number. The donor's personal details will be kept in a safe to which only the doctor, responsible for the sperm bank and Drsse Dorothea Wunder have access.

After the interview, a visit is organized for the donor in the laboratory as well as the rooms where the sample will be given. No sampling takes place on the day of the interview.

What happens after the interview?

The donor gives a sperm sample that will enable us to judge if its quality is sufficient for cryopreservation. If the characteristics of the sperm are good, the donor will continue giving his sperm, theoretically once a week. The sperm samples can be given as frequently as one can. However, the minimum number of donations is 20 though 40 samples are preferable. On the basis of one sample a month, we will have to wait 2 years to reach the required number of samples. A blood sample and a urine test to search for sexually transmittable diseases will be performed every 3 months.

What kind of medical tests are to be carried out?

The urinary and blood tests are performed to reduce to a minimum the risk of sexually transmittable- and genetic diseases.

Genetic Research

A caryotype (=control of shape and number of chromosomes) is performed in the first blood test. We search whether the donor is a carrier of Cystic Fibrosis disease (chronic, progressive, and frequently fatal disease of the body's mucus glands, affecting the respiratory and digestive systems in children and young adults).

Every three months, a blood test and a urine culture have to be performed.

Screened diseases

• In the blood: HIV1 and 2, hepatitis B and C, retroviruses HTLV I & II, Cytomegalovirus CMV, herpes, syphilis.
• In the urine: Chlamydia, mycoplasms, pathogenic germs.

Is a person financially compensated for sperm donation?

There is no compensation for sperm donation in Switzerland. he act is assimilated to an organ transplant. However, the sperm donors are repaid for their travel expenses and the time spent in the laboratory. The participation amounts to 100-150 SFr per donation, depending on his place of residence. It is obvious that the costs of blood tests and urinary tests are chargeable to us.

Conclusion

We are in great need for sperm donors. Indeed, to date only a few Centres in Switzerland have a sperm bank and the demand for treatment with donor sperm is steadily increasing. The banning of sperm donation in Italy has induced a "medical tourism".

By donating, couples, presenting a final sterility, are motivated to regain hope and happiness. Thanks to sperm donation, some women have access to a much-wanted pregnancy.

Do not hesitate to contact us by email or telephone. We will gladly answer your questions.