Reciprocal IVF vs. Donor IUI: Options for Using Donor Sperm

Parenthood journeys come in many forms.  Fertility protocols can vary immensely depending on the path chosen.  Donor sperm is a reproductive option that benefits intended parents for many purposes including:

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• Single women who may not have a partner

• Women whose partners suffer from conditions where sperm is inadequate to achieve pregnancy

• Women in same-sex relationships who want biological children

 

Donor sperm is acquired via sperm banks that regulate sperm using FDA guidelines.  FDA guidelines guarantee that the sperm donor meets specific criteria, ensuring the women (who receive the sperm) will be medically safe. 

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These guidelines include testing the sperm donor for the following:

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• Infectious diseases such as HIV, hepatitis, syphilis, gonorrhea, and chlamydia

• Genetic diseases so the woman receiving the sperm can make sure she is not a carrier for the same condition and risk passing it on to the child

• Completing a comprehensive questionnaire to rule out high-risk behavior

• Completing a physical with a healthcare provider

 

Besides comprehensive medical screening, sperm bank websites will also provide other details on sperm donors, such as height, weight, hair color, eye color, ethnic background, education level, and upbringing. Some sperm bank websites do not contain photographs, others might include photographs of the donor at a young age.  Rarely sperm banks include adult photos. 

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Sperm banks must guarantee that the sperm meet specific criteria in terms of parameters.  For instance, the sperm count in each vial must be at least 10 million motile sperm.  When screening sperm banks, read the contract carefully to see what the bank guarantees.  Fertility centers often refer women to specific sperm banks based on successful outcomes (pregnancy rates and live birth outcomes).  Once women select their sperm donor, they work directly with the sperm bank to transfer the sperm to their respective fertility centers, where fertility treatment can be performed.

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Donor sperm via a sperm back is anonymous.  However, due to advancements in the genetic testing space, companies like 23 and Me and Ancestry.com, children produced with donor sperm may be able to find their biological father. Women, who use donor sperm, may worry about what to tell their children who their father is once older.  Fertility centers recommend speaking to a fertility therapist to understand what this can mean and guidance as to how to counsel children.

 

IUI vs. Donor IUI

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Intrauterine insemination (IUI), commonly called artificial insemination, is a process where women are monitored via blood work and ultrasound, and sperm insemination is carefully timed when her hormone levels and follicle(s) sizes are adequate.

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A typical IUI cycle involves making an appointment around cycle day 3 of her period and going in for a baseline visit which entails a pelvic ultrasound to visualize the ovaries and blood work to check hormone levels. After this visit, the fertility doctor may start her on oral medications to stimulate her ovaries.  She will go back for routine ultrasounds and blood work (every few days) to see how her ovaries and hormone levels respond to the medication. 

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Once her follicles are deemed an adequate size (usually around 18-20 mm), and her hormone levels are acceptable, the doctor might give her a trigger injection to stimulate ovulation.  The doctor will perform the insemination based on the time of the injection. On the day of the insemination, the woman’s partner will provide a semen sample for insemination. 

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The andrologist in the lab processes the sample to ensure good quality sperm is isolated. The IUI procedure is done in an exam room, and no anesthesia is involved. Most women claim the procedure is painless, with only mild discomfort like a Pap smear. The women will then be given dates to return to the office for blood work to check for progesterone levels and pregnancy tests.

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Donor IUI

 

For women undergoing IUI using donor sperm, all the steps detailed above will be performed; however, instead of using the partner’s sperm, the andrologist will thaw the frozen donor sperm in the lab.  A report will be provided with the sample, which details the parameters of the sperm (count and movement of sperm). If there is anything wrong with the parameters, such as low sperm count, and the IUI is unsuccessful, it is worthwhile to contact the sperm bank.  Some banks will replace the donor sperm complimentary, depending on what is outlined in the initial contract.

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IVF vs. Reciprocal IVF

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In-vitro fertilization (IVF) is a medical procedure in which women are given injectable hormone medications that is carefully timed.  Like an IUI, the schedule is the same: coming in for a baseline visit (usually around cycle day 3 of her period); however, the significant difference is that she will be put on injectable hormones.  In some IUI cycles, women may also take daily hormone injections; however, this is typically not the case. She will then be asked to come in every few days to be monitored via ultrasound to see how the follicles in her ovaries respond.  The goal is to make multiple follicles of an adequate size.  She will also do blood work at these visits to check her hormone levels.  Once her follicles and hormones are adequate in measurement, she will be given an injectable trigger medication to make her ovulate. 

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Based on the time the trigger medication is taken, she will have a scheduled egg retrieval, which is a medical procedure under anesthesia performed in the operating room. On the day of the egg retrieval, the partner will provide a semen sample, and insemination will be performed by an embryologist in the lab.  The couple will know how many viable embryos were created one week later. 

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A fresh or frozen embryo transfer may take place, depending on the options reviewed with the fertility doctor. This procedure involves taking additional hormones to thicken the woman’s uterine lining so an embryo transfer can be performed, which is also timed accordingly.

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A typically frozen embryo transfer cycle:

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1. Takes about four weeks

2. It is not performed under anesthesia since there is minimal pain and discomfort.

3. On the day of the transfer, the embryo is thawed, placed into a catheter, and then transferred into the uterus by the fertility doctor.

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Reciprocal IVF

 

With reciprocal IVF, the procedure outlined above is the same, with some significant differences.  In a same-sex relationship, one partner will undergo hormone injections and the egg retrieval procedure.  Instead of using the partner’s sperm, the donor sperm is thawed by the embryologist, and insemination is done in the lab.  However, with the embryos created from this cycle, the partner of the woman who did the egg retrieval will have the embryo transferred into her uterus.  This way, both women in the relationship partake in the pregnancy journey.  

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With reciprocal IVF, parental and custodial rights should be established.  These rights can vary state by state and whether or not the couple is married or not.  It is best practice to consult a reproductive attorney.  To find an attorney, please visit the website: www.adoptionart.org.