Abstract
Assisted conception techniques using donated gametes includes the use of donated sperm in donor insemination (DI) or in vitro fertilisation (IVF) with donor sperm (DIVF), egg donation or embryo donation.
1 Introduction
1.1. Types of Treatment Using Gamete Donation
Assisted conception techniques using donated gametes includes the use of donated sperm in donor insemination (DI) or in vitro fertilisation (IVF) with donor sperm (DIVF), egg donation or embryo donation.
1.1.1 Donor Sperm
Use of donor sperm has fallen dramatically since the introduction of intracytoplasmic sperm injection (ICSI) for severe male factor fertility and the ability to surgically retrieve sperm directly from the testis or epididymis for men with azoospermia (Figure 32.1). This trend may be reversing slightly since 2010: 4,452 cycles of DI were performed in 2012 in the United Kingdom compared to 4,101 in 2011, and 3,878 in 2010. This recent increase reflects an increasing demand for the use of donor sperm from single women and same-sex couples [1].
1.1.2 Egg Donation
The majority of egg donation cycles are anonymous with a smaller proportion of cycles using a known donor such as a relative or friend. Anonymous donors may be altruistic non-treatment seeking donors or egg-sharing donors who donate eggs as part of their own IVF treatment cycle. The demand for egg donation increases in women over 40 years, and in women over 45 years more treatment cycles are now performed using donor eggs than using their own eggs (Figure 32.2) [2].
1.1.3 Embryo Donation
Embryo donation is not commonly performed, but may be an option for couples or individuals who need both donor eggs and donor sperm to conceive. Embryos are normally donated by couples who have frozen embryos following their own treatment, and no longer wish or need to keep them for their own use.
1.2 Proportion of ART Cycles Using Donated Gametes in the United Kingdom
In 2013, there were 48,477 fresh IVF cycles and 4,611 DI cycles in the United Kingdom. 5% of these fresh IVF cycles used donated sperm, 4% used donated eggs and less than 1% used both donated eggs and sperm, or donated embryos (Figure 32.3). Therefore, in total, just under 1 in 10 IVF cycles used donated gametes. 2% of the 13,353 frozen embryo transfer cycles in 2013 used donated embryos [1].
1.3 Proportion of Patients Having Fertility Treatment with Donated Gametes Who Are Single or in a Same-Sex Partnership
Of the 6,285 patients accessing fertility treatment with donated gametes in 2013, almost two-thirds registered with a male partner, 15% had no registered partner and 21% registered with a female partner. Women in same-sex partnerships may choose to donate eggs to each other (Figure 32.4) [1].
3 Counselling
3.1 HFEA Requirements
Under the HFEA Code of Practice [3] it is obligatory for clinics in the United Kingdom to offer implications counselling to potential gamete donors, and also to individuals or couples seeking to use donated gametes or embryos in their treatment. Specific counselling about the use of donated gametes or embryos should be separate from the implications counselling of treatment in general and should take place before treatment starts.
3.2 Scope of Counselling
Counselling will normally discuss issues such as legal aspects, rights and responsibilities for donors and recipients, as well as exploring how individuals may feel, who to tell, whether or not to tell a child he or she was born as a result of use of donated gametes and if so when, what information will be available about a donor to parents of a donor-conceived child and to the child him- or herself at the age of 18.
4 Sperm Donation
4.1 Indications for Sperm Donation
4.1.1 Azoospermia
Non-obstructive azoospermia with no sperm found in testicular biopsies or for those men unwilling or unable to go through surgical sperm retrieval.
4.1.2 Severe Oligoasthenoteratozoospermia (OATs)
Most couples will normally choose to try using the male partner’s sperm with ICSI, but a small proportion of couples may elect to use donor sperm or resort to use donor sperm if IVF/ICSI is repeatedly unsuccessful.
4.1.3 Single Women
In the last two decades there have been an increasing number of single women seeking help to conceive using donor sperm. In 2013, 943 (15%) of the patients using donor gametes in the United Kingdom were single women.
4.1.4 Women Registered with a Female Partner
An increasing number of IVF and DI cycles are being performed for women who register for treatment with a female partner (Table 32.1). In 2011 there was a 36% increase in IVF cycles with donor sperm performed compared to 2010 and a 24% increase in the number of DI cycles to these women.
Table 32.1 Cycles of DIVF and DI in women registered with a female partner
| Year | Number of DIVF cycles | No. Live births | No. DI cycles | No. Live births |
|---|---|---|---|---|
| 2010 | 568 | 177 (31.2%) | 1028 | 141 (13.7%) |
| 2011 | 766 | 223 (29.1%) | 1271 | 148 (11.6%) |
4.1.5 Other Indications
Other indications include avoiding transmission of genetic risk to children, severe forms of ejaculatory failure refractive to treatment and rarely where there has been severe Rhesus isoimmunisation.
4.2 Sources of Donor Sperm
All sperm donors used in UK licensed clinics are registered with the HFEA and have to undergo appropriate screening tests (see Chapter 31) before the sperm can be used. Sperm is cryopreserved while these tests are completed. Most donor sperm is used anonymously, but some individuals or couples will choose to use a known donor. Many clinics in the United Kingdom import sperm from one of the sperm banks abroad, such as those in Denmark or the United States, because the cost, time and resources required to recruit donors themselves is too high. [1]. Sourcing sperm abroad may help meet the need for specific matches for particular ethnic groups. The number of imports of donor sperm has increased steadily since 2004 and now accounts for approximately a third of donor sperm used in the United Kingdom (Figure 32.5).
4.3 Factors Affecting Success of Treatment with Donor Sperm
4.3.1 Female Age
As with other types of assisted conception treatment, increasing female age adversely affects the chances of a successful outcome (Table 32.2). National data for live birth rates following IVF for 2012 demonstrate that for each age group, use of donor sperm rather than partner sperm was associated with at least as good as, if not better, chance of a successful outcome.
| Age (years) | IVF own eggs with donor sperm | IVF own eggs with partner’s sperm | DIUI (unstimulated) | DIUI (stimulated) |
|---|---|---|---|---|
| <35 | 40.3% | 32.2% | 14.9% | 19.7% |
| 35–37 | 30.5% | 27.4% | 11.6% | 14.1% |
| 38–39 | 26.9% | 19.9% | 7.7% | 10.5% |
| 40–42 | 16.7% | 13.4% | 3.8% | 5.7% |
| 43–44 | 6.6% | 5.1% | ||
| 45+ | 0.8% |
4.3.2 Number of Cycles
Cumulative pregnancy rates over a number of cycles of DIUI are similar to the pregnancy rate expected for couples trying to conceive naturally over several months to a year for each age group [4] (Figure 32.6).
