Donor insemination

Donor insemination (DI) is the process of conceiving a baby using donated sperm. Many people who use DI are same-sex female couples or women who want to conceive without a partner.

If you're in a heterosexual relationship and considering DI, it may be because other assisted conception treatments haven’t helped you conceive. DI may be your best chance of having a baby after months of trying other routes to parenthood.

Is donor insemination an option for me?

Your doctor may recommend trying DI if you're:

• a woman in a same-sex relationship and want to conceive
• a single woman who wants to have a baby on your own, or to co-parent with someone who isn’t your partner
  (AA 2016, VARTA ndd)

Some clinics may only offer treatment to heterosexual couples and single women who are medically infertile (Hammarberg et al 2011), so you may need to check out a few before you find one that’s right for you.

You may want to use a sperm donor if your partner has a problem with his sperm, such as:

• A low sperm count (AA 2016). You may want to try DI to avoid invasive or more expensive treatments, such as intracytoplasmic sperm injection (ICSI) and in vitro fertilisation (IVF) (NCCWCH 2013).
• No sperm, or sperm that's unlikely to result in conception (AA 2016, NCCWCH 2013, VARTA ndd).
• A known genetic disorder or infection that may be passed on to your baby if you use your partner's sperm (AA 2016, NCCWCH 2013, VARTA ndd).
• A severe rhesus problem that would affect the pregnancy if you carried a rhesus positive baby (AA 2016, NCCWCH 2013).

DI may not be the answer if you also have fertility problems, such as a fallopian tube blockage.

How do I begin the donor insemination process?

Most fertility clinics offer sperm from:

• an unknown donor you select from your clinic's pool of Australian donors
• a donor known to you
  (AA 2016, NHMRC 2017)

Some clinics can also offer sperm from overseas donor pools (AA 2016).

If you’re considering DI you should be offered counselling (NHMRC 2017) at this early stage. DI has far-reaching implications for everyone concerned, especially the child you may conceive. You'll need to think carefully about when and how you’ll tell your child how she came into the world.

You may find the idea of making a baby with a stranger, friend or acquaintance’s genes difficult to handle, especially at first. If you're in a relationship, your partner may be less comfortable with raising a child who isn’t genetically related to them (AA 2016, VARTA nde).

Bear in mind that one day your child may want to find out more about the donor and whether she has half-siblings in other families. Some donor-conceived children and adults aren’t interested in their heritage (VARTA ndb). But others want to know as much as they can about their genetic history. You'll need to be prepared for either scenario and support your child when she makes that decision (VARTA ndb).

Your clinic or counsellor should be able to give you information about local support groups. Talking to other parents who already have children conceived by DI may help you think through the issues (HFEA 2018b). The Australian Donor Conception NetworkOpens a new window and Access AustraliaOpens a new window offer local groups, events and online forums with parents who have experience of DI, infertility or fertility treatments.

How can I find a sperm donor?

If you're considering donor insemination, it's best to go through a licensed Australian clinic. All sperm used for DI in licensed clinics in Australia is regulated under legislation in the state or territory where the sperm is donated. This is to reduce the risk of disease and other problems.

Buying sperm from sources other than a licensed clinic is illegal, because it may not have been through the robust checks that a fertility clinic provides. Unregulated individuals or companies selling fresh sperm for home insemination are breaking the law (NHMRC 2017).

In the case of unknown donors, sperm is usually from men between 25 and 40. If you've chosen a known donor who is older than about 45, your clinic may agree to use his sperm if you clearly understand the increased risks that come with using sperm from an older man (NHMRC 2017).

All clinics screen potential donors carefully to reduce the chances a child inheriting a genetic disorder (AA 2016, NHMRC 2017). Donors are also tested for infectious diseases such as hepatitis B and HIV/AIDS. Ask your clinic about its criteria for screening donors.

In Australia, donors can't be paid, but they can be reimbursed for expenses such as travel, childcare and some loss of earnings (NHMRC 2017).

If you're using an unknown donor's sperm, your clinic will give you information about potential donors to help you select one, including:

• his physical characteristics such as hair, skin and eye colour, occupation and interests
• his medical history and family history
• the number, age and sex of any children already born using his sperm, and the number of families involved
  (AA 2016)

If you'd like to use the same donor for more than one child, tell your clinic from the outset (AA 2016). Your caregiver will make sure there's enough sperm available and that the donor has given consent for his sperm to be used in this way.

What are the legal implications of donor insemination?

Both you and your partner, if you have one, have to consent to the donor insemination process before treatment can start (AA 2016). You will automatically become the legal parents of your child, and your names will appear on her birth certificate (AA 2016, VARTA nda).

Most sperm donors, including all unknown donors, have no legal rights or obligations, or financial responsibilities to children born through donor insemination (AA 2016, VARTA nda).

The legal situation for a man who wants to donate sperm and be involved in co-parenting the child can be more complex (ICLC nd). If you're considering this path, you and your donor should seek advice from a lawyer who specialises in this area of law.

Your child can find out information about the donor once she’s 18 years old by applying to the donation register in the state or territory she was conceived, or going through the clinic you used (NHMRC 2017, VARTA 2017). In some circumstances, she may be able to apply at a younger age (NHMRC 2017, VARTA 2017). Either way, she'll be offered counselling before any information is shared with her (NHMRC 2017).

Depending on your state or territory, you may also be able apply for information on your child's behalf before she turns 18, but the donor must consent before his information is released to you (VARTA 2017).

Clinics must try to notify the donor before they give you or your child any identifying information (such as his name and address) (NHMRC 2017). If the donation was made before 2005, the donor may not have consented to his identifying information being released, and you may not be able to access it (NHMRC 2017).

Your child can also apply for non-identifying information about other people created using your donor's sperm (donor siblings) (NHMRC 2017, VARTA ndc). She may do this if she's curious about potential siblings, or worried that she may be in a relationship with a half-sibling.

If your child does have a donor sibling and that sibling has consented for his information to be released, your child will be given her donor sibling's identifying information (NHMRC 2017). If he hasn't consented for his information to be shared, though, your child may still be able to get non-identifying information, such as her donor sibling's sex, and year and month of birth (VARTA ndc).

This information may be enough to determine that your child's partner isn't her donor sibling. If it's not, though, she should encourage her partner to investigate their donor's information (VARTA ndc).

How is donor insemination carried out?

Donated sperm is commonly used as part of an intrauterine insemination (IUI) procedure, which is also known as artificial insemination. Or it can be used for in vitro fertilisation (IVF) if necessary (NICE 2013).

Whether you have fertility drugs at the same time as having DI depends on your circumstances. If you’re ovulating regularly, you have a choice as to whether you use fertility drugs to stimulate your ovaries.

If you have an ovulation problem, using ovulatory stimulation drugs is the only option. Although using fertility drugs increases the rates of success, it can also increase the risk of multiple pregnancy (NCCWCH 2013, NHS 2017).

If you are using fertility drugs, your doctor will track your egg development using vaginal ultrasound scans (HFEA 2018a). You'll be given a hormone injection to release the egg when it's ready. If you're not using fertility drugs, you'll be given blood or urine tests to determine when you're about to ovulate (AA 2016, HFEA 2018a).

Sperm used in DI is frozen for a minimum quarantine period of three months, but usually for six months (AA 2016, IVFA nd, MIVF nd). Freezing doesn’t harm the sperm. The donor is retested and confirmed negative for specific infectious diseases before the sperm is released (AA 2016). The sperm is then thawed, washed and prepared just before it’s used (HFEA 2018a).

IUI using donor sperm
During donor-IUI, your doctor places a concentrated dose of the donated sperm in your uterus (womb) when or just before you’re ovulating (VARTA ndd). The process is like a cervical smear, with your doctor inserting a speculum into your vagina, then injecting the best-quality sperm through a catheter (thin tube) she's threaded through the speculum and into your uterus (AA 2016, HFEA 2018a).

Having IUI doesn't require anaesthetic and shouldn’t cause you pain or discomfort (AA 2016, HFEA 2018a, NHS 2017). Some women, though, experience mild cramps (HFEA 2018a, NHS 2017).

Read more about IUI.

IVF using donor sperm
There are a few more steps if you're using donor sperm for IVF. Your doctor will first give you a series of drugs to suppress your natural menstrual cycle, then to boost your egg supply, and finally to help your eggs mature before they're collected (HFEA 2018a).

You'll have vaginal ultrasound scans, and possibly blood tests as well, to track the development of your eggs. When they're ready, your eggs will be collected while you're under anaesthetic. Afterwards, you may feel a little sore and bruised, and experience cramps or a small amount of vaginal bleeding. Your doctor will give you another medication, to help prepare your uterine lining for embryo transfer.

Meanwhile, your eggs will be mixed with the donor sperm in a laboratory. The best of any fertilised embryos that develop will be selected for transfer (HFEA 2018a). Using ultrasound to guide her, your doctor will transfer the embryo into your uterus through your cervix with a catheter.

Transfer happens between two and five days after fertilisation (AA 2013, VARTA ndg). It’s usually recommended that only one embryo is transferred in order to avoid a multiple pregnancy (VARTA ndd).

Embryo transfer doesn't require anaesthetic and shouldn't cause you any pain (HFEA 2018a). Because ultrasound is used, though, you'll need a full bladder, so you may feel a bit of discomfort.

Read more about IVF.

Self insemination using donor sperm
Only doctors can perform IUI and IVF, but some women choose to inseminate themselves at home (VARTA ndd). This is legal, but may not be the safest option because there's no medical screening of the donor or his sperm.

Going through a clinic also ensures that you, your partner (if you have one), the donor and his partner (if he has one) all receive counselling, and that your child can apply for information about the donor and any donor siblings once she's an adult.

How long does donor insemination treatment take?

Once you’ve chosen a clinic, staff there will advise you on how soon you may be treated. The Access Australia websiteOpens a new window lists licensed fertility clinics in Australia.

If you're having IUI, the insemination itself is straightforward and takes just a few minutes (HFEA 2018a). But if you’re having a stimulated cycle, you'll also need to take fertility drugs for a number of days before you ovulate.

If you're having IVF, a cycle takes up to six weeks to complete, depending on the course of treatment your doctor advises (HFEA nd).

What are the success rates of donor insemination?

In Australia and New Zealand in 2017, about 12 per cent of all DI cycles resulted in a live birth (Newman et al 2019). Whether or not DI is successful tends to depend on your age, though:

• 14 per cent for women aged under 30
• 15 per cent for women aged between 30 and 34
• 11 per cent for women aged between 35 and 39
• four per cent for women aged 40 or more
  (Newman et al 2019)

The number of unsuccessful DI cycles you may have to undergo before your doctor will recommend moving on to other treatment options will depend on your circumstances.

What are the advantages of donor insemination?

• If your partner doesn’t produce sperm, or he carries a genetic disorder, infection, or other condition which could be passed on to your child, DI gives you the chance to have a baby (NCCWCH 2013).
• If you are single or in a same-sex relationship, DI gives you the chance to have a baby (AA 2016).
• It’s a highly regulated procedure. Fertility clinics that practise DI using donated sperm must keep to strict safety laws. All sperm used by clinics must be screened for infections, such as HIV, hepatitis B, and hepatitis C (NCCWCH 2013, NHS 2017).
• Sperm should also be screened for inherited diseases such as sickle cell disease and cystic fibrosis (NCCWCH 2013, NHS 2017). The sperm is kept in frozen quarantine as part of the screening process, and washed before it can be used (AA 2016, HFEA 2018a, NHS 2017).
• You and your partner are named as the parents on your child’s birth certificate (AA 2016).
• A man who donates sperm through a clinic has no legal rights or responsibilities over the resulting children (AA 2016, VARTA nda). Before donating he (and his partner, if he has one) will have received counselling about this and the implications of donation for himself, his partner and his own children (AA 2016, NHMRC 2017, VARTA 2017).

What are the disadvantages of donor insemination?

• If you're a single woman or in a same-sex relationship, Medicare may not cover the treatment unless you've been diagnosed as medically infertile (AA 2016).
• If you take fertility drugs followed by DI, the drugs may make you release more than one egg. This could result in a multiple pregnancy, which may be more likely to lead to complications than a singleton pregnancy (NCCWCH 2013, NHS 2017).
• Not being the biological parent may affect how your partner feels about your child (AA 2016, VARTA nde). Your wider family members may also need to come to terms with an addition to the family who is not genetically related to them.
• You'll need to think about how and when you'll tell your child about her genetic origins and the many emotional issues that donor conception presents. Talking about it openly and honestly during childhood can help (AA 2016, DCN nd, HFEA 2019).
• There's a cap on the number of women who can have children from the same donor (IVFA nd, NHMRC 2017, VARTA nda). The maximum number varies between states, territories and clinics, from about five to 10 women, including the donor's current and past partners. Clinics in regional areas or smaller jurisdictions may impose a smaller limit of families (VARTA nda). Donors can also specify that their sperm is used to create fewer than the maximum number of families specified in local legislation or clinic policies (NHMRC 2017, VARTA nda). So you may not be able to access your preferred donor's sperm if his maximum is reached by the time you select him.
• Because your donor's sperm can be used by multiple women, it's possible for your child to have half-siblings ("donor siblings") that you don't know about. As your child grows, it’s wise for her to apply for information about any possible siblings, to reduce the risk of accidentally having a romantic or sexual relationship with one of them (VARTA ndb).
• There's generally a shortage of sperm donors in Australia, so your clinic may have a waiting list (AA 2016, VARTA ndf). Some clinics have access to overseas sperm banks (AA 2016, VARTA ndf), though, which may also give you a wider range of sperm donors to choose from, particularly if you're hoping to choose one with a specific racial or ethnic background (AA 2016). If your clinic uses sperm from overseas donors, the donor and his sperm must meet the same requirements as local ones, including medical criteria and consent to release identifying information (NHMRC 2017).
• A donor may withdraw consent for his sperm to be used at any point before your treatment cycle starts, or before any embryo is created (NHMRC 2017). A donor may also withdraw consent after you've had one child and before you've had a chance to conceive another.

You can find a counsellor specialising in fertility issues and treatments through the Australian and New Zealand Infertility Counsellors AssociationOpens a new window.

More information and support:

• To talk about sperm donation with others who've done it or are thinking about it, join our community.
• Find out more about intrauterine insemination (IUI).
• Discover what's involved in egg and embryo donation.