Donor insemination in the post-anonymity world: one clinic's experiences

The consequences of the removal of anonymity for donors in terms of quality and number have been a cause of concern to patients, clinics and policy makers in the UK. At the London Women's Clinic (LWC), donor insemination (DI) is an integral part of our life. We have the largest sperm bank in the UK and, following the change in the law to donor anonymity in 2005, are now one of the only UK fertility clinics able to provide donor sperm with no waiting list. We also have one of the longest pedigrees of offering DI to single women and same sex couples. Because of this, we decided to study the impact of the legal changes on clinical practice and donor compliance, with a further aim being to determine the role of other factors including age and sexual orientation on the live birth rate (LBR) following intrauterine insemination (IUI).

A retrospective analysis of 500 consecutive patients (1036 IUI cycles) who attended for treatment during 2005-6 was performed. Single women and same sex couples contributed to 81 per cent of the treatment cycles. Ninety-five per cent of patients used donor sperm and five per cent used partner sperm. The age range of the women treated was 21-49 (the mean age being 36.3).

Lesbian women (mean age 35.1) achieved a LBR of 21.4 per cent, significantly higher than that for single women (mean age 38.3), which was 14.95 per cent. We surmise that this is probably due to the age factor, though the possible implication of the psychosocial status should not be overlooked.

According to data from the Human Fertilisation and Embryology Authority, a downward trend in DI was evident for 1991 - 2006. A further decrease was feared in response to the removal of anonymity in April 2005. To compensate for the expected decline in the number of sperm donors, LWC tried to develop a less daunting approach to the donation experience. With better facilities, focused advertising and well-trained staff, we were able to improve our recruitment and retain the majority of those donors that pass the initial screening phase. Recipients also have expressed concern about the possible shortage of sperm for treatment. However, we can confidently state that following a successful year in 2007 when no patient waited for donor treatment, in 2008, the LWC will maintain stability and ethnic diversity of sperm donors attending our programme.

Last October, the LWC ran the first ever seminars for women considering conceiving by DI. The two free half day 'Inseminar' events were chaired by clinic director Peter Bowen-Simpkins and included several talks as well as a tour of the clinic and laboratories. Even though the Inseminars were widely publicised (including adverts on the London Underground!), their popularity surprised us: the first two were so oversubscribed that attendees were literally sitting cross-legged on the floor around the feet of the speakers by the time we started.

Not only do we have lots of experience providing DI to single women and same sex couples, but in October 2007 we launched our in-house legal service, and this meant that, with leading solicitor Natalie Gamble from law firm Lester Aldridge LLP on board, Inseminar could cover not only the medical side of things but also the complicated legal issues.  Responding to an altered landscape for sperm donors in the UK, we wanted Inseminar to be an event which would educate, inform and assure women considering conceiving with donor sperm. As far as we know, it's the first time an event like this had ever been held. As it turned out, donor conception was an immensely topical subject during October and November. The government's new Human Fertilisation and Embryology Bill was introduced and provoked a debate in the media and in parliament about sperm donation, particularly clinics' obligation to assess 'the need for a father' and the new proposed parental rights for lesbian partners.

Our first Inseminar comprised of a three part presentation - a format we will stick to. Mimi Aria-Schad, Head of Nursing, talked about the process of donor insemination, explaining the preliminary tests patients must have, and the different treatment options available. Then Venessa Smith and Elena Linara, our Sperm Bank Managers, provided details of recruitment and screening of sperm donors and the adjustments the LWC sperm bank has made to survive in a country that has withdrawn anonymity from sperm donors. The types of donors, their motivations for donating, and how patients and donors are matched were also discussed. The pregnancy rates and research done at the LWC were the other important areas included for discussion.

Natalie Gamble then addressed the legal issues associated with DI, particularly who the legal parents are and how lesbian partners acquire parental rights. She also discussed the legal position of known and unknown donors, children's rights to information about their donors and genetic siblings, and the legal rules which surround the storage and use of donor sperm for subsequent pregnancies.

The feedback from our patients has made the work done over the last three years completely worthwhile for the entire team. To meet the initial demand, we repeated Inseminar during November and December, and its continuing popularity has made us decide to make it a regular fixture in the London Women's Clinic calendar.  During 2008, we plan to take it on a road show around the rest of the UK, as well as running more events in London. See the 'Recommends' section of BioNews for up-to-date events listings.