Single and ready to have a baby – what are my options?

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I’m a single woman – what are my options?

Donor sperm – clinic-recruited versus known donors

Essentially, there are two options for obtaining sperm: accessing donor sperm through a fertility clinic’s sperm bank, or using a sample provided by someone you know.

At Newlife IVF we have an on-site sperm bank containing samples recruited from local and international donors. The benefit of using sperm from our clinic-recruited donors is that it is thoroughly tested for infectious diseases and common genetic problems. After we freeze the sperm, it is then quarantined before donors are retested to make sure it is high quality and safe to use.

When you use a clinic-recruited donor, you also have the advantage of very clear legal boundaries. The donor has no legal connection to your child – they are not entitled to custody and do not have to pay child support. They also remain anonymous to a large extent; that is, you will not know the donor’s identity (but you will know their family medical history and some of their traits). However, your child can request that the donor’s identity be revealed to them when they turn 18.

If you choose not to go the clinic-recruited donor route, you may consider using a sperm sample from a friend or acquaintance. A benefit of using a known donor is you will likely have a good understanding of their appearance, background and traits. However, the social and legal boundaries are not as clear-cut as they are when using a clinic-recruited donor. Discussing expectations and creating firm boundaries with a known donor requires careful negotiation, and you may wish to seek legal advice on how best to proceed.

If you do decide to use a sample from someone you know, it’s best to involve a fertility clinic. That way, you can have the sample rigorously tested for safety and quality in the same way we test donor sperm.

In this video, Dr Chris Russell talks about donor sperm and its use in IVF and IUI procedures.

Insemination – how egg and sperm meet

The next consideration is how best to introduce the sperm sample to your egg. There are a few different options for insemination, and the most suitable will depend on your specific circumstances.

One possibility is home insemination. In this method, sperm is injected into the vagina using a syringe at home. As this mimics the natural fertilisation process, home insemination is effective when the donor has a normal sperm count. It is also one of the most cost-effective options. However, it does not afford the same degree of protection from infectious disease as undergoing a similar process via a fertility clinic.

The clinic-based alternative is intrauterine insemination (IUI). This is where a sperm sample is concentrated to contain a very high number of sperm. It is then injected directly into your uterus soon after your ovaries release an egg. Using a concentrated sperm sample increases the chances of a sperm fertilising your egg. Depending on your circumstances, your specialist may recommend combining IUI with a medication to stimulate the release of an egg from your ovaries, further increasing the chance of success.

The last option is in vitro fertilisation (IVF). In this process, several of your eggs will be introduced to sperm in laboratory dishes. When utilising clinic-recruited donor sperm, the best sperm may be selected and a single sperm injected directly into each egg, a process called intracytoplasmic sperm injection (ICSI). One of the best embryos resulting from IVF insemination will then be transferred back to your uterus. The rest can be frozen and stored for later use, if necessary.

Two embryologists performing the intracytoplasmic sperm injection procedure.In ICSI, a single sperm is injected into the centre of a mature egg.

There are a few reasons you may be advised to undergo IVF. If you have known infertility, you’re in your late 30s or early 40s (when female fertility naturally declines significantly), or you struggle to get pregnant through other forms of insemination, your specialist may recommend this procedure. Likewise, IVF may be advisable if you’re using a known sperm donor with low sperm quality or quantity for other methods of insemination. If you wish to do preimplantation genetic testing, which is the process of genetically testing your embryos before they are transferred to your uterus, IVF will be necessary. For more information about these procedures in relation to your particular circumstances, chat to your fertility specialist.

I’m a single man – what are my options?

To have a baby as a single man, you will need the help of an egg donor and a surrogate. According to Victorian law, these must be two different women.

You may choose to use a clinic-recruited egg donor, or a known donor, i.e. a friend, acquaintance, or a family member (note: the last is only okay if you are not using your own sperm). Egg donation must be altruistic in Australia, meaning no financial compensation is paid for providing eggs. Once the donor eggs are ready, your sperm will be introduced to them using IVF (discussed earlier in this article), and the best resulting embryo will be transferred to your surrogate’s uterus. If you are not using your own sperm, donor embryos may be an appropriate option for you.

It’s common to ask a friend, acquaintance or family member to be a surrogate. Surrogacy is also an altruistic process in Australia, however ‘reasonable’ medical costs can be paid by you. Keep in mind that in Victoria, multiple medical consultations, counselling sessions and legal advice are required for both you and the surrogate prior to proceeding. You will also need to seek permission from the Patient Review Panel (this is a legal requirement in Victoria), and the sperm or embryos must be quarantined. This process can take several months.

Seeking a surrogate overseas may also be an option. However, according to Australian law, this is only legal if it is altruistic. Be aware that this is a very expensive route and you will need to plan to potentially be overseas for a few months after your baby is born to organise their entry into Australia.

For advice related to your particular circumstances, you may wish to seek legal advice and talk to a fertility specialist. Unfortunately, Newlife IVF is not permitted to assist you in finding a surrogate (nor can any other IVF provider). However, our counsellors can certainly orientate you to the Victorian surrogacy community and provide support and information as you look for a potential surrogate.

Ready to have a baby on your own?

Make an appointment with one of our caring and experienced Newlife IVF fertility specialists to discuss the most appropriate way forward based on your medical history, circumstances and preferences. Call (03) 8080 8933 or book online and take the next step towards your dream.

My doctor says we need ICSI – how will this improve our chances of a successful IVF cycle?

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The traditional IVF approach is to allow this meeting to take place ‘naturally’, albeit in a laboratory dish: the woman’s egg is placed in a special culture medium with a prepared semen sample containing thousands of sperm. The fittest sperm fertilises the egg, mimicking what would normally happen in the woman’s reproductive tract.

As its name suggests, ICSI is far more precise. Rather than leaving the egg and sperm to meet of their own accord in a laboratory dish, this technique allows us to directly inject a single sperm into a woman’s egg – thereby, overcoming any issues that may be getting in the way of a sperm and an egg meeting and coming together naturally. Here, we consider some of the reasons why ICSI may be considered during IVF and what specific fertility problems it can help overcome.

Who is ICSI suitable for?

When a couple is experiencing difficulties getting pregnant, it can be easy to focus solely on the woman’s fertility. However, a male factor contributes to infertility in approximately 40% of couples who fail to conceive.1 ‘Male factor infertility’ typically involves an alteration in the number, shape and/or movement of the man’s sperm, all of which can affect the sperm’s ability to fertilise an egg the natural way. ICSI is most commonly used to help overcome these types of sperm-related issues.

ICSI may also sometimes be offered if a woman has very few eggs available (e.g. due to age). In this case, ICSI is used to increase the chances of successful fertilisation, thereby lowering the risk that the woman runs out of eggs before she achieves a successful pregnancy through IVF.

ICSI may also be recommended if one or more previous standard IVF cycles were not successful due to failed fertilisation, or if the reason for cycle failure is unclear but a sperm-related issue is suspected despite a normal semen analysis.2

A checklist for fertile sperm

If your doctor suspects male factor infertility could be affecting your chances of pregnancy, they will usually suggest a semen (sperm) analysis. This is the main method used to test male fertility. During the analysis, a number of different factors that could be affecting your ability to conceive naturally are studied, including:

  • The volume of semen, which needs to be sufficient to transport sperm into the female reproductive tract
  • The sperm concentration and total sperm count, which affect the likelihood that enough sperm will reach the egg in order for one to fertilise it
  • The physical shape of the sperm, as abnormally shaped sperm can have difficulty swimming to the egg or penetrating the egg’s outer layer
  • The motility of the sperm (i.e. how well it can swim) – if large numbers of sperm in the sample are ‘weak swimmers’, then a natural pregnancy will be more difficult to achieve.

Your specialist might also recommend additional testing for:

  • Sperm DNA damage or fragmentation: sperm with damaged or fragmented DNA have a reduced chance of fertilising an egg
  • Sperm antibodies, which if present, can attack and impair sperm function.

Depending on your results, your doctor may then order follow-up tests to make sure the results are accurate and/or to see if anything else is preventing the semen from doing its job.

Once the tests are complete, your specialist will discuss your results with you and explain what your options are, including whether ICSI is likely to increase your chances of successful fertilisation and the overall success of your IVF treatment cycle.

Success rates with ICSI

Because of ICSI, many previously infertile men now have a good chance of fertilising eggs with their sperm. With some couples, pregnancy rates as high as 45% have been achieved with ICSI.3 However, rates this high are not always possible because of other factors, including age and egg quality.

The fertilisation of an egg and its subsequent development into a growing embryo is a complicated process, and there are many reasons why IVF may not be successful, even with the assistance of ICSI. To aid our success rates at Newlife IVF, we:

  1. Ensure an egg is suitable for fertilisation prior to ICSI: Using polarised light microscopy, we assess a structure inside the eggs called a ‘spindle’. We call this ‘egg spindle visualisation’. This allows us to identify if an egg is at a certain stage of development (called metaphase II) and therefore, in optimal condition for fertilisation via ICSI.
  2. Select the healthiest-looking sperm for ICSI: If the genetic information in the sperm has been damaged, or if the sperm is unable to use its DNA correctly, then there is a risk that development of the embryo will fail, even if it has been successfully fertilised via ICSI.4 A number of factors can increase this risk, such as smoking and older age.5,6 It’s not currently possible to know if the sperm we choose for ICSI is completely free of genetic defects. However, by using an advanced imaging system with an extremely high-powered microscope, we are able to study the structure of individual sperm, helping us to select the optimum sperm to inject into an egg. Sometimes, we may also use another technique, called intracytoplasmic morphologically selected sperm injection (IMSI), to help us pick out a healthier sperm based on its shape. A DNA test can also provide us with more details about sperm quality.
  3. Assess the best position to inject the sperm into the egg: Our extremely high-powered microscope also allows us to very precisely inject the selected sperm into the egg, such that we avoid an important structure inside the egg called the spindle. Research has shown that injecting eggs away from the spindle results in higher fertilisation rates and better embryo quality.

Still have questions?

If you are concerned about the possibility of male factor infertility or would like more information about the role of ICSI in an IVF treatment cycle, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933. You can also book online via our appointments page.

References

  1. Agerwal A et al. Reprod Biol and Endocrinol. 2015;13:37–46. ↩
  2. Palermo GD et al. Sem Reprod Med. 2015;33:92–102. ↩
  3. Palermo GD et al. Sem Reprod Med. 2009;27:191–201. ↩
  4. Colaco S & Sakkas D. J Assisst Reprod Genet. 2018;35:1953–1968. ↩
  5. García-Ferreyra J et al. Clin Med Insights. Rep Health 2015;9:21–27. ↩
  6. Zini A & Sigman M. J Androl 2009;30:219–229. ↩