Views and reviews: therapeutic donor insemination

Area of Science:

• Reproductive Medicine
• Human Reproduction
• Infertility Management

Background:

• Therapeutic donor insemination (TDI) is a key method for individuals and couples needing donor gametes.
• Clinical management of TDI involves optimizing live birth rates and cost-effectiveness.
• Decisions regarding transitioning to in vitro fertilization (IVF) are crucial.

Purpose of the Study:

• To review clinical considerations in therapeutic donor insemination (TDI).
• To focus on live birth rate estimation, cost-effectiveness, and timing for transition to in vitro fertilization (IVF).

Main Methods:

• Review of clinical considerations in TDI management.
• Analysis of live birth rates based on age and cycle number.
• Evaluation of cost-effectiveness strategies and IVF transition criteria.

Main Results:

• Natural cycle TDI live birth rates approximate natural conception (18-20% per cycle <37 years; <5-10% ≥40 years).
• Cumulative rates for six cycles are 50-60% (<37 years) and <10-15% (≥40 years), diminishing significantly after age 42.
• Empiric ovulation induction offers minimal benefit in younger ovulatory patients and increases multiple gestation risk; it should be case-by-case.
• Cost-effectiveness is improved by avoiding unnecessary ovulation induction, using home LH monitoring, single insemination, and minimizing unproven therapies.
• For younger patients (<35 years), three natural TDI cycles (50-60% cumulative) may approximate one IVF cycle (40-50%).
• For older patients (≥40 years), earlier transition to IVF is recommended due to diminishing returns.

Conclusions:

• Therapeutic donor insemination (TDI) success is age-dependent, with rates declining significantly after age 42.
• Cost-effective TDI management involves strategic ovulation induction and avoiding unproven therapies.
• Individualized decision-making, considering patient age, preference, and treatment fatigue, is essential for transitioning to in vitro fertilization (IVF).