Q. For three years, my husband and I have been trying to have a child. After having some tests done, we've discovered that he is infertile -- his sperm count is too low. We are now thinking about having artificial insemination with donor sperm but are worried about whether there are any risks from this procedure. Specifically, can you get AIDS from artificial insemination?
A. Although the risk is very low, it is possible to contract a sexually transmitted disease through artificial insemination. But proper screening of semen donors should be able to reduce this risk to almost zero.
Artificial insemination -- the fertilization of a woman using semen from a donor -- is responsible for approximately 60,000 pregnancies a year in the United States. It's uncertain how many additional women undergo insemination who don't become pregnant.
In most cases, donor sperm is used, but in some cases of a husband with low sperm count, his semen can be concentrated and used for insemination.
Although complete information is not available, only about 30 cases of infection of any kind caused by artificial insemination from a donor have been reported. The actual number of cases is undoubtedly higher, but the overall risk of getting a sexually transmitted disease from this procedure remains very small.
Many diseases that can be passed by sexual contact have occurred with artificial insemination. These include 1) hepatitis B virus (a liver infection), 2) gonorrhea (a pelvic infection and cause of infertility in women), 3) trichomonas (a vaginal infection), 4) chlamydia (another cause of pelvic infection and infertility) and 5) human immunodeficiency virus (the AIDS virus).
As for your concern about AIDS, four women in Australia seem to have become infected with the AIDS virus following artificial insemination. Although three women have not developed AIDS so far, one woman developed multiple swollen lymph glands, a pre-AIDS condition.
Currently, all blood donations in the United States are screened for evidence of syphilis, hepatitis B virus and the AIDS virus. Although the American Fertility Society and the American Association of Tissue Banks have issued recommendations for screening semen donors, physicians and fertility centers are not required to follow these guidelines.
In addition to screening practices, another controversy concerns the choice of fresh versus frozen semen for insemination. Some physicians believe that using fresh semen is better for achieving pregnancy, but this practice leads to problems in screening donors adequately for evidence of AIDS virus infection. Because it takes from six to 12 weeks for the AIDS antibody to show up in the blood, a negative blood test on the day of donation doesn't guarantee that the donor is free of AIDS virus infection. With frozen semen, donors can be re-tested three months later.
However, many programs that use fresh semen and carefully screen donors have been very successful, with no cases of sexually transmitted disease reported.
Until screening practices are more uniform, I recommend that you reassure yourself that donors are adequately screened before you have this procedure.
Q. I was interested in your discussion about antidepressant medications. My husband has been depressed for over a year now. His medical doctor sent him first to a psychiatrist, then to a psychologist, both without any improvement after several months. After talking with the psychologist, the medical doctor gave my husband a prescription for the antidepressant imipramine -- 50 milligrams every night. My husband had some of the side effects you talked about but didn't really get any better. What can we do next?
A. It is hard to make specific suggestions without knowing more about your husband's condition, but I will offer a few general recommendations.
First, it's important that your husband's depression be properly diagnosed. While most cases of depression are psychologic, there are some medical conditions that make people depressed. Some examples are having an underactive thyroid gland, having cancer of the pancreas or experiencing a depressive side effect of certain medications. Medical doctors and psychiatrists routinely look for underlying medical conditions that may cause a depression before diagnosing it as psychologic.
Assuming your husband has a psychologic depression that's being treated with an antidepressant, it's important to give the medication a full trial before giving up on it. For drugs like imipramine, that means several weeks at full dose -- 150 to 200 milligrams or more. In many cases, doctors don't build up to full dose, often because of unpleasant side effects. Your husband may need to try several antidepressants until he finds one he can take at full therapeutic dose.
Another thing to keep in mind is that your husband may experience side effects from the drug well before any beneficial effects. For many people, this is the most difficult period of treatment -- waiting to feel better when initially the medicine may make you feel worse.
Last, if your husband doesn't feel that a particular psychiatrist or psychologist is helping him, I suggest having him discuss this with his physician. A given therapist may not suit an individual patient. Your husband's doctor should be able to help him find a psychotherapist in whom he feels confident.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
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