UNIVERSITY OF UTAH ANDROLOGY REQUIREMENTS FOR PATIENTS USING DONOR SPERM

1.     You must be working with a physician.
Non-University physician. The donor sperm sample that you select can be sent directly to your doctor’s office near the day of your insemination, OR you may choose to have one or more samples sent to the Andrology Lab for storage.
The Andrology Laboratory will prepare your donor insemination if shipped directly to us.
We do require a written Physicians Order from your care provider indicating you are under their care and are transporting the donor sample to their office for insemination. Please see the Fee Schedule and Policy for price of the donor sample preparation.
You would then be able to pick up the prepared sample and take it back to your doctor’s office for the insemination.
OR
University physician
•    Patients having the insemination performed at the Utah Center for Reproductive Medicine will need to have a consultation with one of the UCRM physicians or Dr. Carrell.
•    You must sign the Donor Insemination Consent form in the presence your doctor. In addition to the consultation visit, your doctor will write an order for the recipient of the donor insemination, the following, required lab tests (fee):
•    HIV 1 & 2
•    HTLV I/II
•    Hepatitis B surface antigen and core antibody 
•    CMV IgG, IgM (Cytomegalovirus)
•    RPR
•    Hep C Abs
•    Chlamydia/Gonorrhea (cervical swab)
•    Blood Type
•    Positive immunization for Rubella (If you have not been immunized against Rubella, it will be necessary to do so prior to insemination.
If inseminations are discontinued for six months or more, it will be necessary to sign a new Donor Consent form and repeat some of the testing.
2.    Have a Donor Semen Storage Consult (fee) with the University of Utah Andrology Lab prior to shipping any samples. Sign a Donor Semen Storage Agreement.

3.     Choose a sperm bank to work with: Samples sent to us must come from an institution that is FDA compliant in regards to collecting and distributing reproductive tissues; if you have any questions about a specific facility please call us at (801) 581-3740.
•    California Cryobank (www.cryobank.com)
•    Xytex (www.xytex.com)
 
4.    You are responsible for purchasing the donor samples and having them shipped and stored; payment for the current storage period must be paid in advance, and is based in part on the number of vials you will be storing. In addition, there is a fee of $25 to process each shipment and a Minimum Storage fee (fee).

5.    Once the preceding requirements are complete and you are ready to have your insemination (fee) call us at (801-581-3740) to set up an appointment, so that we can have the sample prepared (fee) for you. If you have any questions please don’t hesitate to call. For additional information please see Ovulation Timing by LH Measurement.

6.    You may terminate a Storage Agreement at any time by requesting and completing an Order for Destruction form from the Andrology Lab.  Please carefully read and complete the entire form. Please note: your signature must be witnessed by an Andrology employee or a Notary Public. The Andrology Laboratory must receive the original written notice before the agreement is terminated. You will also receive a phone call for a verbal confirmation of your request.

Rev. 5/10