“Hey Doc, is that my IUI sperm?”

January 10, 2013Carole 1 Comment »

This is a question that you might be reluctant to ask, but you really should.  The story Fertility doctor quits insemination after sperm mix-ups describes the sad tale of a 72 year old physician who finally quit performing inseminations in 2012 after three women came forward with children born after being inseminated with sperm other than the sperm from their chosen donors. To make matters worse, this Canadian physician is only stopping inseminations in 2012, after the incidents that occurred in 1986, 2004 and 2006. If you think he only made this mistake three times, there’s a bridge I could sell you.

Most sperm or embryo mix-ups are not detected through DNA testing but rather because the child is a different race than expected. In this New York case in 1990, a patient sued the sperm bank who was storing her dead husband’s sperm, because they provided her another specimen for insemination. Another mixed-race insemination using sperm from the wrong patient is described in this 2004 case in new Haven, Conn. where a patient sued her doctor after he admitted his error on the day of the insemination, literally running after her as she left the clinic. Apparently, sperm mix-ups were big news in 2004, as another lawsuit for sperm mix-up was filed  in North Carolina. In this case, a Wilmington , NC woman was awarded $400,000 when she was inseminated with not the sperm she ordered but left-over sperm from an insemination prepped the previous day. A nurse practitioner performed the insemination using an unlabeled syringe.

Again, if you think that all sperm-mix ups are those between different patients and donors of different race, I have a bridge to sell you. Sperm mix-up or embryo mix-ups between different races are just the easiest to discover. Most of these mix-up cases are handled quietly between the clinic’s malpractice attorneys and patients and never become public because they do not go to trial.

Okay, so what can a patient do about protecting herself and her family from a sperm mix-up? The first step is to know how this procedure should work and be alert for deviations from the normal procedure.

Normally, when either donor sperm from a sperm bank or sperm from a partner enters the lab’s custody, the sample either comes with a unique identification number (from the bank) or is assigned one by the lab. This number and the patient or partner’s name- if not BOTH- should accompany the sample as it is processed for the IUI.  Sample processing is a multi-step procedure in which the ejaculated sample moves from a collection cup to test tubes for centrifugation and washing and then into the final insemination syringe. Each container must bear a sample specific identification code unique to the patient and partner as it moves through the process. Sometimes a color or other visual code (sticker) is used in addition to the name-number code. The most obvious opportunity for error is that the technician just skips the labeling step and thinks- I’ll just keep the tubes from the same patient together. That might work if the tech is processing a solitary sample but with IUI, semen analysis and IVF specimens to process as well  in a busy program, most techs are working on multiple samples in parallel or series.

Another opportunity for mix-ups is created by massive overbooking of cases, usually first thing in the morning, so that too few technicians are handling too many samples with inadequate spacing between patients. Early slots are popular with patients and their partners who need to get to work on time or can’t afford time off work for an appointment. Unfortunately, too many clinics don’t hire enough staff to handle the high volume parts of the day and as a consequence, safety and quality suffers. Keep in mind that the clock is running on the sample. Usually the insemination must occur within 1-2 hours of collection or thaw, the sooner the better. So technicians are rushing to meet the IUI appointment time, especially if they have multiple samples at once. If they don’t have the IUI samples on time, the clinic schedule gets behind, so they rush to get through if there aren’t enough staff for the volume.

Here’s what you can do:

If possible, see if your IUI can be booked at a slower time of day for the lab.

Take your paperwork from your sperm donor order with you to the IUI appointment so you know what donor number to expect.

Ask to see the cryovial from the sperm bank and compare the number on that empty cryovial  to your paperwork. It must match. If it doesn’t, you have the wrong sample or the labeling is sloppy. Either should give you pause about continuing with the insemination.

If  your sperm sample is  your husband’s specimen that was stored frozen, there should also be a thawed cryovial with his name on it. Some programs will even show you the labeled collection cup in the case of a fresh sample. If collecting a fresh sample, the male patient is typically asked to write his name on his collection cup in front of the technician before the collection.

When the nurse or doctor enters the room with the sample, sometimes in a pre-filled syringe, ask to see it and the accompanying paperwork. Because the syringe is stored sterile, sometimes the outer wrapping is labeled and not the syringe itself. Other clinics leave the final processed specimen in the labeled test tube and load the syringe in front of the patient so the actual syringe may be unlabeled. Clinics handle this identity cross-check process in different ways but every insemination should be proceeded by some evidence that proper identification and labeling took place. Usually the clinic asks you to sign something consenting to being inseminated with this specific sample so you might as well be confident that what your are signing is true.

Good programs provide evidence that the “chain of custody” for the sample is intact without you having to ask, because they want to address their patient’s concerns before they have a chance to worry about what might have gone wrong. Some programs may need more supervision by the patient. It is noble to trust, but smart to verify. So next insemination, go ahead, ask him, “Hey Doc, is that my IUI sperm?”




© 2013, Carole. All rights reserved.

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