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Donor insemination (DI) remains a very important treatment option with acceptable pregnancy rates. In order to optimize pregnancy rates with DI, careful consideration should be given to various aspects of this service, including the recruitment and screening of sperm donors, cryopreservation of semen, and the screening and management of recipients. This chapter examines these important aspects of treatment to consider how to optimize DI services in the future. Treatment using DI was initially designed to treat male factor infertility. However, DI remains a therapeutic option for male factor infertility when either too few or no sperm are obtained at surgical sperm aspiration. With the advent of intracytoplasmic sperm injection (ICSI) many assumed that DI would become a very limited treatment. Although the numbers of cycles have reduced considerably there has been an increasing trend for DI to be used for other groups of patients such as single women and lesbians.