Trying to Conceive

Donor Insemination Options

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For same-sex female couples, single women interested in pursuing single motherhood by choice, and heterosexual couples with male factor infertility, insemination using donor sperm is a treatment option that offers the possibility of conception. You may use an anonymous sperm donor through a sperm bank or fertility center, or a known donor who may be a friend or a relative of your partner.

The type of insemination you’ll use will be based on a number of factors, including personal preference, cost, and fertility potential.

Intravaginal Insemination (IVI)

IVI is the least common form of artificial insemination. To be successful, you need to have regular, predictable ovulation and a sperm sample with good parameters (lots of sperm that all have good motility and morphology). While you can use unwashed sperm, this may lower your chances of success as the seminal debris and malformed sperm may inhibit the healthy sperm from traveling up the reproductive tract. IVI is most commonly performed in your home using an insemination kit you purchased online. It is important to time your IVI during your fertile window—the five days leading up to and the day of ovulation. In a manner similar to how sperm is released during intercourse, the sperm is deposited in the vagina using a syringe.

Intracervical Insemination (ICI)

ICI is slightly more common than intravaginal insemination, and the goal is to get the sperm as close to your cervix as possible. One option is to use a needless syringe inserted into your vagina (much a like you’d insert a tampon) until the tip of the syringe is close to your cervix. You will slowly press in on the plunger, releasing the sperm. Another option for ICI is to use cervical caps, or cervical caps with tubes. With a cervical cap, the sperm is deposited into the cap, and then inserted vaginally. You’ll keep the cap in for about four to six hours to give the sperm ample time for fertilization.

ICI can be done at home using an at home insemination kit with either washed or unwashed sperm, or rarely, at your doctor’s office.

Intrauterine Insemination (IUI)

By far the most common form of insemination, intrauterine insemination (IUI) is done in your doctor’s office. Leading up to the actual insemination procedure, your doctor will monitor your menstrual cycle using ultrasound monitoring and bloodwork to detect when you are ovulating. You may also be prescribed fertility drugs to help induce ovulation. At the time of ovulation, your donor sperm will be thawed and washed (this process separates normal sperm from the seminal fluid and dead or malformed sperm).

Your doctor will pass a long, thin, soft catheter through your cervix and into your uterus in order to release the sperm near your fallopian tubes. By bypassing your vagina and cervix, a more concentrated level of sperm will be deposited as close to the ovulated egg as possible. After the sperm is placed into the uterus, you will lie quietly for about a half an hour.

Before You Begin Treatment

Prior to starting treatment, it’s important to have a full medical work-up to ensure you are healthy and capable of carrying a pregnancy. You may also consider preconception carrier testing to see if you carry any heritable mutations you may pass on to your future child(ren) as this may influence your decision regarding your sperm donor.

If you have a same-sex partner, you’ll need to decide who will carry the pregnancy, and this may be based—at least in part—on age and any medical conditions.  I’s important and recommended to get tested for immunity against cytomegalovirus (CMV), which if contracted in pregnancy can lead to birth defects. Donors are always tested for CMV, and your immune status will help you decide on which donor to use (if you’re not immune to CMV, you are strongly advised to use a CMV-negative donor).

If you are using known (or designated) donor’s sperm in the doctor’s office, FDA- mandatory testing for communicable diseases will have to be performed and sperm quarantined for at least 3 months, after which repeat testing is performed and sperm can be used for insemination.

A consultation with an attorney specializing in reproductive matters is also recommended. They can help with any necessary documentation needed with a known sperm donor to release him of parental rights/obligation as well as define his role in the child(ren)’s life. For a same-sex couple, an attorney will need to help certify legal parental status for the non-genetic/non-biological parent, via birth order, second parent adoption, etc. Because laws regarding parental rights vary state-by-state, having both of your names on the birth certificate helps—but does not guarantee—that the non-birth mother will retain custody of the child(ren) should something happen to her partner (the birth mother) or in case of divorce.

Dr. Jenna Friedenthal is a Fellow in Reproductive Endocrinology and Infertility at Reproductive Medicine Associates of New York. Dr. Friedenthal completed her undergraduate education at Yale University. She went on to complete her medical degree from the Albert Einstein College of Medicine with Distinction in Research. While in medical school, she received the Senior Research Fellowship award for her research accomplishments in reproductive endocrinology and immunology. Dr. Friedenthal then completed her residency training in Obstetrics and Gynecology at New York University. During her residency training, Dr. Friedenthal received the Mortimer Levitz Best Basic Science Award for her research on pre-implantation genetic testing

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