alternative insemination

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This is an orientation for the clients interested in the the alternative insemination program that took me over two years to implement at an LGBT health center in Chicago. I set out to develop the program to offer options to single individuals, same gender couples, transgender individuals to conceive without being pathologized as having an infertility problem. It's not rocket science, just a little help to get sperm and egg together. The program included the orientation, the consultation visit to review the medical history and tests as indicated. Then there is the extensive consent forms and the logistics of ordering sperm, timing the shipping and the insemination. The insemination occurs in the medical office by a trained clinician using an intrauterine catheter.

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Reproductive Parenthood By Alternative Insemination

Reproductive ParenthoodBy Alternative InseminationRegina Kim, MDFebruary 200911

Method of conception whereby sperm is inserted manually into the vagina or uterus

LGBT sensitive and supportive care: Alternative insemination, not artificial

Not an infertility issue2

IUIICIVaginal Insemination33

Vaginal-poolInside the vaginaIntracervical, or ICI Just inside the cervix, the opening of the uterusIntrauterine, or IUI Inside the uterus Performed by trained medical professional

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Known donorFresh sperm - from friend, familyFrozen sperm - from friend family processed at andrology lab

Unknown donorFrozen sperm - purchase from sperm bankOpen donor - open to being contacted when child is 18

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Cost effectiveHome insemination in the vaginaCan provide a child with an identifiable fatherMay have more viable and motile spermDifficulties: Cant keep longer than 1-2 hours after ejaculation - difficult to obtain for optimal timingCustody and visitation rights; legal issues Greater risk for sexually transmitted disease when using untested or unquarantined familiar sperm Parenting and family complexities 6

Known donor (friend, family) to donate, then sent to be processed and frozen for inseminationRoutine donor screening is performedInsemination (IUI) done by health care professionalParenting and family complexitiesExpensive - Cost to process, store, and inseminate 7

Frozen sperm - anonymous or open donorInsemination: Vaginal, ICI or IUI Safer and more reliableTested for sexually transmitted diseases Medical history availableTested for count and motility Mitigates legal or custody issues DifficultiesMore expensive Timing is crucial - thawed sperm lives for only 1 day compared to 1 week for fresh spermThawed sperm may be less motile8

Known donorFresh sperm - from friend, family (home)Frozen sperm - from friend family processed at andrology lab (Vaginal, ICI at home or IUI in office) Unknown donor (Vaginal, ICI at home or IUI in office) Frozen sperm - purchase from sperm bank Open donor - open to being contacted when child is 18

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Data from The Sperm Bank of California 2004-2005VP- vaginal pool IUI- intrauterine insemination10

Women reach peak fertility during their 20s

Young, healthy woman, fresh sperm with a normal sperm count 20-25% pregnancy rate with well-timed inseminations

Older women and those using frozen sperm, the odds of success per insemination decline

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Ovulation prediction and timing of ovulation is the most critical elementOvulation detection kits are typically used along with careful tracking of cycle for a minimum of 3 monthsMost likely to conceive about 24 hours after the ovulation detection test is positive12

Fertility Awareness Methodtracks basal body temperature, cervical mucus, and cervical position and textureOvulation predictor kits detects the LH surge in the urineovulation occurs 12-24 hours after LH surge13

Women are born with all their lifetime supply of eggsHealthiest eggs are ovulated during 20s and early 30sOvarian reserve decreases after age 35 Rate of miscarriage increases after age 35Consider fertility testingRecommend consulting reproductive specialist after 3-6 cycles without positive result14

Depending on individuals coverage Different degrees of coverageBased on medical definition of infertility Infertility - timed unprotected intercourse for more than 12 months without pregnancy

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Ovulation detection kits $ 17- 30 Frozen sperm $200 -$500/vial x 1-2 vials per cycleShipping fee for sperm $0 for local pick up to $190 Speculum and syringes for home inseminationInsemination fee varies $350-500Pregnancy test kits $ 10 per cycle

= Total using frozen sperm, IUI $600-$1600 per cycle

(these are approx costs and does not include pre-conception consultation, labs and exam) 16

Financial resourcesPregnancy can take months to achieve expect 6-18 monthsEmotional resourcesCo-parenting is complexThe coming out process escalates17

Understanding the parental rights of known and unknown donorsYour partners rights to co-adopt your child, if desirableLegal protections in the health care setting, such as powers of attorney and willClarifying your desires for guardianship in the event you can no longer care for your child18

Care for your health:Stop smoking, reduce alcohol, caffeine, exercise, get a health check upStart tracking your cycle and ovulationTake a folic acid 1mg a day Make a timeline Consult medical and legal professional

19Alternative Insemination- Howard Brown Health Center19

Insemination - home or clinicSperm- fresh or frozen Your comfort with various levels of donor screeningYour own medical care before, during, and after achieving pregnancyYour selection of qualified medical professionals to assist in the process of inseminationYour selection of a qualified health care practitioner to care for your child20

Sperm banksThe Sperm Bank of Californiahttp://www.thespermbankofca.orgPacific Reproductive Services https://www.pacrepro.comCalifornia Cryobankwww.cryobank.comMidwest Sperm Bankwww.midwestspermbank.com

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National Center for Lesbian Rights www.nclrights.orgLamda Legal Defense and Education Fundwww.lamdalegal.orgHoward Brown Health Centerwww.howardbrown.orgThe Center on Halstedwww.centeronhalsted.org

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HIV-1 and HIV-2Hepatitis B and CSyphilisBlood ABO-Rh typeChlamydia, GonorrheaCMV antibodyHTLV-1,2Complete chromosome analysis Herpes Simplex Virus- 1,2Chem profileComplete Blood Count Lipid panelThyroid testingComprehensive seminal analysisCystic fibrosis testThalassemiaSickle cellTay-sachs23