Reproductive ParenthoodBy Alternative Insemination

Regina Kim, MDFebruary 2009

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 issue

IUI

ICI

Vaginal Insemination3

Vaginal-pool Inside the vagina

Intracervical, or ICI Just inside the cervix, the opening of the

uterus Intrauterine, or IUI

Inside the uterus Performed by trained medical professional

4

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

Cost effective Home insemination in the vagina Can provide a child with an identifiable

father May have more viable and motile sperm Difficulties:

Can’t keep longer than 1-2 hours after ejaculation - difficult to obtain for optimal timing

Custody and visitation rights; legal issues Greater risk for sexually transmitted

disease when using untested or unquarantined familiar sperm

Parenting and family complexities

Known donor (friend, family) to donate, then sent to be processed and frozen for insemination

Routine donor screening is performed Insemination (IUI) done by health

care professional Parenting and family complexities Expensive - Cost to process, store,

and inseminate

Frozen sperm - anonymous or open donor Insemination: Vaginal, ICI or IUI Safer and more reliable Tested for sexually transmitted diseases Medical history available Tested for count and motility Mitigates legal or custody issues Difficulties

More expensive Timing is crucial - thawed sperm lives for only 1

day compared to 1 week for fresh sperm Thawed sperm may be less motile

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

Data from The Sperm Bank of California 2004-2005

VP- vaginal pool

IUI- intrauterine insemination

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

Ovulation prediction and timing of ovulation is the most critical element

Ovulation detection kits are typically used along with careful tracking of cycle for a minimum of 3 months

Most likely to conceive about 24 hours after the ovulation detection test is positive

Fertility Awareness Methodtracks basal body temperature, cervical mucus, and cervical position and texture

Ovulation predictor kits detects the LH surge in the urineovulation occurs 12-24 hours after LH surge

Women are born with all their lifetime supply of eggs

Healthiest eggs are ovulated during 20’s and

early 30’s Ovarian reserve decreases after age 35 Rate of miscarriage increases after age 35 Consider fertility testing Recommend consulting reproductive

specialist after 3-6 cycles without positive result

Depending on individual’s coverage Different degrees of coverage Based on medical definition of

“infertility” Infertility - ‘timed unprotected

intercourse for more than 12 months without pregnancy’

Ovulation detection kits $ 17- 30 Frozen sperm $200 -$500/vial x 1-2 vials per

cycle Shipping fee for sperm $0 for local pick up to

$190 Speculum and syringes for home

insemination Insemination fee –varies $350-500 Pregnancy 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)

Financial resources Pregnancy can take months to achieve

expect 6-18 months Emotional resources Co-parenting is complex The coming out process escalates

Understanding the parental rights of known and unknown donors

Your partner’s rights to co-adopt your child, if desirable

Legal protections in the health care setting, such as powers of attorney and will

Clarifying your desires for guardianship in the event you can no longer care for your child

Care for your health:Stop smoking, reduce alcohol, caffeine, exercise, get a health check up

Start tracking your cycle and ovulation Take a folic acid 1mg a day Make a timeline Consult medical and legal professional

19Alternative Insemination- Howard Brown Health Center

Insemination - home or clinic Sperm- fresh or frozen Your comfort with various levels of

donor screening Your own medical care before, during,

and after achieving pregnancy Your selection of qualified medical

professionals to assist in the process of insemination

Your selection of a qualified health care practitioner to care for your child

Sperm banks The Sperm Bank of California

http://www.thespermbankofca.org Pacific Reproductive Services

https://www.pacrepro.com California Cryobank

www.cryobank.com Midwest Sperm Bank

www.midwestspermbank.com

National Center for Lesbian Rights www.nclrights.org

Lamda Legal Defense and Education Fundwww.lamdalegal.org

Howard Brown Health Centerwww.howardbrown.org

The Center on Halstedwww.centeronhalsted.org

HIV-1 and HIV-2 Hepatitis B and C Syphilis Blood ABO-Rh type Chlamydia, Gonorrhea CMV antibody HTLV-1,2 Complete chromosome

analysis Herpes Simplex Virus-

1,2

Chem profile Complete Blood Count Lipid panel Thyroid testing Comprehensive seminal

analysis Cystic fibrosis test Thalassemia Sickle cell Tay-sachs