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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 ...

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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    Alternative insemination Alternative insemination Presentation Transcript

    • Reproductive ParenthoodBy Alternative Insemination Regina Kim, MD February 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 ICIVaginal Insemination 3
    •  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 donor  Fresh sperm - from friend, family  Frozen sperm - from friend family – processed at andrology lab Unknown donor  Frozen sperm - purchase from sperm bank  Open 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 donor  Fresh 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
    • VP- vaginal pool IUI- intrauterine inseminationData from The Sperm Bank of California 2004-2005
    •  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 Olderwomen 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
    •  FertilityAwareness Method tracks basal body temperature, cervical mucus, and cervical position and texture Ovulation predictor kits detects the LH surge in the urine ovulation 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)
    •  Financialresources 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 Alternative Insemination- Howard Brown Health Center 19
    •  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 Fund www.lamdalegal.org Howard Brown Health Center www.howardbrown.org The Center on Halsted www.centeronhalsted.org
    •  HIV-1 and HIV-2  Chem profile Hepatitis B and C  Complete Blood Count Syphilis  Lipid panel Blood ABO-Rh type  Thyroid testing Chlamydia, Gonorrhea  Comprehensive seminal CMV antibody analysis HTLV-1,2  Cystic fibrosis test Complete chromosome  Thalassemia analysis  Sickle cell Herpes Simplex Virus- 1,2  Tay-sachs