At-home insemination:
Pros and cons of "the turkey baster method"
Women who want to save money or have a less clinical experience for conception sometimes opt for at-home insemination. They might be using a known donor or having a sperm tank shipped to her home. While no valid statistics are available for "the turkey baster method," it is generally considered less effective than an in-office insemination by a qualified physician or nurse. (And note that syringes - not the utensil your mother used on Thanksgiving Day - are the preferred tool.) But done correctly, and at just the right time of ovulation, at-home insemination is a viable alternative to fertility centers.
There are three types of insemination techniques: 1) vaginal (or peri-cervical), which uses a syringe (the kind used to give infants liquid medicine) to place sperm into a woman's cervix, 2) intracervical insemination (ICI), and 3) intrauterine insemination (IUI). The latter two involve the use of a catheter, or cannula, to place the sperm directly into the uterus.
Some midwives and women's health experts teach the at-home method of vaginal insemination. But IUI or ICI need to be done by a medical provider, since it involves introducing substances into the uterus, which is a sterile environment. Medical providers who do ICIs and IUIs in their offices use sterile techniques to introduce the instrument into and through the cervix and into the uterus.
"If sterile technique were not used, bacteria could be introduced, causing a high risk of infection, which could develop into pelvic inflammatory disease and cause infertility, not to mention pain and fever," says Liz Coolidge, a licensed mental health counselor who runs the Alternative Insemination Program at Fenway Community Health Center in Boston. "[On the other hand] a woman really cannot hurt herself doing a home vaginal insemination."
Whether a woman is using ICI, IUI, or doing an at-home insemination, she must order either unwashed or washed sperm from the bank. specifying the method [preparation of the specimen]. "Washed" means the sperm is separated from semen. Most experts recommend against putting unwashed sperm (sperm unseparated from semen) into the uterus because it can cause a bad reaction, including nausea and vomiting.
The biggest medical risk in using fresh sperm is that of sexually transmitted, as well as other, diseases. (See page 73 for our discussion of the conversations you should have with a known donor if fresh sperm is being used.) Sperm banks no longer use fresh sperm, which is a big change from the pre-AIDS days, when a donor was called in to donate at a time that coincided with the insemination appointment of a female client down the hall. The freezing process allows sperm banks to screen for all sexually transmitted diseases, as well as some (but certainly not all) key congenital defects, during the required six-month quarantine process.
If a known donor (aka directed donor) is used in a clinic setting, the standard is to only use fresh sperm from someone who is the woman's sexual partner. This is because the woman has already assumed the risk of contracting an STD or passing along a condition to her baby if the donor is a sexual partner. If she is using the sperm of a friend or other donor with whom she has not been sexually involved, the liability becomes that of the provider-which is then going to require it to be tested, frozen and quarantined for six months.
"We won't do inseminations with fresh sperm in our office. We teach women how to use it for at-home insemination. But I counsel them about evaluating the risks of STDs," Coolidge says.
Kristin Kali, a licensed midwife who provides fertility consultations at Maia Midwifery and Preconception Services in the San Francisco Bay area, believes fresh sperm is preferable to frozen in many ways, assuming the important safety precautions are in place.
"Fresh sperm is more effective for achieving pregnancy than sperm that has been frozen and thawed," she says. "Many women don't realize that the quantity of semen they are receiving from a bank is only 0.5cc, while the normal volume of a man's ejaculate is 3-5cc. And fresh sperm that is inseminated vaginally lives for up to 72 hours, or three days. When sperm is frozen for quarantine, or purchased from a sperm bank, the lifespan of the sperm is reduced to about 24 hours when inseminated vaginally. With intrauterine insemination, excellent timing is imperative, as sperm only live for 6-8 hours once they are placed directly into the uterus."
There are legal issues involved in using fresh sperm, of course, as well as the safety and how-to concerns. If fresh sperm is used in a home setting, even if it is not through intercourse, the known donor is considered to be a legal parent of the child in the eyes of the law. (See the "Choice Mom Guide to Legal Issues," to be published in 2008, as well as information on the ChoiceMoms.org website for more information.) Anonymous donors, on the other hand, legally give up parental rights and responsibilities to children conceived by their sperm specimens. Directed donors whose sperm is used in a clinic insemination also affords more legal protection.
