IVF, IUI, ICI, And IVI: There Are So Many Ways To Make A Family
The process of deciding and trying to have a baby looks different for everyone. Some couples, both gay and straight, as well as single women, need assistance helping sperm meet egg.
The good news? You have a lot of options.
Artificial insemination (where sperm is put in a woman's reproductive system without involving sex) is an increasingly popular option for many people for a variety of reasons. This might be a good choice for you if your partner is not a cisgender male, if you don't have a partner or if you have a male partner who doesn't produce sperm.
Artificial insemination is also used in conjunction with fertility treatments.
Here's the scoop on your options when it comes to artificial insemination:
In vitro fertilization (IVF): The egg and the sperm meet outside of the body (in a petri dish), and then the fertilized egg is placed into the uterus. This is usually done in cases of infertility, and always by a medical care provider.
Intrauterine insemination (IUI): The sperm is placed directly into the uterus via a very small tube that is passed up the cervix and into the uterus. This is done by a medical provider. The sperm needs to be “washed" by a sperm bank, to remove dead sperm and proteins that would otherwise cause a lot of cramping when they're inserted. IUI has been found to be slightly more effective than ICI (below).
Intracervical insemination (ICI): The sperm is placed into the cervix via a small tube. This is done by a medical provider. This sperm does not have to be washed.
Intravaginal insemination (IVI): The sperm is placed into the vagina with a syringe. Many people choose to do this at home by themselves.
To learn more about these processes, we spoke with Abby Brown, a certified nurse midwife at Community Midwifery Care in New York City. Community Midwifery Care does in-home IUIs so clients can conceive in the comfort of their own homes (pretty awesome, huh?).
What options do people have for sourcing sperm?
People can either choose an anonymous donor via a sperm bank or a known donor (someone they have a personal relationship with).
Using an anonymous donor can get pretty pricey, but then you don't have to worry about the potential legal logistics of using sperm from someone you know. Your health care provider can help you determine whether fresh or frozen sperm would be the best choice for you.
How much does sperm cost?
Anonymous donors via sperm banks, like California Cryobank or Manhattan Cryobank, are probably the easiest to deal with, but can be expensive. Sperm is approximately $700 per vial, and when you are doing natural cycle, unmedicated intrauterine inseminations, you'll likely need two vials per cycle, so that's $1,400 each month. Using known donor sperm from someone you know personally is cheaper or free.
Is artificial insemination covered by insurance?
Unfortunately, without an infertility diagnosis it usually is not, so people often have to pay out of pocket. Some practices (like ours) offer sliding scales, so with a bit of research you may be able to find a more affordable option.
Are there any legal implications people should consider?
When we have clients who are using a known donor, we always advise them to engage a family practice lawyer and hammer out a legal agreement with the donor before they start inseminations. Agreements should protect both parties, establish that the donor relinquishes any legal parental rights to a child that might be conceived with their sperm, and that the recipient of the sperm agrees that they will not seek child support from the donor.
What types of testing is done on donors?
When the sperm passes through a bank, the bank requires proof of sexually transmitted infection (STI) testing from the donor at the time of donation, and again six months later; this is known as the quarantine period. Other screening tests may be done as well. In the case of a known donor, we would strongly recommend having them screened for STIs, just as we'd recommend having a new partner get tested for STIs before having sex with them.
Deciding how to move forward with your artificial insemination is an involved process, and one that should involve close collaboration with your medical care providers. Ultimately, as with all decisions regarding your health and family, you should pick the option that feels best to you.
Ask questions, trust your intuition and demand respect from everyone involved in your care.