•  Infertility Treatments

As thousands of women and men who are trying to start a family have discovered, sometimes you have to help nature along. Insemination -- either with a partner's sperm or using a known or anonymous donor -- is about the lowest-tech and the least expensive method of giving Mother Nature a boost.

There are two methods of insemination. The simplest is called intracervical insemination and involves placing the sperm in what looks like a common syringe but with an opening instead of a needle. This propels the semen directly into the cervix (the "neck" or opening, of the womb). Nowadays, for couples with fertility problems, a procedure known as intrauterine insemination (IUI) is considered more effective, according to Toni Weschler, MPH, author of the popular book Taking Charge of Your Fertility.

If a woman's partner has a low sperm count, intracervical insemination may be enough to help the sperm on their way. Among other problems that might call for a doctor's help, the chemistry of her cervical mucus could be impeding the sperm. Poor sperm motility (ability to swim) may also make it more difficult to conceive. For these conditions, a fertility specialist may suggest the couple try intrauterine insemination so that the sperm will have fewer obstacles.

IUI is performed with sperm that's been "washed" -- or separated from the semen -- making it highly concentrated. The process also cleanses the sperm of toxins that can cause adverse reactions or severe cramping in the uterus The liquid containing the concentrated sperm is placed in a long tube and injected directly into the uterus, giving it an advantage over sperm that have to fight their way there and then progress to one of the fallopian tubes.

For women whose partners don't have viable sperm, a third-party donor is also an option. The choice then is whether to use a donor the couple knows -- perhaps a friend or a relative of her partner -- or to go with an anonymous donor from a sperm bank. As sperm banks have become more accessible in recent years, women without male partners, single lesbians, and lesbian couples are also turning to donor insemination. In fact, in some sperm banks, women in these groups make up the majority of the clientele.

For some would-be parents dealing with male infertility, "donor sperm remains the most affordable, successful, and readily available option," according to the book Resolving Infertility, written and edited by the staff of Resolve, a national nonprofit organization that aids people with fertility problems.

An IUI with donor sperm costs about $200 to $500 a try, compared to one cycle of in vitro fertilization -- in which the egg is extracted and fertilized with sperm in a lab, then implanted in the uterus -- that costs between $7,000 and $15,000 per cycle. Of course, whether you are able to benefit from donor insemination depends on what your fertility problems are.

If you work with a sperm bank, you'll need to choose a donor. Most of the dozen or so sperm banks in the United States conceal the donor's identity forever. But a few, like the Sperm Bank of California in Berkeley, offer the child the option of obtaining the donor's identifying information after the child turns 18. That way, finding out who the donor is stays under the child's control. (The Berkeley bank and other such identity-release sperm banks send frozen sperm to clients all over the country.)

Regardless of how the sperm bank you choose operates, you can glean a lot about donors from their files. Most sperm banks give their clients basic information on donors, including height, weight, age, hair and eye color, and ethnicity. Some reveal donors' occupations and ask them to write a little about their interests and character traits. "I'm not very good with mechanical things: I call a plumber," one donor writes whimsically. "I have a good sense of humor and like to laugh and make people laugh."

Asked for the message he would like to pass on to potential mothers or couples, he wrote, "I'm smart, decent-looking, and have straight teeth. The rest is up to you."

All donors should undergo rigorous health assessments, including a complete blood workup and tests for HIV, chlamydia, and the carrier traits for such diseases as Tay Sachs, cystic fibrosis, and sickle-cell anemia. Every sperm bank should have thorough medical histories on all of their donors, according to the American Society for Reproductive Medicine.

The physician group recommends that sperm be frozen for six months before it is used to allow enough time for HIV testing. At the time of the donation, the donor is tested for HIV. He's tested again six months later, and if he's still HIV-negative, his original donation can be released.

One clear advantage of choosing a friend as a donor is that you know the kind of person he is and what he looks like. In time, your child could even have a relationship with him. The main disadvantage is that he may find he has strong feelings for the child and claim paternity rights. It's wise to discuss the arrangement with a lawyer or at least draw up a donor agreement right from the beginning.

With an anonymous donor, you have almost no risk of HIV and zero risk of ending up in a custody battle. You can shop for the genes you'd like, and you get to screen out donors with specific medical histories. The downside is that your future child may have questions about the donor that you'll never be able to answer.

The odds of success depend greatly on a woman's age and fertility issues. Generally, with monthly inseminations, the chance of getting pregnant using frozen sperm is about 8 to 15 percent each cycle, according to a guide from the American Society for Reproductive Medicine.

The National Institute of Child Health and Human Development recently examined the results of inseminating women who had fertility problems with fresh sperm from their partners. The study found that women who received injections of follicle-stimulating hormone (FSH), which induces ovulation, and then had an IUI, fared the best. Over a period of four cycles, 33 percent of them got pregnant, according to the study, which was published in the New England Journal of Medicine.

In the group that received FSH and had intracervical insemination, 19 percent conceived. Those who had intrauterine insemination without added hormones did nearly as well, with an 18 percent pregnancy rate. Only 10 percent of those who had intracervical insemination alone got pregnant.

All of these choices involve careful planning, a clear sense of when you're ovulating, and some good advice from a fertility specialist. You may find that getting pregnant is much less complicated than you think.

-- Elaine Herscher is a senior editor at Consumer Health Interactive.

References

First published December 19, 2002
Last updated April 24, 2007
Copyright © 2002 Consumer Health Interactive

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