Alternative Insemination (AI)

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Types of AI

The four types of insemination are defined by where the sperm is placed:

• Intracervical, or ICI (just inside the cervix, the opening of the uterus)
• Intrauterine, or IUI (inside the uterus)
• Pericervical (near the cervix)
• Vaginal-pool (inside the vagina)

A medical provider performs intracervical and intrauterine insemination using a sterile cannula (straw-like instrument) attached to a needleless syringe. These procedures require especially careful and sterile insertion. Sperm used in ICI is washed before it is inserted. All of the sperm inserted during IUI bypasses the cervix and enters the uterus, which means that most sperm reaches the fallopian tubes, where fertilization occurs. IUI is considered the most successful method, especially when combined with fertility drug therapy. Fertility drug therapy is determined by a woman's age and medical history and is not imperative for AI. It may be particularly useful in women whose cervical mucus, which lines the cervix during menstruation, is absent or detrimental to the sperm.

A support person, medical professional, the woman herself, or, most commonly, a partner inserts sperm into the vagina or uterus during vaginal-pool and pericervical insemination. These methods are performed at home with a needleless or oral medication syringe and diaphragm or with a cervical cap. Some cervical caps feature a tube through which the sperm is injected; it is then placed over the cervix. The cap contains the sperm and encourages its flow into the uterus. Fresh sperm or bank sperm that has been properly thawed is used. Because a medical professional must fit a cervical cap to a woman's cervix while she is ovulating, a syringe is the easiest method.

Timing and Ovulation Prediction
Timing the insemination and accurately predicting ovulation are probably the most important aspects of AI. A woman is most likely to conceive during the 24 hours that follow ovulation, when the egg is viable. Over-the-counter ovulation kits test the urine for an increased level of luteinizing hormone (LH), which is released about 24 to 36 hours before ovulation. These kits typically cost $25 to $35 and may contain 5 testing strips. Another method is to observe and note body signs of fertility, including elevated body temperature in the morning, consistently elevated temperature throughout the day, presence of cervical mucus, and lowered or "dipped" cervix. Many women wishing to conceive record these signs on a calendar to predict ovulation.

Sperm
Women can obtain sperm from a friend, while others prefer sperm from an anonymous donor. Sperm banks provide women with frozen sperm from anonymous donors. Sperm stored at sperm banks is properly frozen and preserved in liquid nitrogen. It is tested for viability; sexually transmitted disease, including human immunodeficiency virus (HIV); and is accompanied by a profile of the donor's background.

Washing sperm before IUI kills some of the sperm and interferes with others. "Dizzy sperm," as they are called, may not be able to swim through the uterus and into the fallopian tubes. Still, IUI is successful because all of the sperm is inserted directly into the uterus. Sperm that has been frozen in a home freezer is not viable for insemination. There is a greater risk for sexually transmitted disease with fresh sperm, as it has not been tested.

Legal Issues
The laws regarding visitation rites and parent support among people who choose AI are undeveloped. There is a lack of statutes and precedent for unmarried partners. For these reasons, anyone donating or using sperm should consult a lawyer who is knowledgeable about legal issues surrounding AI. Women working with known donors are advised to hire an attorney and to make a legal agreement that protects all concerned. Lesbian partners are advised to make coparenting agreements that stipulate the care of the child in the event of separation. Some states allow coparent adoption, or same-sex parent adoption, and legally recognize both partners as parents.

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