Alternative Insemination

Welcome to Fenway Health’s Alternative Insemination Program

Since 1983, Fenway Health has been an international pioneer in helping lesbians, gay men, bisexuals and transgender people become parents. Fenway was one of the first in the nation to offer alternative insemination services to lesbians. Today we continue to provide medical alternatives for achieving conception for the entire LGBT community, couples and singles of any sexual orientation, as well as education, resources, support networks, and referrals.

What is the Alternative Insemination (AI) Program?

The AI Program at Fenway Health offers office inseminations performed by medical practitioners as well as instruction for home inseminations. We create access to sperm banks’ frozen sperm specimens from anonymous donors, and provide education and information about ovulation prediction, the sperm bank choices, issues to consider when choosing to work with known or anonymous donors, legal issues for same sex and transgender couples, and resources for alternative families.

Why was the Alternative Insemination Program created?

Fenway Health’s AI Program was founded in 1983 to support lesbians and single women to get pregnant and create families through alternative insemination. At that time, lesbians were often denied access to sperm banks, whose services were only available to married heterosexual couples. Although this is no longer true today, it continues to be our goal to provide high quality AI services to all LGBT and single people in a most supportive and accessible environment.

How does the Alternative Insemination Program work?

There are several steps involved in Fenway’s Alternative AI Program, which serves those who are fertile and under the age of 44.

  1. The first step is to attend an AI Orientation, where we discuss the basics of fertility and reproductive health, methods of predicting ovulation, donor choices (known or anonymous), information on sperm banks, methods of insemination, and some of the emotional and legal issues to consider.
  2. Chart your menstrual cycles for 3 months by monitoring your basal body temperature (BBT). Concurrently, use an ovulation prediction kit for at least one cycle. Basal body thermometers and ovulation prediction kits are available at pharmacies and online. There are smart phone apps to track this information that many find helpful.
  3. Have a physical exam and the required lab tests done with your medical provider.
  4. Enroll in the AI Program through the Enrollment and Preconception Counseling visits. These appointments are usually scheduled on the same day for your convenience.
  5. Based on all the information we review with you, including your medical tests, we will grant you AI medical clearance. This gives you access to order sperm specimens from the sperm bank of your choice, and to schedule insemination appointments. In our office, you can review long profiles of any donor at any of the sperm banks with which we work closely.
  6. We will store the sperm specimens at Fenway. We provide office inseminations seven days a week.

Known Donor or Recipient Consultations

For those who are considering working with someone they know for sperm donations, i.e. a known donor, we offer education consultations. These are also appropriate for those who want to have a friend or relative, i.e. known recipient, conceive and give birth to their child. These consultations cover choices about and expectations of the relationships between the recipient, donor, partner(s) and child; legal implications; medical screening information; ovulation prediction and handling and insemination with fresh semen at home.

LGBT Family and Parenting Services

LGBT Family and Parenting Services provide education, support, information and referrals for lesbian, gay, bisexual, transgender and single parents and prospective parents such as:

  • LGBT Considering Parenting Workshops or Consultations. For those couples and singles who want to discuss concerns and choices about becoming parents.
  • LGBT Parenting Workshops. Presentations, discussions, resources, support, and networking for LGBT parents.
  • Resources and referrals for LGBT parents, prospective parents, and children.

For more information, please contact Liz Coolidge at lcoolidge@fenwayhealth.org or 617.927.6243.

Orientation sessions for Fenway Health’s AI Program are held every other month.

 

Upcoming AI Orientations

For information on upcoming AI Orientations, please visit our online calendar section, which is updated on a regular basis. Please contact Liz Coolidge at lcoolidge@fenwayhealth.org or 617.927.6243 for a registration form and more information.

The AI Orientation will provide an overview of alternative insemination and more specific details about the Alternative Insemination Program at Fenway. We discuss:

  • Ovulation prediction and methods of insemination (including home and office insemination).
  • The sperm banks we use and the information they give us about their sperm donors.
  • Information on some of the issues to think about when choosing to work with known or anonymous donors.
  • Legal issues for LGBT couples.
  • Emotional experiences that many encounter in the process of inseminating.
  • Folic acid and the need for it when pregnant or considering pregnancy.
  • We will be teaching you how to chart your menstrual cycle for ovulation prediction at the AI Orientation. If you feel comfortable and well enough informed, you could begin charting your ovulation by the basal body temperature (BBT) method. You can purchase a basal body or digital thermometer, which comes with charting instructions, at any drugstore. We require a minimum of three months of careful and consistent charting before insemination.
  • And much more. Packets of information with many resources, including a bibliography and networking contacts for LGBT- and single- parented families, will be distributed.

Alternative insemination is an expensive undertaking with initial costs that are generally less than $300. The cost of monthly inseminations is commonly about $1000, though it can range from about $450 to $1800 depending on the sperm bank you use and the method of insemination you choose. At the Orientation, we will discuss cost in more detail. Health insurance does not cover AI unless a person has a diagnosis of infertility.

The cost for the Orientation is $50.00 for a person who plans to inseminate and their partner and/or support person.

For more information or to register for the AI orientation, contact Liz Coolidge at 617.927.6243 or check our calendar section for upcoming orientation dates. Orientations are held at Fenway Health in Boston.

Basal Body Temperature (BBT) Charting

Knowledge of whether and when ovulation occurs is essential. Identifying the time when ovulation is likely to occur allows for proper timing of insemination when fertility is optimal.

A simple method to use for fertility screening and for estimating the time of ovulation is by charting daily oral temperatures. Your temperature is lower during the first part of the menstrual cycle than it is during the last 2 weeks. The temperature shift occurs after ovulation. Ovulation is assumed to occur when there is a rise of 0.4 to 0.6 degrees Fahrenheit or more between 24-hour readings. Comparing this information with the ovulation predictor kit results helps to pinpoint the time ovulation is presumed to occur.

If you have not already started, it is time now to begin charting your ovulation by regular observations of your basal body temperature (BBT) and confirming ovulation by using an ovulation predictor kit (OPK). You can consider performing cervical self-exam to recognize patterns in changes of your cervical mucus and your os, the opening in your cervix that leads to your uterus. Cervical self-examination and observations of cervical mucus provide interesting and useful information, but are optional.

You can buy a digital or basal body temperature thermometer at any drugstore. BBT or “metabolic” thermometers include directions for use. Blank BBT charts are available on the internet, and many prefer smart phone apps.

BBT Charting Instructions

  • Use a new chart for each cycle.
  • The first day of your period (bright red bleeding) is day one of your cycle.
  • Take your oral temperature each morning immediately after waking, before arising, eating, drinking, smoking, or undertaking any type of physical activity.
  • Take your temperature at the same time of day, or after at least 3 consecutive hours of sleep.
  • Record your temperature as a solid dot at the intersection of the appropriate temperature and date lines.
  • Also indicate, in the appropriate places, when menstruation occurs and when you observe fertile cervical mucus. And note, on the chart, any reasons for temperature variation such as illness, infection, insomnia, etc. Be sure to place on “x” on the medication line. Then write in the name of any medication, such as aspirin, acetaminophen, antihistamine, or antibiotic, taken during the cycle.
  • Your BBT is an indirect predictor that cannot pinpoint the exact day of ovulation.
  • Start a new chart when menstrual bleeding begins.

Ovulation Predictor Kits

We highly recommend the use of ovulation predictor kits (OPK) to verify that the LH surge has occurred. This surge usually proceeds and predicts ovulation, which will occur 24-36 hours later. There are many brands on the market which can be purchased at drugstores or online. They cost between $15-60. They all come with instructions.

Observe a definite negative test before the kit turns positive. After your kit has turned positive, stop testing. Use an OPK at least once in 3 cycles of BBT charting.

Cervical Mucus Changes

To observe changes in your cervix and cervical mucus, you will need a speculum, a hand-held mirror, and a flashlight. A speculum can be obtained from your health care facility. Specula come in three sizes. If you have had a vaginal birth you might try a large. If you can comfortably fit three fingers in your vagina, you might try a medium. Otherwise, you can try a small. Even though these are plastic you can wash them with warm water and hand soap after each use and re-use again (never share a speculum with another).

For home-based insemination, it can be useful to observe your cervical mucus to determine when it is fertile. Fertile mucus is more stretchy, slippery and usually clearer, like egg white, as opposed to white and tacky or creamy. You can identify this mucus either on your vulva or labia (vaginal opening) or by using a speculum to observe it on your cervix. Record your observations of the consistency and color of your mucus daily during the week in the middle of your cycle (usually days 10 through 20). Record changes in the opening of your cervix, which is called your os. Your os will gradually become more open as you approach ovulation. Your cervix appears softer and higher around the time you ovulate.

Folate is a B Vitamin found in a variety of foods and added to many vitamins and mineral supplements as Folic Acid. Folate is needed both before and during pregnancy to help reduce the risk of certain serious and common birth defects called Neural Tube Defects (Spina Bifida), which affect the brain and spinal cord.

Neural Tube Defects can occur in an embryo before you realize you are pregnant. That is why it is important for all who are planning a pregnancy to begin taking a Folic Acid supplement at least three months before planned insemination.

The U.S. Public Health Service recommends those of reproductive-age and those planning a pregnancy to take: Folic Acid 0.4mg (400 micrograms) daily starting at least three months before conception. This dose of Folic Acid can be found in form of a Vitamin Supplement or Prenatal Vitamin.

Other ways to increase your Folate intake is through diet. Foods rich in Folate include; fortified breads and grain products, fruits, dark-green leafy vegetables, dried beans and peas.

If you have any questions regarding the use of Folic Acid, Diet, Exercise or Life Style, please discuss them with your Primary Care Provider, or your OB/GYN. It is important to begin preparing your body now as you plan your future pregnancy.

The following laboratory tests and a physical examination are required before acceptance into the AI Program.

  • Up to date Cervical Cancer Screening
  • The following tests must be done within 1 year of AI enrollment visit:
  • Physical Examination (visit notes, including blood pressure and BMI)
  • Chlamydia (cervical culture or urine test)
  • GC (cervical culture or urine test)
  • The following tests must be done within 6 months of AI enrollment visit:
  • HIV antibody
  • Blood Group/Rh factor (or proof of blood group/Rh factor)
  • Antibody Screen
  • HBsAG surface antigen (Hepatitis B)
  • Rubella Titer (or proof of vaccination)
  • Syphilis testing
  • Hemoglobin A1c, if diabetic or pre-diabetic
  • LFT, if recent testosterone therapy
  • Cystic Fibrosis
  • SMA (Spinal Muscular Atrophy)

The following tests may be indicated:

  • If 35 or older:
    • FSH and estradiol on day 3 of menstrual cycle
    • Prolactin
    • TSH
    • Progesterone 7 days after presumed ovulation (may be cycle day 21)
  • HCV (Hepatitis C)
  • Varicella (Chicken Pox)
  • Sickle Cell (if African American descent)
  • Tay Sachs (if French-Canadian descent)
  • Jewish genetic panel

Since 1983, Fenway Health has been an international pioneer in helping LGBT people become parents. Fenway was one of the first in the nation to offer alternative insemination services to lesbians and today we continue to provide medical alternatives for achieving conception for the entire LGBT community, couples and singles of any sexual orientation, as well as education, resources, support networks, and referrals.

Fenway also provides resources, information, and educational services to LGBT-headed families. We hold educational presentations where parents can network. We offer adoption resources, legal referrals, surrogacy resources and other information for prospective LGBT parents.

LGBT Family & Parenting Services

Sperm banks recommended by Fenway Community Health’s AI Program:

California Cryobank Inc.   

New England Cryogenic Center

The Sperm Bank of California 

Xytex Corporation

Seattle Sperm Bank

For More Information:

617.927.6243

Director

“Meeting My Sperm-Donor Dad”

In February 2011, The Good Men Project Magazine featured a piece written by Ben Sommer, who was conceived through Fenway’s Alternative Insemination Program and raised by two lesbian moms. It tells the story of him meeting his sperm donor father. The story is published in two parts:

Read Part 1 Read Part 2