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Alternative Insemination

Helping Families Grow Since 1983

Fenway Health has always been a pioneer for LGBTQIA+ parents and families. We were one of the first healthcare facilities in the nation to offer insemination services to people who were looking to grow their families, but who lacked access to sperm. Today we continue to provide medical alternatives for achieving conception for anyone with a uterus, regardless of whether they are single, married, partnered, part of the LGBTQIA+ community, or not. 

Our Alternative Insemination (AI) Program provides patients with a baseline fertility assessment, behavioral health support, and office inseminations 365 days a year. For those who prefer to inseminate at home with fresh or frozen sperm, we teach home insemination methods. We can also provide social work consults for those looking to work with a known donor. If it sounds like the AI program is a good fit for you, the first step to becoming a patient in our program is to attend our orientation. 

We hold orientation every other month, where prospective patients can learn about ovulation prediction, sperm banks, donor selection (whether known or anonymous), common legal issues experienced by LGBTQIA+ parents, and resources for alternative families or single parents by choice. Attending this orientation is the first step to enrolling in our program, and we find it typically answers many of the questions patients have as they start their path to parenthood. The cost is $50 per family, and you can register for orientation here.

After orientation, you will need to take the following steps before beginning inseminations: 

  1. Track your menstrual cycle and ovulation for 3 cycles (OK to start before orientation)  
  2. Have physical exam and labs done with PCP or GYN (Labs List PDF) 
  3. Email [email protected] to schedule Enrollment and Preconception Counseling visits 
  4. Set up account with sperm bank; review and select donors 

Once you are given clearance by our providers, you will be able to order sperm, have it delivered to Fenway, and set up insemination appointments.

Alternative insemination (AI), is an in-office procedure where sperm is placed in the uterus or cervix by a medical provider in an attempt to achieve pregnancy. This is done during the peak of a person’s ovulation in order to maximize the chances of achieving pregnancy. 

We typically work with individuals who are 43 and younger, and have no known fertility issues. We create access to sperm banks and insemination services. We are not a fertility clinic, and do not have all of the resources fertility centers typically have. If we determine there might be a need for a patient to get a higher level of care at a fertility center, we have working relationships with many in the area that we can refer you to. 

The first step to enrolling in our program is to attend orientation. Orientation is a 2.5 hour educational session where you will meet the team, learn about the program, how to track ovulation, sperm bank selection, common legal issues that arise for LGBTQIA+ families, and much more. The cost is $50 per family. 

While we can work with those who live outside of Massachusetts, we do require patients to be located in Massachusetts for their enrollment visits, which are done via telehealth. If you live out of state, and would prefer to come for in-person enrollment visits, we can accommodate that. 

Our program orientation is $50, and our enrollment visits cost $236. These are not covered by insurance. Office inseminations cost $250 each. Insurance coverage for these procedures varies, and we encourage you to check with your individual insurance plan

No. At Fenway Health, we can only use frozen donor sperm for in-office inseminations. 

If you are looking to use a fresh sample, we can provide instructions on how to do home inseminations. If you are looking to do office inseminations with a known donor, you will need to work with a fertility center where the sample can be tested, washed, and quarantined for the FDA-mandated time period.

Enrollment visits and preconception counseling visits are scheduled through our program coordinator after you attend orientation. Insemination appointments are scheduled through our program coordinator after you receive medical clearance. Please email [email protected] to schedule these appointments. 

Knowing whether and when you ovulate is essential for inseminating when your fertility is optimal. If you have not already started, begin charting your ovulation by regular observations of your cycle and by using an ovulation predictor kit (OPK). We will need to know:

– When day 1 of your cycle is (first day of bright red bleeding)
– How many days your period lasts
– What cycle day your OPK turns positive

Ovulation Predictor Kits (required):

We require the use of ovulation predictor kits (OPK) to verify that the luteinizing hormone (LH) surge has occurred. This surge usually proceeds and predicts ovulation, which will occur 24-36 hours later. You can use any kit brand and can purchase at pharmacies or online. They cost between $15-60 and come with instructions.

Observe a definite negative test before the kit turns positive. When in your insemination cycle, test twice a day, once in the morning and once in the evening. Once your kit has turned positive, stop testing. Test with an OPK for 3 cycles before your enrollment visits.

Cervical Mucus Changes (optional):

To observe changes in the cervix and cervical mucus, you will need a speculum, a hand-held mirror, and a flashlight. You can get a speculum from your health care facility. Specula come in different sizes. If you have given birth vaginally, you might try a large. If you can comfortably fit three fingers in the 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 person).

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 the vulva or labia (vaginal opening) or by using a speculum to observe it on the 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 of your os (the opening of the cervix). The os will gradually become more open as you approach ovulation. The cervix appears softer and higher around the time of ovulation.

Basal Body Temperature (BBT) Charting (optional):

Another 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. We assume that ovulation occurs when there is a rise of 0.4 to 0.6 degrees Fahrenheit or more between 24-hour readings.

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 within 1 year of your enrollment visit in order to receive medical clearance to begin inseminations:

  • Up to date Cervical Cancer Screening
    • Age < 30: Normal Pap smear and/or HPV test within 3 years
    • Age 30+: Normal Pap smear and/or HPV test within 5 years
    • Any age: If currently being monitored for an abnormal Pap smear, will discuss at your AI enrollment visit. This is likely not a contraindication to joining the program.
  • Complete physical examination  or pelvic examination, office visit notes including blood pressure and BMI
  • Chlamydia (genital swab or urine test)
  • Gonorrhea (genital swab or urine test)
  • Blood Group with Rh factor
  • Blood Antibody Screen
  • Rubella Titer or proof of complete MMR vaccination
  • HIV antibody
  • Hepatitis B surface antigen (HBsAG)
  • Hepatitis C Antibody
  • Syphilis testing (RPR or Trep)
  • Hemoglobin A1c* (if patient is diabetic or pre-diabetic)

 

Genetic carrier screening is recommended but not required. This can be completed through your personal health care provider, or by scheduling a visit wit hthe Fenway Health OBGYN team.

If you wish to schedule a visit at Fenway Health to complete the health requirements, please call 617.267.0900 to schedule a visit with your PCP (current patients) or the Fenway Health OBGYN team (current and all new patients).

If you complete the health requirements outside of Fenway Health, please send us your lab results through the MyChart patient portal to Alix Quinn NP, by emailing the [email protected], or by faxing to Fenway Health at 617.247.3460 (Attention Alix Quinn, NP).

For More Information:

[email protected]

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Alternative Insemination, Artificial Insemination, AI, ai, AI Program, AI program, ai program

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    1340 Boylston Street
    Boston, MA 02215
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Fenway Health receives HRSA Health Center Program grant funding under 42 U.S.C. § 254b and has been deemed a Public Health Service employee for purposes of certain liability protections, including Federal Tort Claims Act coverage, under 42 U.S.C. § 233 (g)–(n).

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