Rebecca Matthews, PhD, Author at FertilitySmarts

Understanding Male Infertility

Rebecca Matthews, PhD / January 12, 2021

Although fertility problems have often been considered a female problem, both men and women can contribute to infertility. In the United States, around 9% of men and 11% of women of reproductive age experience fertility issues. With couples experiencing infertility issues approximately one-third is related to male infertility, one-third female infertility, and one-third combined male/female or no answer. Infertility should be seen as a shared challenge, no matter where the diagnosis lies. The Male Reproductive System The testes are the most important part of the male reproductive system. This is where the sperm are made and stored, as well as the site of testosterone production, the hormone that gives men their masculine characteristics and helps sperm development. The testes are made up of very small tubules called the seminiferous tubules where the sperm mature. Nature has designed the anatomy of a man so that the testes are kept suspended away from the body; this is to keep them approximately 1 degree cooler than the rest of the body. In colder weather, the scrotum contracts to pull the testes closer to the body to maintain a constant temperature. As the sperm mature, they pass from the testes into the epididymis, a tightly coiled tube at the top of the testes (stretched out it would be approximately six meters — about 19 feet — long!). Here, they further mature and develop their ability to swim. It takes approximately 12 weeks for the full cycle of sperm development and 10 to 15 days for them to travel to the end of the epididymis before entering the vas deferens. The vas deferens is a long curving tube that carries the sperm from the epididymis up into the groin. pouch-like glands called seminal vesicles at the far end of the vas deferens produce most of the fluid (semen) in the ejaculate. A man who has had a vasectomy can still produce semen because the vas deferens has been cut close to the epididymis so that the seminal fluid can still leave the body, but the sperm stay trapped. The prostate gland is the largest of all the male reproductive glands and lies just below the bladder. The prostate gland also produces some of the seminal fluid discharged into the urethra during ejaculation. This fluid helps to change the pH of the semen, which neutralizes the acidic environment of the vagina. The Role of Sperm in Fertilization After ejaculation, the sperm swim through the cervical mucus and enter the uterus. They then swim up into the fallopian tubes where they meet an egg at the far end closest to the ovary. Although millions of sperm are deposited in the vagina, only a couple of hundred reach the egg, and only a single sperm is needed for fertilization. The sperm binds with the outer shell of the egg and enters it in a process called the acrosome reaction. As soon as this happens, the shell of the egg changes to stop any more sperm from entering. The DNA is then released from the head of the sperm and combines with the DNA of the egg to form the embryo. Causes of Male Infertility Sometimes the male partner is found to have a problem with his sperm. A semen analysis will identify problems involving the sperm count (numbers) and morphology (the shape and size) or motility (the movement). If a specific problem is identified, then the cause can be investigated by a specialist. Most often the only advice is to change environmental and lifestyle factors that may be contributing to a low sperm count. But occasionally further testing is needed to eliminate underlying health conditions or undiagnosed genetic disorders. Causes of fertility problems in men include the following: Obstructive problems (blockages in sperm-carrying tubes) Testicular injury and disease Varicocele (a varicose vein in the scrotum) Sperm disorders Genetic disorders Problems with erections and ejaculation Hormonal problems General medical disorders that reduce fertility Drugs that reduce fertility Environmental toxins and radiation Sperm Quality Factors in Male Infertility Sperm quality influences not only rates of fertilization but also subsequent embryo development. Remember, half of the genes come from the father. The male partner may carry a chromosomal abnormality that is responsible for him having a low sperm count and that increases the risk of implantation failure and miscarriage. A standard semen analysis usually tests sperm count, motility, and morphology. Several tests that are more advanced can be carried out if the sperm count is low for no apparent reason or if several treatment cycles fail without explanation. Several studies have shown increased sperm quality when a man takes vitamin supplements for a prolonged period. This is especially true if the supplement contains vitamin C, zinc, and folic acid. Eating a balanced, healthy diet with plenty of fresh fruit and vegetables, along with good quality proteins and healthy oils, has also been shown to improve fertility in men. Interestingly, most of the sperm found in a man’s ejaculate is actually abnormal, even in men with normal fertility. This is a case where the body is focused on quantity rather than quality. Semen Analysis One of the first investigations done by a fertility doctor is a semen analysis. This is done by the man producing a semen sample through mastrubation into a sterile container. This may be done at a clinic in a special room or potentially at home if you live close by. The clinic will supply you with a container and sperm-safe lubrication, so don’t use any household products or this may affect the results. Getting the sample When you get your semen assessment done, your doctor will receive a report from the lab with all the findings. The following table shows the normal ranges for sperm count, motility, and morphology. Normal Value Sperm concentration 2.0 mL or more Concentration 20M per mL or more Count 40M or more Total Motility 40% or more Progressive Motility 32% or more Morphology 4% or more Vitality (% alive) 58 Interpreting a

Fertility Health, oldposts

Understanding Blocked Fallopian Tubes

Rebecca Matthews, PhD / November 4, 2020

Getting pregnant is a complicated business. The egg and sperm have to meet and fertilize and the resulting embryo has to grow and implant in the uterus. Most of this early part of conception takes place in the fallopian tubes. These thin tubes, around 8-10 cm long, stretch between the ovary and the uterus. After ovulation, the egg is picked up by the open end of the fallopian tube which is close to the ovary, where it begins its journey towards the uterus. Millions of tiny hairs called cilia line the end and the inside of the tubes. These cilia beat hundreds of times a second and help to catch the egg and move it through the tube towards the uterus. The cells lining the fallopian tubes provide lubrication for the egg on its journey and nourishment for the sperm, egg, and developing embryo. If sperm is present around the time of ovulation, the egg and sperm will meet in the second portion of the tube known as the ampulla. The egg and sperm combine to form the embryo, which starts its life as a single cell for the first 24 hours and will then continue its journey through the fallopian tube to the uterus. Fallopian Tube Disorders You can imagine that any serious dysfunction of the fallopian tubes will prevent conception, in which case in vitro fertilization (IVF), which bypasses the fallopian tubes, may be needed. As well as acting as a transport system for the egg, sperm, and embryo, the tubes are the site of sperm capacitation and storage, fertilization, and early embryo development. The tubes are an important contributor to the nutrition and development of gametes and embryos. Any changes in the delicate cells lining the fallopian tubes can affect a woman’s ability to conceive. In addition to being patent (open), the tubes must be healthy and disease-free to allow normal function. Identifying tubal occlusions, or blockages can be done using ultrasound or radiological imaging of the tubes after filling them with saline or a special dye. This investigation is usually done soon after you visit your doctor to discuss your fertility because the results will determine whether a couple should continue trying on their own or if they need surgery or the help of IVF. HSG: Diagnosing Issues with Fallopian Tubes A hysterosalpingogram (HSG) is a common test used to determine whether the fallopian tubes are patent (open) and if the uterine cavity is normal. During an HSG, a catheter is placed through the cervix into the uterus, and a contrasting dye is injected into the uterine cavity. Several X-rays are taken of the pelvic area to identify if the dye is traveling through the tubes, indicating that they are clear and whether there are any uterine abnormalities. An HSG is preferable to a sonohysterogram (which uses saline) because it provides more detailed information about the reproductive system, including the fallopian tubes. An HSG is part of the basic testing done in the early stages of diagnosis. It is performed between Days 5 and 11 of the menstrual cycle, and a woman can attempt conception in the same month. This test is typically performed by a radiologist in the X-ray department of a hospital or clinic and usually takes 15 to 30 minutes. You may feel some cramping similar to menstrual cramps during the test and for a short time after. Most women with blocked fallopian tubes do not have any symptoms. If only one tube is blocked, a woman can still get pregnant naturally, although usually only in the months when she ovulates on the side with the open tube. In rare cases, women have gotten pregnant when they ovulated on the side with the blocked tube, so it’s still worth trying every month if this is the case. It is also possible for a tube to be partially blocked, this increases the chances of an ectopic pregnancy, so it’s important to have a full investigation done if you are trying to conceive and have a history of pelvic infection. What Causes Blocked Tubes? The most frequent cause of blocked fallopian tubes is pelvic inflammatory disease (PID) which is usually the result of an infection. Salpingitis is the medical name given to enflamed fallopian tubes. Here are some of the common causes of blocked fallopian tubes and their symptoms: Salpingitis This inflammation of the fallopian tubes is usually caused by a bacterial infection and is one of the most common causes of blocked fallopian tubes. Salpingitis is sometimes called pelvic inflammatory disease (PID), although PID can also refer to inflammation of other parts of the reproductive tract. Salpingitis may have no symptoms. In other cases, signs may include abnormal vaginal discharge, spotting between periods, painful periods, pain during ovulation or sex, and lower back pain. Treatment options include prompt antibiotics when an infection is identified. Infection of one tube can easily lead to infection of the other tube because of their proximity. Diagnosing salpingitis involves several tests, including: General examination: to check for localized tenderness and enlarged lymph glands Pelvic examination: to check for tenderness and discharge Blood tests: to check the white blood cell count and other factors that indicate infection Mucus swab: a test to identify the type of bacteria causing the infection Laparoscopy: a way to view the fallopian tubes with a slender instrument inserted through abdominal incisions Sexually transmitted diseases, especially Chlamydia and Gonorrhea, can cause the tubes to become blocked. If you have a history of STDs and are having trouble conceiving, talk to your doctor about testing to see if your tubes are healthy. Uterine infections caused by pregnancy termination, surgery, or miscarriage can also lead to blocked tubes so make sure you mention any relevant history to your doctor. Hydrosalpinx A hydrosalpinx is a blocked fallopian tube filled with clear fluid; this is usually in response to an infection or other cause of PID such as endometriosis or surgery. Symptoms vary. Some patients have low, recurring abdominal

oldposts, Trying to get Pregnant

Fertility Tests for Women

Rebecca Matthews, PhD / November 27, 2018

When seeking help for infertility, diagnosis usually begins with a detailed medical history. By asking questions about your medical, surgical, gynecological, and obstetric history, doctors can discover relevant information that may explain or provide a clue as to why you aren’t getting pregnant. This is followed by a pelvic ultrasound examination that can reveal abnormalities of the uterus, fallopian tubes, or ovaries. The number of resting follicles in the ovary can also be counted using ultrasound to give an indication of the potential response to ovarian stimulation during fertility treatment. Most couples will have basic fertility testing done before being informed of their chance of success and treatment recommendations. Basic fertility testing usually includes: Measurement of the ovarian reserve by measuring follicle-stimulating hormone (FSH) and estradiol levels Resting follicle count and anti-mullerian hormone (AMH) Basic blood tests to measure hormone levels Hysterosalpingogram (HSG) to check the uterus and fallopian tubes Semen analysis These basic tests can be started as soon as you visit a fertility doctor. It’s possible that following these tests, no further testing will be necessary. Pregnancy can be attempted during the diagnostic phase; for example, intrauterine insemination (IUI) can be done in conjunction with clomiphene and can be carried out in the same cycle as a hysterosalpingogram. Blood Tests to Measure Ovarian Reserve The body is a delicate balance of chemicals, and blood tests help identify whether there is an imbalance in the endocrine (hormone) system that could be contributing to your infertility. Here are some of the blood tests that may be done: Follicle-stimulating hormone (FSH) Luteinizing hormone Prolactin Estrogen Vitamin D levels Progesterone Testosterone Thyroxin Thyroid-stimulating hormone Blood tests can be used to assess how many eggs are left in the ovary (also called ovarian reserve). The tests include anti-Müllerian hormone (AMH), Day 3 FSH and estradiol. These are strong predictors of how well your body will respond to fertility drugs. The results of these blood tests, along with the resting follicle count (also called the antral follicle count), are the most conclusive tests of ovarian reserve. Follicle-Stimulating Hormone (FSH) Levels A measure of the follicle-stimulating hormone (FSH) level shows how hard your body has to work to stimulate a follicle to grow each month. A high FSH level on Day 3 shows that the pituitary gland in the brain is trying to stimulate an ovary that has a diminished capacity to respond. This is a poor prognostic sign. Although FSH levels mainly correlate with egg quantity, it should be taken as part of the bigger picture and used in conjunction with other diagnostic factors. The age of the woman is the most overwhelming predictor of success from fertility treatments. A young woman with a high FSH still has a better chance of becoming pregnant than an older woman with normal FSH has. The older woman could have many eggs, but they are more likely to be abnormal because of her age. In the end, quality is what really counts. FSH levels can predict the chance of a cycle being canceled because of a low response or low egg yield, but age is a better predictor for pregnancy. Ovarian reserve, together with the female partner’s age, are the best predictors of a treatment’s success. Anti-Müllerian Hormone (AMH) Test Anti-Müllerian hormone (AMH) is a protein made by cells in small ovarian follicles. Production is highest in the early stages of follicular development when the follicles are smaller than 4 millimeters (less than 1/8 inch) in diameter and stops when the follicle gets bigger. Because only small follicles produce AMH, the circulating blood level can be used as a fairly accurate indicator of how many tiny microscopic follicles are left in the ovary. This is the ovarian reserve. With increasing age, the ovarian reserve and the amount of AMH produced decline. On the other hand, women with many small follicles (such as those with polycystic ovaries) or a good supply of primary follicles, have a high level of AMH. Remember, AMH level is not an indicator of egg quality. We do know, however, that the more eggs we retrieve in an IVF cycle, the greater the chance we have to create good quality embryos for transfer. AMH levels may give us an indirect prediction of a woman’s chance to conceive. One advantage AMH testing has over FSH testing is that the levels are quite constant, and testing can be done on any day of the cycle. No test is perfect, so the results from both the FSH and AMH testing are used in conjunction with other factors when predicting success rates for fertility treatments. It is important to remember that no test for ovarian reserve can predict your ability to spontaneously conceive. Additionally, a normal test tells you that your ovarian reserve is normal today, it cannot predict what your reserve will look like in one year or three years. The tests simply tell you egg quantity and how well you are likely to respond to fertility treatment. Hysterosalpingogram for Infertility A hysterosalpingogram (HSG) is a common test used to determine whether the tubes are (patent) open and if the uterine cavity is normal. A catheter is placed through the cervix into the uterus, and a contrasting dye is injected into the uterine cavity. X-rays are taken of the pelvic area to determine if the dye is traveling through the tubes and spilling into the pelvis, indicating that they are clear and whether there are any uterine abnormalities. An HSG is part of the basic testing done in the early stages of diagnosis. It’s performed between Days 5 and 11 of the menstrual cycle, and a woman can attempt conception in the same month. This test is typically performed either by your fertility doctor or by a radiologist in the X-ray department of a hospital or clinic and usually takes 15 to 30 minutes. You may feel some cramping similar to menstrual cramps during the test and for a short time after. Sonohysterogram for Infertility A

Fertility Treatment

What you need to know about Ovarian Hyperstimulation Syndrome (OHSS)

Rebecca Matthews, PhD / November 19, 2018

Complications from fertility treatments are rare; nevertheless, some people do experience side effects. Anyone undergoing ovarian stimulation either for in vitro fertilization (IVF), egg freezing, or egg donation, is at risk of developing ovarian hyperstimulation syndrome (OHSS), a rare but potentially serious side effect of fertility treatments. Because of this, It’s to your advantage to be informed and on the lookout for symptoms to bring to your doctor’s attention What is OHSS? OHSS is caused by the presence of multiple ovarian cysts in the ovaries that can occur after a robust response to IVF injections. OHSS is characterized by high levels of vascular endothelial growth factor (VEGF) that gets released after taking the final injection of hCG during IVF. The sustained, high levels of VEGF, along with estrogen and progesterone, lead to the dilation of blood vessels in the body causing fluid to shift out of the bloodstream and into the abdominal cavity, or in more severe cases, the lung cavity. Even though a woman with OHSS drinks plenty of fluids, she can become severely dehydrated. As a result, the blood becomes thickened leaving her at risk for blood clots in the legs and lungs. Related: Dealing with IVF Injections When You’re Scared of Needles Preparing for Your Egg Retrieval From Eggs to Blastocysts: Understanding IVF Attrition What are the Symptoms of OHSS? The symptoms of OHSS may be mild, moderate, or severe and can be classified as: Early-onset. Less than 10 days from retrieval. Late-onset. More than 10 days after retrieval, which is usually associated with early pregnancy. The accumulation of fluid in the abdominal cavity can be very uncomfortable and cause bloating, and sometimes breathlessness. In severe cases, the fluid enters the lungs and causes respiratory distress. This is why it’s very important to inform your doctor if you have any of the following symptoms: Mild OHSS Mild abdominal distention and discomfort Mild nausea/vomiting Vomiting Diarrhea Enlarged ovaries on ultrasounds Moderate OHSS All of the signs of mild OHSS plus: Ultrasound evidence of ascites (abnormal build-up of fluid in the abdomen.) Severe OHSS All of the signs of mild and moderate OHSS plus: Severe abdominal pain Persistent nausea and vomiting Decreased urinary frequency Dark urine Shortness of breath Tight and enlarged abdomen Dizziness Mild or moderate OHSS usually resolves within a few days unless pregnancy occurs, which may delay recovery. OHSS & Pregnancy Because the symptoms of OHSS are exacerbated by pregnancy, sometimes a “freeze all” cycle is the safest option during an IVF cycle. In this case, all the embryos are frozen and a transfer is delayed until full recovery. Who is at risk? Some women are more at risk than others of developing this complication. Women with polycystic ovary syndrome (PCOS) are most at risk because they have many tiny follicles present that can respond to the stimulation medicine. Other women at risk are those who have: A high number of antral follicles (greater than 24) High anti-mullerian hormone (AMH) levels (higher than 3.4 ng/mL) High peak estradiol levels during stimulation (higher than 3,500 pg/mL) A high number of eggs retrieved (more than 25) An individual’s risk should be assessed by a doctor ahead of starting an IVF cycle to adjust the starting dose of stimulation medication accordingly. Additionally, the doctor will do regular ultrasound scans of the ovaries during the stimulation phase and monitor the circulating estrogen levels as they rise. If the blood estrogen level is rising too high or too quickly, the doctor can reduce the dose of FSH medication or “coast” the treatment by stopping the FSH injections for a few days. This will give the ovaries a break from being over-stimulated and help to reduce the chance of OHSS. How common is OHSS? Symptoms of mild OHSS, such as bloating are a common side effect of ovarian stimulation for IVF. The symptoms are easily managed with over-the-counter pain relievers, dietary changes, and increased fluid intake. Severe OHSS affects around 1 to 5% of cycles and is managed with medical help. At-Home Treatment of Mild OHSS Treatment usually involves keeping you comfortable until symptoms subside, which can take approximately 1 to 2 weeks or longer if you are pregnant. Your doctor may also recommend: Take over-the-counter pain relievers such as Tylenol. Reduce activities — no heavy lifting and straining or strenuous exercise. Maintain light activity as total bed rest could increase the risk of certain complications like blood clots. Elevate your feet when resting. This helps your body get rid of the extra fluid. Avoid sex until you are cleared by your doctor. Abstain from alcohol and caffeinated beverages. Drink plenty of fluids. Drinks with electrolytes, such as Gatorade or Smart Water, are a good choice. Record your weight twice daily and the number of times you urinate. Contact your doctor if you note a 5-pound weight gain in 24 hours or a reduction in the frequency of urination by approximately 50%. Be aware of bodily changes, and call the doctor with any nausea, pelvic pain, or increasing symptoms. Clinical Treatment of OHSS For more severe cases, the following may be required: Cancellation of embryo transfer until a later date Prescription anti-nausea medication Drain excess fluid from the abdomen with a needle puncture, similar to an egg retrieval Administer intravenous fluids How can OHSS be prevented? Prevention is better than cure, and your doctor should monitor the stimulation phase of the IVF cycle carefully. Ultrasounds and blood tests measure the ovaries’ response to the stimulation drugs. The dose will be lowered if the estrogen levels become too high or you may take a break from injections for a day or two. It is better to start with a lower dose and add extra FSH during ovarian stimulation than start too high and be at risk for complications. If the ovarian response is extremely high the doctor might choose to cancel the cycle altogether and start again with a lower dose next time. Read: IVF Stimulation Protocols Once a high ovarian response

Fertility Treatment, oldposts

Assisted Hatching for IVF

Rebecca Matthews, PhD / March 31, 2018

Assisted hatching is a technique sometimes used during an in vitro fertilization (IVF) cycle where a hole is made mechanically or chemically in the shell of the embryo before an embryo is transferred back into the uterus. This procedure is done: With the hopes of increasing the chances of the embryo attaching to the uterus (implantation) and achieving pregnancy. To make trophectoderm cells accessible for embryo biopsy. Why Assisted Embryo Hatching? To understand exactly what assisted hatching is, you need to first know the anatomy of eggs and embryos. Every egg has a natural shell around it which has two jobs: The first is to only let one sperm enter, making sure the embryo doesn’t have too many chromosomes. The second job is to protect the cells of the dividing embryo and ensure that implantation doesn’t happen too soon in the fallopian tube (rather than the uterus), where a pregnancy would not be viable. This shell is called the zona pellucida, and it is a thin, gelatinous layer made up of proteins that you can see as a halo around each egg and embryo down the microscope. Here is a photograph of a fertilized egg; you can see the shell around the embryo, which is still a single cell. Does Assisted Hatching Help Implantation? Once the embryo has developed to the blastocyst stage, it has to escape from the shell to implant in the uterus. (Read more about the different stages of embryo development.) If the shells of the embryos are thicker or tougher than usual, it may be difficult for blastocysts to hatch naturally. In such a case, the embryo cells cannot come into contact with the uterine lining, meaning that implantation fails and there will be no pregnancy. With assisted hatching, once the embryos are hatched in the lab, there is no chance of them being trapped inside their shells after they are transferred. This does not guarantee implantation. How is Assisted Hatching Done? Assisted hatching can be done in several ways; the most common way is using a laser attached to a microscope. This allows the embryologist to make a small precise hole in the shell using short laser pulses. This may also be called laser-assisted hatching. Other ways are by partial zona dissection or cutting the shell with microtools and acid tyrode’s, which is a chemical that dissolves away part of the shell. These methods are all good for making a hole in the shell and are easily done by a proficient embryologist. You can see a blastocyst that has had assisted hatching with a small section of the shell missing. The three embryos in the photograph below are all hatching out of their shells and are ready for implantation. Is Assisted Hatching Necessary? While several studies have suggested the benefits of assisted hatching, it is not necessary a procedure well-suited for everyone. Some studies have shown no benefit from hatching embryos when comparing two similar groups of patients. It is, however, a standard practice at most clinics and is used in all cases of frozen/thawed embryos and with patients who meet the following criteria: Have a raised FSH level or low ovarian reserve Are over 37 years of age Have poor-quality embryos Have thickened shells around the embryos Have previously failed attempts at IVF Are using frozen and thawed eggs or embryos Assisted Hatching & Chromosome Testing All embryos that are going to undergo chromosome testing have assisted hatching before freezing. This is so the embryologist can easily do the biopsy and take a small number of cells for analysis. The embryo biopsy procedure can be seen in the photograph below; you can see the hatched area allows removal of cells for chromosome testing. Read more about preimplantation genetic testing for aneuploidies (PGT-A). Can Assisted Hatching Damage Embryos? The zona pellucida is not a living part of an embryo, so there is no damage done by penetrating the shell. Assisted hatching is considered to be a very low-risk procedure and will not usually cause any damage to the embryo. Rarely, an embryo can be damaged to the point that it is unusable. Can Assisted Hatching Create Twins? It may increase the chances of an identical twin, but the risk of an embryo splitting is still very low (and does also happen without assisted hatching). Talk to your doctor if you think you might benefit from this procedure.

Trying to get Pregnant

A Guide to At-Home Insemination

Rebecca Matthews, PhD / February 24, 2018

Insemination at home is an option for individuals and couples looking to conceive without penetrative intercourse and who have no known fertility issues. If you plan on using donor sperm or have ejaculation-related difficulties, this could be a conception method that works for you. Here we’ll take a look at what it entails—and how to do it yourself. What is at-home insemination? At-home insemination means placing semen or sperm in the vagina by a method other than having sex, usually without the help of a healthcare provider. There are several different terminologies for insemination that you might come across. Intrauterine insemination (IUI) is always done at the doctor’s office. With IUI, the sample is washed, and the sperm are concentrated into a small volume. The sperm is then placed through the cervix directly into the uterus using a thin catheter. Raw semen cannot be placed directly into the uterus as it can cause a severe adverse reaction. Intracervical insemination (ICI) and intravaginal insemination (IVI) are similar methods. With ICI, the sperm is placed very close to the cervix, either by the doctor or at home using a long syringe or insemination catheter. With IVI, the sperm is placed anywhere in the vagina. ICI and IVI can be done at home and, because they do not involve the introduction of sperm directly into the uterus, sperm used for ICI and IVI may be either washed or unwashed At-Home Insemination with Donor Sperm A common reason for individuals considering at-home insemination is that they are using donor sperm. When working with anonymous, prescreened donors who have waived their rights to paternity, you can order vials of frozen semen from several online clinics. These donors have been thoroughly screened for infectious diseases and have waived their rights to any contact with future offspring. The clinics typically offer a variety of samples, and you can choose a donor based on physical characteristics, personality, and educational background. Obtaining sperm from a donor can be a lengthy process. There may be a waiting period of up to six months, even with sperm from a known donor. The sample is shipped to you in a special tank that is kept frozen with liquid nitrogen vapor. You have to keep the vial of sperm in this tank until you are ready to use it (you can’t put it in your home freezer, or it will die). The sperm bank will usually want the tank to be returned to them within a week, so it’s a good idea to track your cycle carefully beforehand, so you know exactly when to schedule the delivery. The donor sperm clinic will give you special instructions on how to handle and thaw the frozen vial of sperm. You should wear protective gloves to remove it from the tank as it will be very cold. Allow the sample to thaw completely at room temperature before insemination, and do not use heat to thaw the vial. There are three types of donor sperm samples. These are usually called intracervical insemination (ICI), intravaginal insemination (IVI), and intrauterine insemination (IUI): ICI and IVI samples contain raw semen that has not been washed and can be used for at-home insemination. IUI samples have been washed and do not contain raw semen. They can be used for both at-home insemination or IUI insemination at the doctor’s office. At-Home Insemination with Fresh Semen If you are using fresh semen either from a known donor or from your partner, you will need a container to collect the semen sample. A collection cup with a wide mouth and a shallow depth is ideal. If you use a container from home, make sure you wash and dry it thoroughly; any small amount of soap or water could kill the sperm. The male partner should produce the semen without using any lubricants unless they are specifically sperm-friendly. You will want to use the sample within an hour of collection. A fresh sample should be easy to draw into a syringe for insemination. Supplies for At-Home Insemination Placing the sample into a vagina is commonly done by using a needleless syringe called an insemination syringe. You can also buy syringes from a pharmacy. Just ask the pharmacist for a medication syringe. In the IVF lab, we use Norm-ject syringes, and these work well with biological samples. The volume of syringe you need will depend on the type of sample you are using: The volume of donor sperm is usually very small (less than 1 mL). You will want a syringe that is as small as possible, between 1-5 mL. A freshly produced sample will be approximately 3 mL. You will need a 5 mL syringe. What you do not want to do is use a turkey baster! These are way too big for the volume of the sample you are using. Timing is Critical with Home Insemination – Know your Fertile Window One of the most important aspects of at-home insemination is to make sure you introduce the sample during the most optimal time to conceive during your cycle, also known as your fertile window. Tracking your menstrual cycle carefully will increase your chances of success. This can be done by observing your basal body temperature, cervical mucus, and cervical position, and the use of ovulation predictor kits. You will likely want three months of tracking to feel comfortable identifying the best time in your cycle to perform the insemination. For more details, check out: How Basal Body Temperature Can Help You Get Pregnant Identifying Fertile Cervical Mucus How do you know when you ovulate? Steps Involved in At-Home Insemination Identify your fertile window, which will occur just before ovulation. Prepare the sample as per directions if using donor sperm or allow a fresh sample to liquefy. Ensure you are in a comfortable place where you can lie down and elevate your hips with pillows. Draw the sample into the syringe and place it into the vagina as far as it is comfortable without

Author name: Rebecca Matthews, PhD

Understanding Male Infertility

Understanding Blocked Fallopian Tubes

Fertility Tests for Women

What you need to know about Ovarian Hyperstimulation Syndrome (OHSS)

Assisted Hatching for IVF

A Guide to At-Home Insemination

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