What A Fertility Doctor Wants You To Know About At-Home Insemination

Photographed by Megan Madden.
Editor's note: This story was originally published on April 19, 2020. We've resurfaced it to bring awareness to topics of fertility in honor of National Infertility Awareness Week.
If you search Google for tips on at-home insemination, you’ll see over a million pages of results. People will give you advice down to the last detail. They’ll recommend taking supplements like evening primrose to change the consistency of your cervical mucus lining. They’ll demonstrate exactly how they positioned themselves with their legs against a wall, so they could use their dominant hand to insert sperm in their vagina. They’ll tell you how to use ovulation sticks and which syringes to buy. (Spoiler: They work better than a turkey baster.) 
There are a few things the internet can't tell you about inseminating yourself at home, though, says Lucky Sekhon, MD, a reproductive endocrinologist and fertility specialist at the fertility clinic RMA New York. She's seen a fair amount of patients who’ve tried to artificially inseminate themselves outside of a medical clinic. Many of them are single mothers by choice or members of the LGBTQ+ community, though some heterosexual couples use the method too.
“If someone wants to do it, I’m supportive and I don’t condemn it,” Dr. Sekhon says. “I do advise: Don’t be afraid to get a consultation with a doctor and ask questions about testing up front… Going to a doctor shouldn’t make you feel like you're automatically signing up for something, you’re just getting all the facts, and you can still choose to do the procedure at home.” 
This is what she tells patients who are interested in the process.

Does at-home insemination work?

At-home insemination can certainly result in pregnancy, though it's not the most effective method out there. Intrauterine insemination (IUI) is about three times more likely to lead to a pregnancy than intracervical insemination (which is what most people do at home; an IUI typically requires doctors' tools or expertise), according to a 2001 study comparing the two methods.
There are multiple reasons for this. For one, inseminating oneself isn't as simple as inserting a syringe and squeezing. You need to find the right spot. “The effectiveness can be reduced unless you have a midwife who knows the curve of the cervix well,” Dr. Sekhon says. “It’s not a straightforward path, and it’s not always easy to find the top… I remember when I was an intern doing my OB/GYN residency and it was difficult at first — it takes expertise to navigate.”
Another reason for the higher success rate of in-office procedures is that medical professionals can perform an ultrasound to make sure you have eggs that are ready to be fertilized before the procedure. Although there are plenty of ways to track ovulation with kits at home and on phone apps, Dr. Sekhon says they’re not 100 percent accurate.

Is it cheaper to do at-home insemination?

Saving money is the primary reason people pursue at-home insemination, Dr. Sekhon says. She notes that an in-office intrauterine insemination (IUI) typically costs around $300.
Plus, couples who have tried at-home insemination without success may have an easier time getting their insurance providers to cover procedures such as IUI or IVF in the future, Dr. Sekhon says. This is good to keep in mind if you need to pursue IVF down the road. If you tell your doctor you've tried to inseminate at home, and it's in your medical record, an insurance provider might not make you wait as long before they cover the costs of your procedures.
Still, most patients also have to pay for sperm to do an at-home insemination, and that can cost up to $500 per vial, depending on the sperm bank you use, Dr. Sekhon says. What's more, since at-home insemination is thought to be less effective than in-office procedures, the cost of sperm can get expensive. “If you need six rounds, that adds up,” she says.
Hoping to cut costs by having a friend donate sperm? That can also come with some legal issues. There are laws and paperwork that prevent sperm bank donors from claiming parental rights on any children that are born from their sperm; not so if you use a friend. “The donor could definitely fight for custody, which could be a major legal battle in the end,” Dr. Sekhon says. “While it’s cheap up front, it would be a huge headache and financial burden down the road."

Is at-home insemination safe? 

There’s a small chance of introducing bacteria into the vagina via an unsterile syringe, which could lead to an infection of the uterus lining such as endometritis. Signs of this include abnormal vaginal swelling, bleeding, and discharge, as well as pelvis pain and fever. This can be treated with antibiotics.
The more common health risk, however, has to do with the sperm. If you get your sperm through an official bank, they’ll most likely do the proper medical testing for you. If you use a friend, “get preliminary testing done on the sperm sample,” Dr. Sekhon stresses. That includes an STI test, including a HIV test, and genetic testing to rule out the possibility that you and the donor carry a mutation that could be passed onto your future child. This is crucial, Dr. Sekhon says.
Genetic testing is covered by most insurance providers — but even if it's not or you don't have insurance, Dr. Sekhon says it's usually heavily subsidized.
Wash your hands and wear gloves when you’re doing the insertion, Dr. Sekhon says. "Whatever can be done to maintain sterility throughout the procedure — including not letting the catheter tip touch anything before it is used for insemination — is advised."

What equipment and supplies do I need for an at-home insemination? 

To complete an at-home insemination, you'll need a sterile syringe and screened sperm. (We'll say it again: It's best not to use a turkey baster.)
That's it — but there are a few things that aren't required, but can help. An ovulation tracker or test strip can help ensure you're inseminating yourself or your partner at the most fertile time. A "soft cup," which looks like a menstrual cup, that helps keep the sperm closer to the top of the cervix.
(I read about a couple who cut a racquetball in half, ejaculated into one side of it, and used that as a soft cup. Understandably, Dr. Sekhon advises against homemade equipment like this, stressing the need for sterility.)
As for the supplements and medicines that may claim to make your at-home insemination more effective — Dr. Sekhon says many of them aren’t worth your money. “There are really no supplements I’d recommend,” she says. There's a rumor, for instance, that taking mucus-thinning cold medicines can thin out the cervical mucus, making it easier for sperm to get to the egg. Dr. Sekhon says this is an unproven theory.
She also advises against taking medication to help you release more than one egg, such as Clomid. These drugs increase the risk of ovarian hyperstimulation syndrome, which can cause ovaries to swell, triggering vomiting, pain, and other more severe complications, says Dr. Sekhon. There's also a higher potential of having multiples. If you think you need this medication, talk to your doctor first.
Dr. Sekhon says the best thing you can take is a prenatal vitamin; they're typically rich in folic acid, and there's plenty of evidence to show that upping your folic acid intake during pregnancy is beneficial.

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