We can help you monitor your cycle – we can even make sure you have maximal fertility while taking medications – but we cannot complete a cervical or intrauterine insemination.

This could put you in the difficult position of being tempted to doing inseminations at home yourself. We cannot speak to the medical safety of doing so, or to the emotional risks of the parties involved, nor to the legal risks up to and including the child support implicit in the biological father’s participation.

What alternatives do you have?

Health Canada will approve known-donor insemination, when the sperm is frozen for six months in an approved setting. As noted above, the only approved setting in Canada is at ReproMed. You would need to contact them directly.

Unfortunately, your known donor may not match Health Canada’s criteria for suitability for known sperm donor. Under these circumstances, there is a special release called “DSSAP”. For example, if your potential donor has had homosexual relations, or is over the age of forty, then sperm could only be released through DSSAP. At Hannam Fertility, we do not work with DSSAP sperm, as it is not in our opinion a process regulated and approved by Health Canada. We can, however, forward your care to other clinics that may well be willing to provide this service.

Though we cannot support known donor sperm insemination, we are comfortable supporting your right to understand and maximize your own personal fertility through cycle monitoring and/or medications where necessary.

These, and additional, guidelines were put in place by Assisted Human Reproduction Canada (AHRC) in 2006, to enforce the Assisted Human Reproduction Act of 2004. However, the AHRC was wound down in 2012 in response to a 2010 Supreme Court of Canada ruling. Health Canada now administers the guidelines. Specific limits of jurisdiction continue to be debated and interpreted. These limits are of particular interest to people interested in third party reproduction (donor eggs, donor sperm, and gestational carriers). Since the legal restrictions to clinical care are not always straightforward, different clinics are responding differently. We believe we have a very conservative interpretation of the law that maximizes healthy outcomes for all parties concerned. If you have any specific questions about how the laws of Canada may impact you, you may want to speak with Sherry Levitan (416-784-1222) or Kelly Jordan (416-203-2899 x 29), lawyers with a particular interest in and experience with reproductive medicine.

The post What are the guidelines for known sperm donation? appeared first on Fertility.ca.

Not everybody needs IVF. Many patients may benefit from intrauterine inseminations.

IUI, where sperm is washed and placed high within the womb, can address a variety of concerns including:

• concerns around cervical mucus or scarring after a LEEP procedure
• erection concerns
• difficulty timing intercourse (perhaps due to work, or irregularity of ovulation)
• unexplained infertility
• donor sperm
• financial: And understanding that IVF may be “better”, but it is also much more expensive and invasive, and a hoped for success through a trial of inseminations

As you can see, there’s a wide variety of reasons why people may choose IUI, so success rates vary greatly from less than 5% to over 20% per cycle. You would really need to speak with your clinical team to understand what the odds of inseminations may be like for you.

It can be difficult to make sense of these wide-ranging numbers. Specific questions of what approach will maximize pregnancy rate can be actually quite tricky to answer. Here are two:

1. Should we always trigger ovulation?

One of the advantages of inseminations is we should be able to get the timing exactly right.

But for the timing to be “exactly right” we want to be able to place the sperm before the egg is released. We say a released egg is viable for twenty-four hours but we know from watching eggs in the lab that they are really optimized in their first six hours upon release.

Sperm, while functional for up to five days, is almost always very functional for the first twenty-four hours. That means we want to place the sperm into the womb before the egg is released, ideally the day before, so that they will be available when the egg is available.

The challenge with placing it the day before, however, is that while we are organizing for the insemination, we don’t actually know if the egg is going to be released on time.

To ensure the egg is ready on time, we often encourage using a “trigger shot”. This is an HCG hormone. It is actually a pregnancy hormone – and after a trigger shot, if you did a home test, it would suggest that you were pregnant. We use HCG because it is almost exactly the same structure as LH, the natural hormone that releases eggs. By taking the HCG shot, you can ensure yourself and us that the timing of the insemination will be ideal.

Different clinics will have different approaches. And it’s important to make note, it hasn’t been proven that HCG shots improve pregnancy rates.

2. Should you do one or two intrauterine inseminations?

The worry is that the timing of the insemination may not have been perfect. For that reason, it may be helpful to do inseminations two days in a row. If one insemination is too early (or the other is too late), at least one of them will be ideally timed. So is it worth doing IUIs two days in a row?

You can discuss this with your clinic. Pregnancy rates that peak at 30% are frustrating: It means that 70% of patients at least won’t succeed with their insemination cycle.

At my clinic, we do the double IUIs as our standard of care, not because we know that it increases pregnancy rates – we can’t know that – but because we are certain that it helps to minimize the stress of all involved. Everybody needs to be able to look back on the IUI and know that it was done in the best possible way.

Having said that, when it comes to donor sperm, which is so much more expensive, we generally encourage a single insemination. Clearly, every clinic is going to have a different opinion on this approach.

As long as you find a clinic and solution that minimizes your stress and maximizes your comfort level, then you have the best approach that fits you.

The post Should I have one or two intrauterine inseminations? appeared first on Fertility.ca.

Dr. Calvin Greene, the Regional Fertility Program clinic’s administrative director, was quoted by the Calgary Herald last week, “I’m not sure that we should be creating rainbow families just because some single woman decides that that’s what she wants,” he said. “That’s her prerogative, but that’s not her prerogative in our clinic.”

There is absolutely no medical or scientific basis for Dr. Greene’s policy regarding race-based selection of donor sperm. There are some complicated moral hazards in fertility management. This is not one of them.

Creation of a happy, healthy family from donor sperm, eggs or embryos is based on the choices of the patients seeking treatment, partnered or single. It’s not the place for doctors to regulate the cultural or ethnic makeup of the families we serve.

The Calgary Regional Fertility Program updated their website this week to claim this policy was reversed and that they have treated numerous patients who requested donors of a different ethnicity in the past year.

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