Molly and I chose to pursue alternative insemination (AI), because we both wanted to go through the pregnancy/birthing process with our own child(ren). Because I already had a hysterectomy, I am unable to carry a child, and even if I had not had a hysterectomy yet, I don’t think I would want to carry a baby. I understand the argument some transmen make about their body simply being a vessel and that carrying a child makes them no less of a man; however, I have personal concerns about the unknown effects of testosterone on female reproductive organs and would not want to expose my child to those unknowns. In addition, I think carrying a child would be too much of a gender incongruent experience for me. Molly would like to carry a child so it worked out well. Discussing our desire to have a family was one of the first conversations we ever had; from the beginning, we decided that if natural intrauterine insemination (IUI) proved unsuccessful, we would pursue other means of having biological children (fertility drugs, IVF) and/or adoption.
Type of Alternative Insemination
There are four basic types of AI:
- Intravaginal (IVI) – Sperm is delivered into the vagina using a simple syringe. This is generally the easiest and cheapest method, and it can be performed at home using fresh semen. Unwashed and washed frozen/thawed sperm can also be used. However, it also has the lowest success rate when compared with other AI methods.
- Intracervical (ICI) – Sperm is delivered into or very near the cervix. The insemination is an in-office procedure and either unwashed or washed frozen/thawed sperm can be used. The success rates are higher than intravaginal but lower than intrauterine.
- Intrauterine (IUI) – Sperm is delivered directly into the uterus. The insemination is an in-office procedure and requires washed frozen/thawed sperm. Success rates are higher than intravaginal and intracervical, but it is also more expensive.
- Intratubal (ITI) – Sperm is delivered into the fallopian tubes. This procedure can be done via the cervix, but it is more often done through laparoscopic surgery, making it the most expensive and invasive method of AI. Success rates have been reported to be similar to intrauterine insemination.
Molly and I chose to start with natural intrauterine (IUI) method of AI due to its higher success rates than IVI or ICI. Although it is more expensive than simply inseminating at home, and it somewhat medicalizes the process, we felt like because it gave us the best chance of conceiving before pursing even more medicalized options (fertility drugs, IVF), it was worth it to us.
Timing of AI Appointments
For about 8 months before our first insemination, Molly tracked her basal body temperature every morning and used ovulation predictor kits (detects the LH-surge) to determine her likely ovulation dates. According to the package, the ovulation kit will turn positive 24-36 hours before ovulation. Because she had tracked when she had ovulated for many months before we started inseminating, she makes doctor’s appointments for the week surrounding the dates she had previously ovulated. Each morning she would use the ovulation predictor kit and call to cancel/confirm that day’s appointment based on the test results. At our local LGBTQA-friendly healthcare provider, they provide the option of doing one or two inseminations per cycle. If doing one insemination, it is done the day after the ovulation predictor test turns positive. If doing two inseminations, one is done the same day the ovulation predictor test turns positive and the other is done the next day. They do not have any published data about success rates comparing one versus two inseminations per cycle, but anecdotal evidence suggests a higher success rate using two inseminations per cycle. Our first insemination cycle we chose to do one insemination, for the second and third inseminations we used two per cycle, and for the fourth insemination we used one (for a total of six inseminations at our local LGBTQA-friendly healthcare provider before we moved on to going to a fertility clinic).
They ask you to arrive 20-30 minutes before your scheduled appointment time so they can defrost the sperm. After undressing from the waist down, a doctor comes into the room and asked Molly to sign consent forms and to confirm the “identity” (ie. number) of the donor written on the vial. Assuming the position with feet in the stirups, the doctor uses a speculum to visualize the cervix and insert the catheter through the cervical opening and into the uterus. The plunger on the syringe containing the sperm is depressed slowly, and some report a cramping feeling during or immediately after the insemination process. Molly had varied experiences with the inseminations, everything from barely feeling it at all during and after to having vaso-vagal response during insemination and strong cramping afterwards. They ask that you remain lying down for at least 15 minutes after the procedure but can remain there for as long as you want. The entire process usually takes about 25 minutes. It is recommended to avoid strenuous or jarring activities and exercises the day of insemination but light-to-moderate exercise can be resumed the next day.
We used the commercial urine pregnancy tests available in the drug store for pregnancy testing. The entire process revolves around a process of 2-week waiting periods. There are roughly two weeks from the negative pregnancy test/period to insemination and time of insemination to the next pregnancy test. We found ourselves in a constant state of “hurry up and wait,” cycling with the ups of joy over a positive ovulation test and the downs of disappointment over a negative pregnancy test. The patience required to deal with this process has been good practice for both of us to help us deal with the long 9-months of pregnancy.