Seattle Midwife Answers Our Questions About At-Home Insemination

Working with a midwife while utilizing at-home insemination is a wonderful option during the COVID-19 pandemic to continue your journey to parenthood. It offers benefits not only to promote social distancing, but it can also be done in a comfortable and relaxing environment of your choice at home. SSB spoke with one of our favorite midwives and a Seattle local, Liam Kali, to get down to the details about at-home insemination with a midwife.

What is the best type of vial to use, ICI (unwashed), or IUI (washed)?

And a lot of people want to know, “What is washing anyway?”

I can take the mystery out of this for you with a quick biology lesson: A fresh semen sample contains sperm cells and seminal fluid. The seminal fluid is there to protect the sperm cells from the acidic environment of the vagina during intercourse. Once the sample is in the vagina, the sperm cells swim up into the uterus, leaving the seminal fluid behind.

“Washing” is a process that removes the seminal fluid and isolates the sperm cells. This is necessary for IUI because seminal fluid cannot be placed in the uterus.

An ICI vial is simply a fresh semen sample that has had a buffer solution added to it so that it can be frozen without damaging the sperm cells. So, just like with intercourse, you can place an ICI sample in the vagina and the sperm cells will swim up into the uterus. You don’t have to put the sample into the cervix, as the term “ICI” implies.

You can also place an IUI sample in the vagina, and the sperm cells will swim up into the uterus. In this case, the wash medium takes the place of seminal fluid and protects the sperm cells. So, both IUI and ICI samples can be used for self-insemination.

However, if you plan to do IUI, you can only use washed, IUI-ready vials. That is unless a health care provider washes an ICI vial for you, which can be done in a clinic or by a midwife at home.

When is the best time for me to try at home insemination? Should you monitor when you are ovulating?

Yes! The egg cell only lives for 12-24 hours, so you must identify the time of ovulation in order for insemination to be successful. Furthermore, sperm cells that have been cryopreserved only live for 12-24 hours. This means you absolutely need to know when you are ovulating in order to inseminate at the right time.

What is a fertile window, and how would someone know when they are in their fertile window?

This requires another biology lesson: While sperm cells are constantly being produced, egg cells are only released once a month, about halfway between periods. Once your period ends, there is a sharp increase in estrogen, which helps develop a new uterine lining, making it ready to receive a pregnancy. Meanwhile, the egg is developing and getting ready to be released. When estrogen levels are at their highest, ovulation occurs.

What you were probably not taught in science class (but you absolutely should have been!) is that high estrogen levels cause symptoms you can observe such as clear, stretchy vaginal fluid, softening and opening of the cervix, increase in libido, changes in mood, appetite, sleep, and abdominal symptoms such as bloating, fullness or cramping. Some symptoms may last for a few days, while some may only happen on the day your egg is released.

You will know you are in your fertile window when high estrogen symptoms are observed. If you are conceiving via intercourse or with a fresh sperm sample, you can inseminate any time in your fertile window. However, because cryopreserved sperm cells only live for 12-24 hours, you must identify the actual time of ovulation in order to make sure there are viable sperm cells present at the time your egg is released.

What is the best way to track when someone is ovulating?

Ok, here is where the biology lesson goes even deeper, but rest assured, you are becoming an expert on your own body, which is a good thing.

Let me start with some common misunderstandings that lead people to inseminate at the wrong time and waste a lot of money. Your period tracker app that only takes the dates of your periods will NOT accurately determine the time of ovulation, even though they say they do. Subtracting 14 days from your cycle length will not accurately tell you the day of ovulation. Tracking your basal body temperature will not give you the information you need until it is too late to inseminate. Even apps that record fertile symptoms do not predict ovulation with enough accuracy to time inseminations well. If they did, it would be so easy…but your body is not a computer.

Some sources tell you to just use an over-the-counter urine test called an OPK (ovulation predictor kit). The package instructions say to inseminate 24-36 hours after your positive reading. However, not everyone ovulates on that time frame – some ovulate sooner, and some later. And because the most reliable lifespan for both sperm and egg is about 12 hours, you will want to be able to identify that 12-hour window accurately for YOUR body. You can do this by tracking your fertile signs on a chart and seeing how they line up. It takes a little time and effort, but I promise it is easier and less time consuming than taking care of a baby.

Here is the basic gist of it: Use an OPK test, because it will identify the surge of LH hormone that precedes the release of the egg. But, be sure to use the OPK twice each day, AM and PM. Around the time of your positive OPK test, but usually after, your estrogen symptoms will increase, resulting in ovulation. The high estrogen signs will go away after the egg is no longer viable. This means you need to inseminate when estrogen signs are strongest, right before they go away. The OPK tells you when that is about to happen, but the timeframe between the OPK positive and the release of the egg is unique to you. A little bit of homework will help you understand how long your body takes to release your egg after your OPK positive.

You can identify your best 12-hour window for insemination if you chart your estrogen signs closely and consistently at 12-hour intervals from the time you get your OPK positive reading until the symptoms peak and then go away. This takes about 15 minutes in the morning and evening, and you will only do it for a few days. Once you have recorded this information in a chart, you can take note of the time frame between the OPK positive and when your strongest estrogen signs appeared. Taking a cycle to gather this information ahead of time allows you to accurately predict the pattern of ovulation signs in your body, which will allow you to time inseminations appropriately in future cycles.

Again, there is a lot more to know about how to identify signs of high estrogen, but I will leave you with some brief examples to illustrate how to use your fertile signs to time insemination. Insemination should be done during your peak signs of high estrogen. So, if your fluid was most clear and stretchy 12 hours after the OPK positive, and then the fluid changed back to sticky/tacky by 24 hours after the OPK positive, then the best time for you to inseminate was 12 hours after the OPK positive – 24 hours later would have been too late. As another example, if your fluid was most clear and stretchy 24 hours after the OPK positive, and by 36 hours it was going away, then the best time for you to inseminate was 24 hours after the OPK positive.

One more thing to note is that sometimes people find the information they get on their charts to be confusing. This may mean you need some fertility support. Or, there may not be a problem, you might just need an experienced eye to help you interpret the information you are gathering. For such basic physiology, it is surprising how few providers understand how to read a fertility chart. This is the heart of my fertility practice, and we have helped thousands of families conceive this way over the years.

What about timing insemination with ultrasound and a trigger shot?

I know it sounds like an easier way, and it does work out for some people – but only when ovulation happens as the protocol expects it to, which is not always the case. The ultrasound + trigger shot method is done by going into the clinic and getting an ultrasound to see if you have an egg follicle that is big enough to ovulate. If your appointment happens after ovulation has occurred, you will miss your cycle (or have an insemination that is too late, wasting your sample, and the money you paid for it). If you have not ovulated yet, a hormone shot is given to “trigger” ovulation, and the expectation is that you will ovulate 24-36 hours after the shot. However, if your egg was about to release, for instance, if it was going to release in 8 hours, it won’t wait just because you go the shot. It will still release when it was going to, and then by the time you go into the clinic for your IUI, the egg will be gone and the insemination will be too late.

The nice thing about the ultrasound + trigger shot method is that the clinic takes over everything for you, and it seems to simplify the process which really takes the pressure off. For those who opt for this method, my advice is to give it up to 3 cycles, and if it doesn’t work, consider charting your fertile signs and timing inseminations that way before moving to IVF, if IVF is not your preference.

What is the best position to insert the syringe into the vaginal canal? How long should someone stay in that position?

For self-insemination, simply elevate your hips on a couple of pillows so that the sample does not flow back out. Insert the syringe into the vagina as far as it will go, and slowly push the plunger. Allow about an hour for all the sperm cells to swim up into your cervix, into the uterus, and to your fallopian tubes to await the release of the egg. You do not need to put your legs up in the air – the sperm cells are not in your legs!

Does an orgasm increase chance of conception? When would be the best time to have an orgasm, before syringe insertion, during insertion, or after?

We don’t have good statistical data on this, but there was a study done many years ago that showed higher conception rates in heterosexual couples when the female partner was “sexually satisfied”. The scientific reasoning here is that orgasm changes the vaginal pH to more closely match the pH of the sperm sample. It also tends to open the cervix, allowing for easier passage of the catheter during IUI. So, I recommend orgasm before insemination, whether you are doing self-insemination or IUI. Some people say that orgasm makes the cervix “pick up” the sperm cells, however, sperm cells swim! They don’t need to be picked up, they just need the presence of fertile cervical fluid to swim in, giving them a pathway to make their way into the uterus and up to the egg.

How many insemination attempts should be performed during each month?

You will want to make sure there are viable sperm cells present when the egg is released. So, if you have been able to narrow down your timing to an accurate 12-hour window, you only need one insemination. However, if you have not charted consistently enough to know for sure, or if your body gives you conflicting signs from month to month, you may want to do two inseminations in order to cover more time.

What makes someone a good candidate for at-home insemination?

It depends on what you mean by at-home insemination. Let me explain.

Anyone can do a self-insemination at home. It is simple: you just draw up the sample in a syringe, insert it into the vagina, and place the sample. However, sperm is expensive, so I highly recommend getting preconception care before inseminating.

You can double your chances of conception per cycle by doing intrauterine insemination (IUI), which can be done by a midwife at home. The availability of this service is surprising to some people, however, IUI is a simple, low tech procedure that can safely be done by a licensed practitioner in the comfort of your home. Not all midwives proved in-home IUI, but more are adding this service all the time.

On average, how many months of trying does it take to get pregnant with at-home insemination?

Studies of people with no known fertility issues using donor sperm to conceive show the highest success rate in the first three cycles. Some data shows an average of four cycles to conceive, with 80% conceiving within 7 cycles. So, all of this means you could get pregnant right away, or it could take 6 months or more. However, if you are not having success, please see a care provider who specializes in fertility, because sperm is expensive and insemination cycles are emotionally taxing – and help is available!

When should I seek help?

I always recommend getting preconception care before you start trying, but preconception care can look very different depending on where you go. Always seek care with a provider who understands what is at stake in donor conception. An approach that includes screening for common causes of infertility, preparing the body for a healthy pregnancy by addressing nutrition and lifestyle factors, and getting the timing right can save you time, money, and heartache in the process of welcoming your child.

If you haven’t had preconception care, it’s never too late to start. And, whether or not you have been in care, I recommend an assessment after 3 months of trying. This may mean doing screening tests you opted not to do before, or it may mean taking a look at your timing. It may mean checking in about self-care and underlying health, which can directly affect your fertility. It may mean a referral to a fertility clinic for more support or starting acupuncture. Or, it may simply mean trying a few more cycles before doing anything differently. The choice is ultimately yours, but your choice should be an informed one. Seeking help does not mean you have failed. It means you are getting information to help you determine your next best steps on your way to becoming a parent.

Liam is a Licensed Midwife and owner of MAIA Midwifery and Fertility Services. Liam has a unique practice here in Seattle, providing in-home inseminations and midwifery care as well as a range of classes and support groups for LGBTQ+ families from conception through pregnancy and new parenthood. Liam also provides preconception care to conceiving families across the U.S. and internationally via telehealth consultations.

You can read more about receiving care at MAIA Midwifery & Fertility Services, download webinars to support your fertility and help you get the timing right, and purchase fertility products at www.maiamidwifery.com. Sign up for a free “Meet the Midwife” consultation to learn more about how Liam can help you make your baby dreams come true!

Want to follow Liam in social media? Find her on Facebook here.