Families Worth Planning

917

Fertility management requires a good understanding of not only the medical needs of the patient, but also the emotional aspect of the journey. It can be frustrating and time-consuming, so it is important to find a physician who takes the time to explain the process and answer all the questions. Though it requires a lot of dedication from both the patient and the physician, the end result may be well worth the effort.

Single women and same-sex couples who decide they want to conceive are encouraged to explore the many options they have for starting a family. A woman who is interested first schedules an initial consultation. At this time, the physician will conduct a thorough medical history and any lab work or radiology deemed necessary. Some women may need medication to encourage ovulation, and the lab work will help determine if this is necessary. The initial consultation is an important opportunity for the patient to discuss goals and expectations. At the same time, sperm donation and ovulation prediction are reviewed. Since most insurance does not cover these services, actual fees may vary.

A woman may choose to use either sperm from a known donor (often a close friend or her partner’s relative) or sperm from a sperm bank. Each option carries advantages and disadvantages. Using sperm from a known donor can have  certain legal implications, so it is wise for the woman to consult with an attorney. The sperm from a known donor can also carry certain risks for sexually transmit- ted diseases (STDs). Undergoing STD tests can reduce the risk, but certain diseases are latent for up to six months, so the risk cannot be totally eliminated until the donor has a negative result after that time. All donors at sperm banks are tested for STDs after six months. Sperm banks can offer anonymity of the donor, which some women prefer, while other women prefer to have a personal con- nection with the donor. There are many additional factors to consider, and it is important for patients to understand all their options.

At the initial consultation, the woman is provided with information about how to chart her cycle so that the maximal date for conception can be determined. The clinic will offer guidance on taking daily basal body temperatures, over-the- counter ovulation prediction kits, and self-evaluation of cervical mucus.

Once the likely ovulation is deter- mined, the patient sets up an appointment for insemination. If the sperm is to come from a sperm bank, most clinics will provide logistical assistance on finding an agency, but the patient is responsible for actually selecting the donor and arranging for her selection to be shipped to the clinic. If a woman is using a known donor, she will arrange for the specimen to be brought to the office for preparation in anticipation of her appointment.

Intrauterine insemination is the most common type of insemination performed. Most women choose this method because it tends to have a higher success rate and they want to maximize their chances of getting pregnant. However, a woman may also choose intracervical insemination. Depending on the circumstances, it may allow a partner to be more involved in the process of getting pregnant, and some same-sex couples choose it for that reason. After the insemination takes place, the woman is tilted with her head down for about 15 minutes. The woman is advised to take a home pregnancy test if she has not had a period within 21 days.

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