The Appointment – What it Feels Like to be Inseminated

I woke up the day of our big appointment full of excitement, but also full of disbelief that we were actually going to do this.  Today.  Like, for real.  At the same time, I was hesitant to let myself get too excited, so I brushed off those feelings and tried to just focus on getting ready for our big trip.

I had been pretty calm, cool and collected (maybe my wife’s personality is rubbing off on me) for the past couple of days, and my current excitement was definitely at odds with my desire to be calm and level-headed about the whole thing.  Over the past few days I had received so many well wishes and questions about how I was doing, and I was never really sure how to respond.  I suppose most people would have expected me to be incredibly excited, but I was feeling more reserved and almost apprehensive about the situation because the outcome was so variable.  Believe it or not, IUI only has about a 20% chance of working the first try (which is about the same success rate as the old fashioned way), which to me meant that there was an 80% chance that it wouldn’t work.  I saw this appointment as yet another stepping stone in our journey.  A stepping stone that could easily disappear or just continue to move further and further away, if things didn’t go according to our plan.

I know, I’m a big downer.  But if you prepare for the worst, then nothing can disappoint you, right?

We jumped into the car and got my last coffee from Starbucks (a delicious latte with almond milk!) and made the familiar 2 hour trip to Saskatoon.  My feelings cycled between nervousness and excitement during the whole trip, as I tried to wrap my mind around what was happening.  I could tell my wife was also excited and nervous, because she was acting just a bit sillier than normal.  Upon arrival at the clinic, we paid our $350 clinic fee (cha ching!) and our $100 storage/admin fee (cha ching!) and sat in the waiting room.  The nurse let us know that our sperm was being thawed, which would take about half an hour, and that we would be taken into the office shortly.  Tired from my erratic feelings, I rested my head on my wife’s shoulder and watched some TV while we waited.

As I was just getting into “The View”, the woman sitting next to us in the waiting room started talking to us.  She was very pleasant, about our age, and just casually offered us her brother’s sperm.  Yep, you read that right.

Seriously.  I could not make this stuff up.

We were initially a little taken aback (you know, with her being a complete stranger and all), but to be fair, it’s not the first time that we have received an offer like that.  When some of our male friends found out we were trying, we got offered sperm by the bucketful (usually as a joke, but not all the time).  But we’ve never received an offer from someone we didn’t even know!  She was very friendly (if clearly a little nosey) and also prefaced her offer by saying she could just mind her own business, if we found her request insulting in some way.  We just chuckled, thanked her sincerely for her offer and let her know we had already picked a donor.  We continued a bit of polite conversation and my wife mused on how that conversation with her brother might go.

Some people may have found this offer offensive, but I actually found it rather encouraging.  I’m sure it took a lot of courage for her to even strike up a conversation with us, let alone make the offer that she did.  So to us, a total stranger offering to help us (a clearly gay couple) start a family was a beautiful sign of support and compassion.  It really warmed my ovaries to see such a genuine gesture from a complete stranger.

We were called into the office by a nurse, who instructed me to take off my clothes from the waist down and lay on the table.  As I was getting ready, my anxiety and excitement came flooding through my calm and collected barricade and everything started to feel very real .  What if this actually works?!  What if it doesn’t work?

The nurse came back into the room and started up the pleasant type of conversation that medical professionals start when they are about to touch you in a very private area.  She was asking us about our jobs, as she told me to scooch my butt to the edge of the bed and put my legs up into the stirrups (a la Pap test, for those familiar with that lovely procedure).  She continued making small talk as she drew the sperm sample up into a pipette with a long cannula (thin tube) attached to it.  She warmed the speculum under the tap, lubed it up and let me know she was going to insert it.  Seeing my discomfort, my wife came to my side and put her hand on my shoulder.  I heard the familiar clicking of the speculum as she expanded it to access my cervix.  She then inserted the cannula into my uterus, squeezed in the sperm, removed the speculum and we were done.

That’s it?!  We drove 2 hours for that?!  As my sister-in-law so eloquently put it, “What were you expecting?  Streamers!?”

The nurse told me to lay flat for 15 minutes, then I could put my clothes on and we were free to go.  Our fertility doctor popped in a couple of minutes later and let us know that the thaw went well, there were 40 million sperm in the sample and that everything looked great.  It was hard to believe there were 40 million of those little swimmers, just paddling their way through my uterus.  Surely that would be enough.  While we waited, my wife and I debated whether we should have a little nookie.  We had heard anecdotally that orgasm can really help draw the sperm up into the uterus and fallopian tubes, and we wanted to increase our chances of conceiving as much as possible.  It appears that the research is split on whether it actually increases pregnancy rates or not, but it can’t hurt, right?  Anyway, I was far too shy, so unfortunately you guys won’t get to hear the titillating details of a medical office romp.  According to this interesting article, there is a little bit of research to support higher sperm retention and motility towards the ovary following female orgasm.  If there is a next time, we may have to give it a try…for scientific purposes of course.

I was given a requisition for blood work to check my hCG levels two weeks from that day.  The lab would deliver the results that same day to the clinic, and the clinic would then call me with some very good news or some very disappointing news.  If it was good news, then I would go for one more blood test 2-4 days after, just to ensure hCG levels were progressing normally.  And if it was the news I was dreading, I would just call them on day 1 of my cycle and start this whole process all over again.

I put my clothes back on and waddled my way carefully out of the clinic down to the car.  I know it’s silly, but I really felt like the sperm were going to fall right out!  We spent good money on those babies, so I wasn’t about to let them get away!  I spent the next few hours moving cautiously, raising my hips when I could and crossing my legs with much more force than was necessary.  My wife just laughed at me, and rightly so, I’m sure I looked ridiculous.  When we got home, we relaxed in bed (with my hips up on a pillow, of course) and cheered on my left ovary to do it’s thing.

Over the next few days, I was hyper-aware of anything going on “down there”.  Any little flutter in my lower abdomen or tiny cramp convinced me that it was the beginnings of a baby…until I realized it was actually just gas.  I knew that it was too early for anything to really be happening, but my anticipation really got the better of me.  I was torn between wanting this so badly, and knowing that it probably wasn’t going to work the first round.

The next step was just to wait.  We had to wait 14 long, grueling days until we could find out if we had made a baby or not.  We’re pretty good at waiting by now, but it felt like there was a constant battle between my mind and my heart, optimism and negativity, hope and reality.  During the next couple of weeks, I found myself frequently putting my hands on my lower belly and just sending as much love as I could to everything that was going on down there, hoping that it would be enough.

-K

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The Pick – Finding Our Dream Sperm Donor

Now that we knew the direction we were headed, it was time for the fun part: sperm shopping!  To be honest, we weren’t really sure what to expect from the whole experience.  Was it just like a big Sears catalog or something?

Actually, yeah, that’s pretty much exactly what it’s like.

There were three sperm banks that were recommended to us by our fertility doctor: Repromed, Fairfax and Outreach Health Services.  Our doctor had said that all the sperm banks have fairly comparable prices (higher prices were for extended genetic testing and “open” donors who were willing to be contacted in the future) and the quality and testing of the sperm is all federally regulated. So, we just started browsing through the different catalogs to see what exactly this process was about.  Everyone I talk to about this always wants to know: what do you get to know about the donors?  Are there pictures?!

You get to know pretty much everything you could know about a person, without actually meeting them.  And yes, we get to see some pictures too!

The Repromed sperm bank, for example, shows the race, maternal and paternal ethnic ancestry, blood type, hair colour, eye colour, skin tone, height, weight, bone size, education, occupation, interests, CMV status, if the donor is open to future contact (or not) and donor portfolio (which includes more details on family history, personality and some pictures of the donor’s eyes/ears/hair/lips/body type and a blurred out photo of the donor, to protect privacy).  And then, if that’s not enough, there is the option to upgrade (for an extra fee, of course) to see extended donor profiles that include a temperament report, donor essay explaining why they wanted to donate, audio recording of an interview, donor likeness photographs and staff impressions.  The other sperm banks had a similar set-up with the bulk of the donor information available on their website (sometimes you needed to create a login to view the profiles) and then additional information available at an extra cost.  The American sperm banks even let us see pictures of the donor from childhood into adulthood!  It was just like Facebook!

We began this whole process knowing very generally what we were looking for in a donor: some post-secondary education (both my wife and I have a couple of degrees and we value education very highly), overall good health, good family history, creative and somewhat talented in the arts (both of us love music!), intelligent and active.  So, basically the perfect man.  Should be easy enough to find, right?

I sometimes get overwhelmed picking a movie on Netflix (that’s now my wife’s job, thank goodness), so to preserve my sanity we started with some criteria that were easy to narrow down.  After coming up with a “short list” of donors, we could then move on to the other aspects of the donor.  As we quickly discovered, it didn’t take much time to get bogged down in the various personality traits and specifics of each donor.  To us, the easiest criteria to narrow down was the Rh factor and CMV status (more on this below!), since they were a simple “positive” or “negative”.  Making a baby never sounded so romantic, right?  Rh and CMV aren’t often considered when a straight couple decides to start trying to have a baby.  In fact, I know lots of people that don’t even know their own blood type, let alone the blood type of their partner that they are trying to get pregnant with!  At around $800 (or more) a pop, we figured we would go for perfection and pick our dream donor.

Rh factor (short for “Rhesus factor”) is a protein present on the surface of red blood cells.  This protein can be present or absent in people, which is where the “positive” and “negative” comes from when talking about blood type.  I have O negative blood, which means I have O type blood and no Rh factor present on my red blood cells.  According to Canadian Blood Services, only about 15% of Canadians are Rh negative (with similar statistics around the world).  This means that our choices for an Rh negative donor will be quite significantly limited.

So, what’s the big deal?  Why does that matter when picking a sperm donor?

Well, that’s where it gets a bit complicated.  Obviously, an Rh positive and Rh negative couple can still have a baby (otherwise our population would be a whole lot smaller!), but the complications come when the baby is Rh positive and the mother is Rh negative.  This is called an Rh incompatibility.  If the mother is exposed to the fetal blood (normally the placenta prevents mixing of maternal and fetal blood) through trauma, amniocentesis or bleeding during pregnancy, then the mother will create Rh antibodies.  These antibodies are designed to damage Rh proteins and can cause problems in future pregnancies, if future babies are also Rh positive.  The maternal antibodies can damage the baby’s red blood cells and result in severe anemia (very low hemoglobin).  Confused yet?  If you’re nerdy like me, this is a nice FAQ page from the American College of Obstetricians and  Gynecologists about Rh incompatibility.  There is treatment in the form of an injection that mothers can receive to prevent formation of these Rh antibodies that is given in the seventh month of pregnancy and after delivery.  Our fertility doctor told us that it’s not the end of the world if our dream donor happens to be Rh positive, but it would just mean having those injections and slightly higher risk than finding an Rh negative donor.

I promise we’ll stop with the biology lesson soon, but one more thing!  CMV status.  Cytomegalovirus (CMV) is a fairly common virus that does not present with symptoms in people with healthy immune systems.  It can be problematic in people with weakened immune systems, as well as babies who are infected before they are born (this is called congenital CMV).  Congenital CMV can cause premature birth, lung/liver/spleen problems, small size at birth, among other symptoms.  There is a very, very low chance of transmitting CMV through a sperm sample, but the risk is not zero.  Therefore, it is worth considering when selecting a donor.

Now that we had our short list of Rh negative and CMV negative donors, we narrowed down based on our other criteria.  We were left with about 5 donors.  All had good education, good family history and positive personality traits like confidence and creativity.  On paper, they were all perfect men with glowing DNA.  So, where do we go from here?

After some discussion, we decided that we wanted to find a donor that was very similar to my wife.  It was important to both of us that she feel connected with the baby, so finding a donor that shared some of her key personality traits and interests seemed like a good place to start.  My wife is delightfully dorky (in a Battlestar Galactica kind of way) and she is very talented with all things math related.  Her intelligence makes me swoon and her nerdy comments make me roll my eyes on a regular basis.  Picking a donor that was similar to her, would be as close as we could get to have a baby that shared both of our DNA.

With this in mind, we narrowed our short list down to our dream donor.  He had a bachelor’s degree and works with computers (nerd factor: check!), blonde hair and blue eyes (just like my wife!), he enjoys theatre and acting (artsy factor: check!) and was open to the child contacting him in the future.  On that note, we had some debate around whether we wanted an open donor or not.  I felt very strongly that we should give our child the oppourtunity to reach out and contact him in the future.  We can’t predict what will be important to our child, and I wouldn’t want to regret having closed that door forever.

At the end of the weekend (we spent two days making our decision) we came to the realization that as much as we try and control the variables, the nature of creating a child is that DNA is all random anyway!  We can’t predict if our kid is going to end up with my brown eyes or our donor’s blue eyes.  But any way our child turns out, he or she will be so, so loved.  And that is what’s really important.

-K

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The Decision – Known Donor versus Anonymous Donor

My head was still spinning from the consultation that we had that morning, as my wife and I settled into bed (where we do most of our important things) and cracked open our respective laptops.  For the next few hours we researched and read and hypothesized and discussed and freaked out (well, I did anyway, thank goodness my other half is always cool as a cucumber) about how we were going to get a baby in my belly.

Now, we didn’t want to ignore the recommendation of our fertility doctor, but we did want to see what other options were out there before deciding to spend $2000 a month on IUI treatments (cha ching!).  Also, being the modern day hippy that I am, conceiving in a sterile clinic environment seemed very…sterile.  Not really a thought that gets my uterus going, ya know?  We had always jokingly tossed around the idea of finding a friend and just getting them to, you know…ahem…and then letting a turkey baster do the rest!  We weren’t really sure about the viability of this option (or why everyone insists on using a turkey baster), given the obvious legal issues, but we still wanted to explore options fully before we committed.

It seemed to us that we had two options to get pregnant: (1) a known sperm donor (and turkey baster); or (2) IUI with an anonymous sperm donor at the clinic.

Now, before we dive into the legalities of known donors and turkey basters (seriously, has anyone ever actually used a turkey baster?!), there is a really important question to be answered: how do you tactfully ask for a dude’s sperm?  Well, if you’re like me, you just have a couple of beers and bring it up jokingly in a conversation with your guy of choice and just see what happens!  That way if things get awkward you can just laugh it off and not make your friendship weird forever.  Chandler and Monica had a slightly different approach to this situation.  Despite my lack of conversational grace, we did receive a couple of offers from male friends who were happy to help us become parents.  This made us really hopeful that we could make this more natural and economical method of baby-making work for us.  That was until we saw the other side of having a known donor.

We started delving more into this topic by simply Googling “known sperm donor” and every variation of that phrase that we could think of.  Surely lots of lesbian couples before us have considered this option and there would be plenty of resources for us to follow in their footsteps, right?

Wrong.

The lack of information out there about known sperm donor law was pretty disappointing.  Actually, the deeper we searched, the less we felt sure of anything regarding both LGBT and fertility law.  Our main concerns were: (1) ensuring equal parental rights for my wife; and (2) ensuring that the known donor could not try to claim parentage in the future.  As we sifted through news stories and blogs, we found quite a few alarming stories of lesbian couples who had their known donor change their mind and try to claim parentage of the child after the birth.  I couldn’t imagine a more devastating situation.  Unfortunately, in most of the circumstances, these couples had not done their due diligence and had a known donor agreement (here is an example contract) in place and also had not consulted a lawyer.  My heart broke for these families who had trusted a friend, only to be betrayed in the worst way.  Clearly, the birth of a child can have a profound and unpredictable impact on everyone involved and not always for the better.

So, as long as we had a known donor contract and a legal consultation, we were good to go, right?

Wrong again.

Apparently, there is very little legal precedent for cases of lesbian couples using known sperm donors in Canada, though there are a few cases that have come up in the States.  That means that even with the legalities in place, it still may be possible for a known donor to try and claim parentage.  Regulations on parentage are by province.  Alberta and BC have made some laws that prevent sperm donors from trying to be parents, but the rest of the country is really falling behind in LGBT parentage legislation (this is a decent article from June 2016 with more details).  Ontario updated legislation (for the first time since 1978!) in November of 2016, to be enforced starting January 1, 2017 that ensures equal parentage rights for LGBTQ2+ and straight couples alike (a quick overview on this law is here).  I guess late progress is better than no progress?  Regardless, we weren’t confident in our rights here in Saskatchewan and didn’t really know where to go to clarify the law.  We did email a fertility lawyer in Regina, but never got a response.

A billion articles and websites later, our eyes slowly began to glaze over and our hearts sank a little as we realized that either way we went, this was not going to be a simple process.  From what we could surmise from the piecemeal information on parental rights for LGBT couples in Canada, it appeared that we would need a known sperm donor contract drawn up with a fertility lawyer.  Following birth, my wife would need to declare parentage either through a legal declaration or a second parent adoption.  Both of these options would come with decent lawyer’s fees, though we weren’t sure how much.  Given the lack of precedent, there was still a slim chance that there could be legal complications down the road.  We really did not want to take that chance, never mind that the lawyers fees could potentially be far more than the price of IUI.

Whew…ya’ll still with me here?

That leaves us with the intrauterine insemination procedure recommended by the fertility clinic.  The pros of this option include: full parental rights (with no chance of the donor changing his mind and trying to claim parental rights of our child in the future) and safe sperm that had been washed of any STIs and genetically tested.   An added bonus of this option was also the opportunity to choose exactly the donor we wanted, from blood type to eye colour to whether or not the donor allowed contact with children in the future.  The cons of this option include: conceiving in a clinic environment, paying approximately $2000 per cycle (cha ching!) and having to do a bunch of travelling and taking time off work for various appointments (which is peanuts in the grand scheme of things, but still not ideal for us).  Overall, this was the most straight forward and legal option.  We seemed to be leaning in this direction, but our only hesitation was the price and inconvenience.  We were hoping that the cost would be a bit lower, or that there may be a home option.  Turns out there is an at-home IUI option (through the Repromed Sperm Bank…more on this later!), but it’s twice as expensive as in-clinic IUI because you have to use two vials of sperm each cycle!  Ain’t nobody got money for that…well, at least we don’t.

Needless to say, we were overwhelmed at the reality of the situation.  The other day, I had a patient ask if I had children and I told him cheerfully that I didn’t have kids yet, but we were planning to have one soon.  He told me that trying was the fun part.  If only he knew.

After watching too many episodes of Friends and eating some pizza in bed, we finally made our decision: we were going to go the IUI route.

This option afforded us the most security and parental rights, which was very important to us.  It was a relief to finally have decided that going through the fertility clinic would be the best option for us.  I think every couple is unique in what is important to them, and for us the biggest deciding factor was guaranteeing our parental rights and ensuring the safety of the sperm sample.  Fortunately for us, we have been saving for a couple of years knowing that we weren’t going to be able to have babies the “old fashioned way”, so the cost is not as big of a burden as it may be for other couples.  That being said, we don’t have an endless supply of cash, so if IUI doesn’t work within a few cycles then we may be back to the drawing board again.

Now on to the next step: picking a sperm donor.

As a side note, I could not imagine navigating this process with anyone other than my lovely wife.  She makes me laugh and reminds me to not take anything in life too seriously.  I’m so lucky that I will get to raise a child with this woman.

-K

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