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What is at-home insemination?

An insemination is any time sperm is put into another body, intercourse included. Artificial insemination is when sperm is put into another body without intercourse.

An at-home or home insemination is when this is done outside a clinic. There are a few different ways this can be done, which I’ll get into below.

Why do people choose at-home insemination?

Folks who are using the at home insemination method to get pregnant  have various reasons. Sometimes its personal preference, other times its a medical issue, issues with timing or relating to sexuality. It could be something totally different. Maybe their reproductive organs don’t match up for reproduction (like a couple with two uteruses and no sperm) or they’re experiencing infertility.
No matter the reason, you are here now

People may choose to make the insemination process more personal and less medical by trying to get pregnant at home, avoiding the sterile setting at a clinic where strangers are involved in the intimate process.

In-clinic inseminations also come with extra costs because of the staff and facilities involved, so trying at home can save a significant amount of money.

One woman told me that she liked the increased flexibility of home inseminations as opposed to having doctor’s appointments at certain times that might be hard to schedule around her work hours.

A nonbinary person told me they’d rather try to get pregnant at home than deal with medical professionals’ potential questions, misgendering, and stigma.

In a world changed by COVID-19, home insemination can be the “perfect option,” according to Fredrik Andreasson, CEO of Seattle Sperm Bank.

He said clinics are hearing from clients that they want to continue with their monthly tries at home even when a clinic closes due to being “nonessential.”

For his own bank, Andreasson shares that while requests for sperm shipments to clinics decreased by 50 percent since the COVID-19 outbreak in the United States, their shipments to residences haven’t gone down at all.

Is it as successful at home as at a clinic?

There are two types of artificial insemination that can be done at home:

  1. intracervical insemination (ICI), which involves putting sperm into the vagina, as would happen with intercourse
  2. intrauterine insemination (IUI), which involves putting sperm directly into the uterus using a tube that goes through the cervix

IUI is almost always performed by a medical professional. However, that doesn’t mean IUI can’t happen at home. Some trained midwives make house calls for this procedure.

Regarding success rates of at-home versus clinic insemination success rates, as well as ICI versus IUI, here’s what we know:

  • An older 1988 studyTrusted Source showed no statistical difference in pregnancy rates between 53 infertile women trying artificial insemination at home versus a clinic.
  • A 2001 studyTrusted Source of 62 women over 189 cycles found that IUI had higher monthly success rates than ICI (15 percent versus 9 percent).
  • A 2015 study of 1,843 women found pregnancy rates over six cycles were only slightly higher for IUI (40.5 percent) versus ICI (37.9 percent), with researchers noting “no substantial benefit of IUI over ICI.”
  • A 2017 studyTrusted Source of three different groups of couples (ages 20 to 33 years, 33 to 36 years, and 36 and up) found at home insemination an effective way of achieving pregnancy, with success rates of 69 percent, 43 percent, and 25 percent in the three different groups over six cycles.

The most important factors for success rates are nailing the perfect timing of the insemination, the quality and quantity of the sperm sample, and the age and the hormones in the body being inseminated — not necessarily the building where the insemination happens.

If you like, you can visit with a fertility specialist and ask questions about insemination processes up front. Going to a doctor doesn’t mean you’re automatically signing up for anything or committing to an in-clinic procedure. You’re simply getting the facts, and you can still choose to do the procedure at home.

For many women and couples, their first step toward parenthood with donor sperm is performing a home insemination. Some people find this to be a more comfortable and affordable method of conception compared to starting off in a clinical environment.

This procedure, also known as intracervical insemination or “ICI,” can be an effective option for women with no fertility issues that can complicate their efforts. It involves using a plastic, needle-less syringe to inject the donor sperm into the vagina. The sperm cells can then travel naturally into the uterus and hopefully progress further on to fertilize the egg.

Electing to perform an insemination outside of a doctor’s office allows you to create the atmosphere you want in the comfort and privacy of your own home. It can also save you additional medical costs associated with fertility treatments done by a clinician.

Here we offer a brief overview of how to start your journey with home insemination.

is a patent-pending insemination syringe designed by women specifically for at-home intracervical insemination (ICI). Pregnancy rates with The Cryobaby Kit were found to be comparable or superior to both IUI and timed intercourse pregnancy rates in a comparable clinical study.

The Impregnator

 If The Impregnator Self Insemination Kit  is for you, You are Not Alone!
Infertility affects 6.1 million American couples (approximately 10% of American couples of childbearing age).
There is over 1 million single women, and alternative couples seeking ways to conceive.

Learn how this Revolutionary New Self Insemination Kit is bringing the “Miracle of Life” to women & families everywhere without expensive medical procedures such as IUI, IVF, and hormonal drugs!

The Impregnator™ was designed by a woman to give women a comfortable alternative to the cold clinical feel of hard, sharp plastic syringes and pipettes entering their body. The Impregnator™ simulates a natural feel, shape, and size so women can have a stress free, pleasurable and intimate attempt of conception in the privacy of their own home.

The “fluid retention” design is for the hope that your dreams will blossom into your little bundle of Joy. 

The Impregnator™ is affordable very effective and easy to use by yourself or with your partner so they can be part of this “Miracle of Life”.

It is a well known fact that if a woman achieves orgasm, her chances of conception are dramatically increased. The Impregnator™ can be reused as many times as you need !

The Babymaker Home Conception Device.

The Babymaker is a uniquely designed innovative device you use at home, during ovulation, to assist your chances of becoming pregnant. Our device uses cervical insemination. This smart technique enables the sperm to quickly bypass the vaginal tract and places the sperm as close as possible to the opening of the cervix, right where it needs to be to swim up through.

A recently published clinical study demonstrated that in 85% of subjects, The Babymaker delivered 3.23 times the sperm score value within cervical mucus compared to natural intercourse and … presents a greater concentration of sperm to targeted cervical mucus than natural intercourse.1

Male Infertility Statistics

Struggling with infertility is a complex and nuanced experience. The emotions and thoughts that you deal with during this time can be challenging, especially when you feel like you’re alone in the struggle. Unlike female fertility, extensive research has not been done to measure all of the factors that contribute to male fertility. Add this to our society’s determination to highlight infertility as a solely female problem and it’s no wonder that so many men feel lost when they find out that their body is the one that’s making it hard to conceive a child.

The reality is that many men struggle with infertility, and many do so in silence. One of the best ways to deconstruct the stigma around male infertility is to bring awareness to just how common it is. Not only is it important that we open a dialogue around male fertility but that we use fact-based research to highlight that, despite how you may feel, you’re not alone.

Pulling from various resources, we’ve gathered some data that will help you — and those you love — understand that male infertility is a problem that many people deal with. Once you understand this, we hope that it will be easier to seek male fertility testing  and treatment so you can become a father.

As defined by the World Health Organization, infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”

Here’s a look at some prominent male fertility statistics, grouped by category. https://www.storkotc.com/male-fertility-statistics/


At-Home Hormone Testing

New Hope isn’t the only business selling more convenient, in-home kits. Modern Fertility is a hormonal testing kit that allows you to gain insight into the hormones that effect fertility with a finger prick. The blood sample is collected at home, then the test is shipped back to the company. They then provide customers with a report analyzing their hormone levels.

The pros: Knowledge is power. “I actually tried Modern Fertility at 38, a few months before getting married, and it was a ‘fertility saver,'” says Ann Murray-Dunning, 40, an expectant mom from San Francisco. “I didn’t realize how low my AMH was for my age (.6), and that this meant that my egg reserve was very low for my age. Due to this new knowledge, I sped up the timeline, if you will, and we turned to the pregnancy journey soon after. After some difficulties likely given my low AMH, I am now 18 weeks naturally pregnant with a healthy girl.”

Murray-Dunning says she’s so confident that all women should do tests like Modern Fertility that she bought a kit for her younger sister. “I talk to her about my challenges and suggested she do what I did earlier—test early, so that she has the power of more time and planning,” she notes.

The cons: Due to the nature of their profession, doctors are natural skeptics of any at-home hormone testing. “There are a number of at-home hormone tests. Some are reliable and some are not, but all should be confirmed and interpreted with a medical provider if someone is concerned about an underlying medical condition or if someone is struggling with fertility,” says Emily Jungheim, MD, MSCI, a board certified reproductive endocrinologist and fertility expert at the Women & Infants Center in St. Louis, Missouri. “That’s why we recommend using at-home hormone tests in conjunction with your doctor’s care rather than in lieu of it.”

The cost: Modern Fertility costs $159. Similar tests include EverlyWell (which costs $159 and looks at the hormones that influence normal ovarian function) and Proov (which costs $39.99 and zeros in on the ebb and flow of your progesterone levels).

For many women and couples, their first step toward parenthood with donor sperm is performing a home insemination. Some people find this to be a more comfortable and affordable method of conception compared to starting off in a clinical environment.

This procedure, also known as intracervical insemination or “ICI,” can be an effective option for women with no fertility issues that can complicate their efforts. It involves using a plastic, needle-less syringe to inject the donor sperm into the vagina. The sperm cells can then travel naturally into the uterus and hopefully progress further on to fertilize the egg.

Electing to perform an insemination outside of a doctor’s office allows you to create the atmosphere you want in the comfort and privacy of your own home. It can also save you additional medical costs associated with fertility treatments done by a clinician.

Here we offer a brief overview of how to start your journey with home insemination.

What You Need for Your Home Insemination

First, you’ll need to select a sperm donor and place your order for samples. If you need guidance or have questions about choosing a donor, we encourage you to contact one of our friendly Client Services Coordinators.  We offer free email, telephone, and in-person consultations, free photo matching, and friendly advice from our team of dedicated coordinators, all of whom interact with our donors on a regular basis. Our staff can also help you properly purchase, order, and plan for the storage of your samples.

After deciding on a donor, it’s important to make sure you purchase an ample supply of vials. Since at least one vial is used per insemination, and it typically takes more than one insemination to become pregnant, you’ll want to have enough in storage to cover multiple attempts. It is not uncommon for a donor’s inventory to temporarily sell out, so it’s better to purchase more up front when they are available. If you get pregnant when you still have samples in storage, you can take advantage of our Buy Back Program.

We also have several discount and incentive programs to help make this process more affordable. For instance, when you make a purchase of five vials, you receive one year of free storage, and our Donor of the Month program is buy one vial, get one free. Once you’ve secured your sperm samples, they can be sent directly to your home, picked up from our lab in Seattle, or sent to your physician’s clinic for you to pick up.

Create a Plan with Your Health Care Provider

We always recommend you consult with a medical professional to discuss your detailed medical questions and help you create a customized care plan.

A great person to start with is your primary care physician, gynecologist, naturopath, nurse practitioner, or midwife. They can perform an initial fertility evaluation, which is similar to your annual gynecological exam, to help you decide if home insemination is right for you. They can also advise you on ways to improve your odds of achieving pregnancy as quickly as possible. This evaluation usually takes about an hour and may include a discussion of your current and past health history, your family’s health history, your diet, exercise habits, and menstrual cycle patterns. They may also perform basic lab tests such as pap smear, blood, urine, and thyroid testing.

All of these tests help you and your care provider determine if doing inseminations at home is a safe and practical method based on your overall health and wellness. If you plan to have samples shipped to your home, pick them up from our lab in Seattle, or you live in the state of New York, your care provider will need to complete our Clinical Release Form.

Along with every home insemination purchase, you will receive a free insemination kit. This includes a re-usable foam tray for thawing vials in a water bath, two plastic needle-less syringes per vial, alcohol sterilization wipes, and basic thawing and usage instructions. You can watch a visual demonstration of this process on our videos page.

If you choose to use a lubricant, which can be helpful when inserting the syringe, be sure it’s fertility-friendly because most lubricants will damage live sperm. ProSeed is a popular brand that can be found at most pharmacies.

For more information and guidance, you may want to read Toni Weschler’s Taking Charge of Your Fertility: The Definitive Guide To Natural Birth Control, Pregnancy Achievement, and Reproductive Health. This highly respected book is recommended by many doctors we work with.

How to Schedule Your At-Home Insemination

The timing of your insemination is critical. This procedure is extremely time-sensitive and should be coordinated with your natural ovulation cycle. The goal is to inseminate during your 12 to 24-hour “fertility window.” For most women, this takes place sometime between days 10-15 of their monthly cycle. We recommend using a home ovulation monitor to help you target your most fertile days. It can be helpful to start practicing this a month or two before your first insemination attempt so you can become more aware of your peak ovulation time.

How the Home Insemination Process Works

Once you have your vial(s) at home, bring it up to body temperature (again, instructions for thawing the frozen vials are provided with the kit and are shown in our demonstration video) and be sure to inseminate within one hour. While the sample is getting ready, take time to relax and put your mind at ease. You can meditate, put on soothing music, dim the lights, or do anything else you find comforting.

When everything is ready and in place, lie down on your back with your hips raised up on a pillow or two. Then, you or your partner will gently insert the syringe into your vagina as far as it will go. Try to direct the tip of the syringe as close as possible to the cervix. Gently press the plunger and make sure to empty it completely. Then leave it in position for 10-15 seconds before withdrawing it slowly.

To create an ideal environment for the sperm to travel, we recommend you remain lying down for at least 15-30 minutes following the procedure. You may choose to only inseminate once, or repeat insemination two or three times during your fertile window to increase your chances of conception.

Finally, a note about managing expectations. On average, it takes five cycles for most women to achieve pregnancy. Don’t be discouraged if it doesn’t happen on your first or second try. By following the tips above, you’ll give yourself the best chance of starting a family. All of us here at Seattle Sperm Bank look forward to working with you and we wish you the best on your path to pregnancy!


The medical information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

Please consult your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition. Seattle Sperm Bank expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this article. Seattle Sperm Bank does not endorse specifically any test, treatment, or procedure mentioned on the site.

How to Use Donor Sperm for Home Insemination

What is at home artificial insemination with donor sperm?

Home insemination is an opportunity to attempt to achieve pregnancy in the comfort of one’s home through an intra-cervical insemination (ICI). The sperm sample is drawn into a needle-less syringe, the syringe is inserted into the vagina, and the sperm is expelled onto the cervix. You can use either the ICI or Intrauterine Insemination (IUI) prepped samples for the home ICI.

Is home insemination right for you?

Artificial home insemination using Fairfax Cryobank donor sperm is a great option for those free of fertility issues who want to begin their journey to parenthood in the comfort of their own home. 

Often when couples begin the journey to pregnancy they are told to “try at home” for a period, then explore options with a healthcare provider. At-home insemination with sperm is a way for those without a sperm-providing partner to “try at home” before moving to an in-office procedure with a medical professional.

We do recommend that you discuss your fertility and desire to do at-home insemination with a medical professional who can best discuss the process with you. In some cases, you will need a provider to sign a consent form that acknowledges that in-home insemination is a suitable option for you. 

Home inseminations can also be an affordable option because you can purchase the less expensive Intracervical Insemination (ICI) prep type and will not incur additional in-office fees.

Home inseminations are not right for everyone, but if this is a path you would like to try, please discuss it with your medical provider then contact Fairfax Cryobank for your donor sperm needs.

Below we included some FAQs about Insemination at Home using donor sperm. Although Fairfax Cryobank’s customer service team is well-equipped to help you with any questions you have about home insemination, we encourage you to consult your doctor to create a personalized insemination plan.

Home Insemination with Donor Sperm FAQs

Do I need to work with a doctor to do home insemination with donor sperm?

Fairfax Cryobank recommends that you do consult with a medical provider who can advise you as you begin this journey. You may choose to work with a physician, your gynecologist, or a midwife, whatever choice feels right for you. Before investing in the home insemination process, it is best to ensure that you are healthy and ready for pregnancy. Your provider will assess your overall health and lifestyle, be able to make recommendations to prime your body for pregnancy and may recommend some initial fertility testing depending on your age and medical history.

Starting this journey with a medical provider’s assessment and advice is the best way to ensure that you are making informed and healthy choices.

What are the success rates?

For individuals with no fertility concerns, home insemination success rates are approximately 10-15% per cycle, which is similar to fertilization rates through intercourse. It can take several inseminations attempts to achieve pregnancy. If you are not pregnant after several home insemination attempts, it is best to speak with your medical provider about having a fertility assessment.

How does at-home insemination with donor sperm work?

On the day of your ovulation, you will thaw the frozen sperm sample, following the thaw instructions that accompany the shipment of your donor sperm vial. While the sperm is thawing, you will get everything ready. 

Make sure you have a comfortable space where you feel safe and secure. Put yourself into a positive and relaxed frame of mind and prepare the needleless syringe and a towel or cloth to have on hand if needed. Once the sperm is thawed the person being inseminated will lay down on their back, raising their hips. You can position a cushion beneath your hips for comfort. 

You or a partner will carefully open the sperm vial and draw the sample up into the syringe, insert the syringe into the vagina placing the tip close to the cervix without making contact with the cervix (bumping or scratching the cervix can cause cramping). Gently expel the sperm sample by pushing the plunger, slowly. Remove the syringe and relax. We recommend that you remain laying comfortably for one to two hours, gently switching from your back to your abdomen every 20 minutes to give the sperm the time to swim through the cervix.

Should I inseminate more than once?

You may choose to do multiple inseminations during your “fertile window” in one cycle. This is an individual choice.  

When can I do a home insemination?

Timing is important. The person to be inseminated will track their menstrual cycle and ovulation. 

This can be done with a commercially available ovulation kit which will indicate your fertility window. There is typically a window during which you are most fertile when the ovary is releasing the mature oocyte (egg). This is typically a 12 to 24-hour window and is most often between days 10 and 15 of the menstrual cycle. There is variability so it is best to use a kit to identify this. Your medical provider will be able to answer questions about this and may recommend that you track your cycle for several months before starting home inseminations.

What do I need for home insemination?

First, consult with your medical provider to ensure that this option is appropriate for you. Once you have identified your donor and have decided to move forward, we recommend that you identify and create a comfortable and soothing environment for your at-home insemination. It is best to reduce stress and increase comfort when trying to achieve pregnancy. Once you settle on the space, all that is needed is the individual being inseminated, the sperm, and a syringe. Fairfax Cryobank will provide instructions for the thaw and insemination when you purchase and ship the donor sperm and we will include a syringe that you can choose to use for this purpose if you would like.  

Choosing a donor is an important step in the process. Click here for more information on how to pick the perfect donor for your at-home insemination. You can also contact our talented customer service team for more advice on picking your donor. If you have the means, it is best to purchase several vials to ensure you have enough donor sperm for the number of inseminations you will need to achieve pregnancy. By purchasing several vials, you are putting you and your future family in the best position to create a family.

Learn more about our storage options here.

What is needed to order sperm for home insemination?

Once you have chosen your sperm donor, you can plan to use 1 ICI or IUI preparation vial/insemination, home consent, etc. Please call or chat to speak directly with a Client Service Specialist for additional information, so that we can further assist you with a residential delivery.

Home Insemination (Artificial insemination) versus IUI

Home insemination refers to the process of inserting ejaculate into the vagina, close to the cervix, using a needleless syringe. This is commonly known as intracervical insemination (ICI). On the other hand, intrauterine insemination (IUI) involves a speculum and the placement of sperm directly into the uterine cavity instead of the vaginal canal.

How to Order Donor Sperm for Home Insemination

What does artificial insemination cost?

The cost will include the cost of the sperm and the shipping/handling fees. Fairfax Cryobank will provide you with a syringe at no cost.

Home Delivery: What’s Needed?

Please call or chat to speak with a Client Service Specialist and we will work with you to ship your donor semen to your residence for your procedure.

What is intrauterine insemination?

Intrauterine insemination is also known as artificial insemination or IUI. Human artificial insemination with another person’s sperm began being used in the 1940s. The IUI procedure can be an effective treatment for some causes of infertility or being used for other reasons such as in some LGBTQ pregnancies and/or when a partner producing sperm is unavailable. AI is usually done by a doctor, but there are alternative ways to do DIY artificial insemination at home.

How can I try artificial insemination at home?

The Turkey Baster Method is the most common way of artificial insemination to get pregnant via artificial insemination at home. More often than not you do NOT actually use a turkey baster but instead, a disposable syringe.

What supplies do I need?

You need the following supplies for artificial insemination at home:

  1. A needleless syringe or oral medicine syringe (instead of the turkey baster)
  2. Collection cup, baggy or condom
  3. Saline without additives or preservatives (optional)
  4. Tube to attach to a syringe (optional)
  5. Mild germicidal soap (optional)

You can ask your doctor for a needleless syringe or you can buy an oral medicine syringe at just about any pharmacy. Select a 4-inch syringe with a plunger, not a bulb end. The oral medicine syringes have about a half-inch narrow tip on the end. You can attach a catheter (thin tube) to the syringe but you don’t need to and it may waste more of the semen to use one.



Step-by-step instructions

1. Take a clean or sterile glass or plastic cup, baggy, or collection condom and have the male ejaculate into it. Do NOT use a regular condom because it may contain chemicals that kill sperm. There are special collection condoms for this purpose that do not have sperm-killing chemicals.

You’ll probably have better luck getting the semen out of a cup since you could suck the baggy or condom up to the syringe and block the opening, but you may get a larger sample with the baggy or the special collection condom. You can use a tiny bit of saline, without additives/preservatives, to help get as much sperm as possible into the syringe, but you don’t need to worry too much about leaving a little behind. If you are using frozen sperm, you need to ask the sperm bank for directions on thawing.

2. Draw back on the syringe once with nothing but air, then push the air out again.

3. Draw back on the syringe again, but this time keep the end of it in the semen — the vacuum created by pulling back on the stopper will suck the semen into the syringe.

4. Try to tap out any air bubbles since you don’t want to inject air into your vagina. You can do this by slowly rotating the syringe until the opening is facing up. Tap the air bubbles to the top and then push the plunger in on the catheter just a small amount — enough to get rid of air without squirting any semen out.



5. Get into a position where you can stay comfortably for a half-hour or can get into the position with minimal movement. It is ideal to either have hips raised or to lay on your side making sure your pelvis is canted (usually hips provide a natural angle if your hips are wider than your waist, but if your bed, or wherever you are lying, is soft, you may want to put a pillow or two underneath your hip).

6. Slowly glide the syringe, or catheter, into the vagina until it is close to the cervix — but do not try to get it into the cervix, and do this gently. Your goal is to coat the outside of the cervix and deposit as much sperm as possible as close to the cervix as you can get it.

7. SLOWLY inject sperm. If you do it too fast, it can squirt out of the vagina or at least spray away from the cervix.

8. If you are concerned about wastage in the syringe, you can use some saline, without additives . . . add some to the syringe, shake it a bit, get the air out, and inject. This is not necessary since there probably won’t be enough wastage to be of concern.

9. Try to have an orgasm. Some suggest that using a vibrator for clitoral stimulation produces a bigger, more powerful orgasm. Use whatever method works best for you (unless it requires lots of water). The orgasm helps the cervix dip into the vaginal pool and suck up sperm — it helps get more sperm up there, and may speed sperm travel. Avoid penetration (intercourse or with a vibrator). 

10. It’s best to use the equipment only once and then discard it to prevent contamination. Otherwise, you can use water and mild germicidal soap to clean your supplies if they will have time to dry completely before re-use or run very hot water over them. 



When is the best time to try at-home artificial insemination?

The timing for this kind of artificial insemination at home is the same as for intercourse. The best timing is the day of ovulation and the 2-3 days before ovulation. If you use an ovulation predictor kit then it’s the day of the LH surge, the day before the LH surge (as detected with an ovulation predictor kit), and the next 1-2 days, the last day or two being insurance. If you don’t have all those options, the day of the LH surge and the day after are the best.

The advantage of this method is that you don’t need any fitted equipment. You don’t even need a speculum (though you can use one).

The success rate is the same as with intercourse, perhaps a bit less because there are usually fewer opportunities for insemination and timing may not cover the bases as well.

Getting Pregnant: Pre-Pregnancy and Fertility Guide

There is a lot of education in school about how to not get pregnant, but there are no school courses teaching you how to get pregnant. If your goal is to get pregnant faster, you can take some important steps to improve your chances. You should start by answering the question: Am I fertile? and learn how to improve your fertility.

Infertility Guide: Why Can’t We Get Pregnant?

Infertility is on the rise. About 1 in 5-6 couples trying to get pregnant are not successful. 1/3 are due to male causes, 1/3 are female causes, and 1/3 both have issues or are unexplained. There are 3 major reasons why infertility is on the rise: 1. Having babies at a later age 2. The environment is changing 3. Our lifestyles have been dramatically changing.

Good Eggs and Bad Eggs: Ovarian Reserve Testing

What is ovarian reserve testing?

Ovarian reserve testing checks a woman’s eggs and her ability to become pregnant. Ovarian reserve testing is the true “fertility test”, in addition to his sperm analysis and checking the patency of her fallopian tubes,  to check if she can get pregnant or not.  Ovarian reserve testing usually consists of: 

  1. Several blood tests: Anti-mullerian hormone or AMH, follicle-stimulating hormone or FSH, estradiol (E2), Follicle-stimulating hormone (FSH), inhibin B, clomiphene citrate challenge test, gonadotropin-releasing hormone agonist stimulation test.
  2. A sonogram to check the ovaries (antral follicle count), and ovarian volume, ovarian vascularity.

The bottom line of ovarian reserve tests

  • Regardless of the results of ovarian reserve testing, attempting conception or pursuing fertility preservation at a younger age (in particular, at <35 years of age) is associated with better outcomes.
  • Ovarian reserve tests predict ovarian response during IVF. Only to a far lesser extent, they might predict birth outcomes from IVF. These tests have not, however, been shown to predict spontaneous pregnancy without IVF.
  • Ovarian reserve tests should be administered for those situations listed below. Counseling beforehand regarding their limitations is suggested.
  • Abnormal ovarian reserve test results do not necessitate IVF or other assisted reproductive methods. They may prompt a patient to accelerate her reproductive timeline and consult with a reproductive endocrinologist to consider her age and health-related risks of infertility or pregnancy loss.



Who needs ovarian reserve testing?

The following are candidates for ovarian reserve testing:

  1. Family history of early menopause (under 46 years of age)
  2. Before assisted reproductive technology (ART eg insemination, IVF)
  3. High risk of diminished ovarian reserve (eg chemotherapy, prior adnexal surgery, smoker)
  4. Infertility
  5. Certain medical conditions associated with diminished ovarian reserve:
  6. Ovulation issues: Anovulation or oligo-ovulation
  7. Women interested in fertility preservation 

Measuring egg quality

Egg quality cannot be determined by looking at the egg, measuring its receptiveness to fertilization, or observing the initial embryo division. Just because an embryo looks good in the lab, doesn’t mean that it will implant.

However, some of the contributing factors leading to embryo implantation failure are:

  1. Diminished Ovarian Reserve
  2. Advanced Maternal Age
  3. Diminished Egg Quality

Almost one in ten women who come in for infertility evaluation has such poor ovarian function that they are extremely unlikely to get pregnant. At the current time, this problem cannot be fixed. Therefore, a thorough assessment of egg quality through ovarian reserve testing is the most important fertility test that a physician does.

Women have all the eggs they are ever going to have in their lives before they are born. By the time of birth, the ovarian reserve — the number of remaining eggs stored in the follicles — has already decreased dramatically. For the rest of her life, ongoing follicular depletion will reduce the number of eggs remaining in the ovaries. In fact, far more eggs will be lost by degeneration than are lost by ovulation.

Testing of the ovarian reserve may also give you an idea of your reproductive lifespan and timing of menopause, as well as diagnose PCOS. Women who are on birth control (and therefore not really ovulating) are told to go off birth control for several months before the test.

Ovarian reserve testing is not the same thing as testing for ovulation. A woman can ovulate normally and have very regular menstrual cycles and still have a low probability of becoming pregnant.

Tests of ovarian reserve are only predictive of fertility when they come back abnormal. A normal test does not mean that the ovaries work well. It just means that no test has yet demonstrated that they work poorly. These tests do not find all women with poorly functioning ovaries.



How ovarian reserve testing works

A test to check your ovarian reserve usually involves a vaginal ultrasound and blood tests to measure hormone levels, which must be conducted when a woman is menstruating (usually cycle day 3).

Between the ultrasound and blood tests, a doctor can determine how many eggs you might be able to grow in one round with the help of hormones. While a 21-year-old woman might grow 30 to 40 eggs in one round, by age 40, that number drops to six or eight eggs. The older you get, the harder it becomes to produce eggs.

Bear in mind that having a low ovarian reserve now does not necessarily predict your pregnancy chances for the future; it simply predicts how many eggs you can grow now. Some women may have a low ovarian reserve but then conceive naturally.

Follicle-stimulating hormone test

The FSH or follicle-stimulating hormone test is done on cycle day 3. If you have elevated FSH levels on cycle day 3 you likely have diminished “ovarian reserve,” which means the ovary is producing less feedback signal to the pituitary gland, and the body responds by making more FSH in an effort to stimulate the ovary.

Women with elevated FSH levels have markedly decreased egg quality and rarely conceive with their own eggs (they do, however, become pregnant readily with donor eggs). The precise physiological reason for this is unclear. However, we do know that when eggs are obtained from women with elevated FSH levels, they appear normal, they fertilize normally, and undergo initial embryonic cleavage at a normal rate. However, they rarely divide beyond the 8 cell stage and almost never implant.

Anti-mullerian hormone levels

A newer test to check ovarian reserve is the anti-mullerian hormone or AMH test. This hormone is secreted by cells in developing egg sacs (follicles). The level of AMH in the blood is generally a good indicator of ovarian reserve. 

Women have all the eggs they are ever going to have in their lives before they are born. An AMH test gives us some insight into the remaining quantity of eggs and the number of fertile years you may have, but it cannot tell us much about the quality of those eggs. AMH does not change during your menstrual cycle, so the blood sample can be taken at any time of the month — even while you are using oral contraception.



Antral follicle count test

This test involves a sonogram (ultrasound) test. Your doctor counts the number of 2-9 mm diameter antral follicles that can be seen with transvaginal ultrasound which gives a good idea about a woman’s ovarian reserve.

Are normal results reassuring?

Normal test results do not necessarily mean that a woman will have an easy time conceiving. Or that she will have no problems in the future. It only provides information at the time of testing. Normal findings on ovarian reserve testing suggest that a woman might have a normal (that is, commensurate with age-matched peers) number of eggs in her ovaries.  Similarly, abnormal results do not mean that she will have difficulty conceiving.

Do abnormal results mean the IVF is needed?

No. Individual results mean different things for different people and situations. A consultation with a fertility specialist is needed to find out what to do next.

The American Society for Reproductive Medicine states, “evidence of [diminished ovarian reserve] does not necessarily equate with the inability to conceive” and  “there is insufficient evidence to recommend that any ovarian reserve test now available should be used as a sole criterion for the use of ART.”

In a published study of 750 women attempting pregnancy, women with a low AMH level (<0.7 ng/mL) or high FSH level (>10 mIU/mL), or both, did not have a significantly lower likelihood of achieving spontaneous pregnancy within 1 year, compared with women with normal results of ovarian reserve testing.

I am not ready to get pregnant now. Should I freeze my eggs? 

If you are interested in seeking fertility preservation and ART, earlier referral to a reproductive specialist to discuss risks and benefits of oocyte or embryo cryopreservation is always preferable. The younger a woman is when she undergoes fertility preservation, the better. Among women planning to delay conception, each one’s decision is driven by her personal calculations of the cost, risk, and benefit of egg or embryo freezing—a picture of which ovarian reserve testing is only one piece.

Advanced maternal age

Even if FSH levels are normal, the age of the woman providing the eggs plays a major role in determining egg quality. Just as with women with elevated FSH levels, eggs obtained from women in their late 40’s appear normal, fertilize normally, and undergo initial embryonic cleavage in a normal manner. However, such embryos almost never implant. Because of low implantation rates in women over 45 years old, normal FSH levels are not considered “reassuring.”


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