Technologies of all kinds have advanced dramatically since propeller planes were common, phones had cords and pop music came on vinyl records. Improvements also have brought assisted conception into a new era of convenience, flexibility and efficiency.
Just as in many other fields, the principles of assisted reproductive technology remain unchanged – while new materials and methods simplify the steps. That makes a huge difference for medical providers and prospective parents.
Modern technology helps couples often overcome common fertility challenges as partners in the privacy of their bedrooms rather than as patients in a medical office. The approach – a cervical cap to help sperm reach an egg – is decades-old. What’s new, thanks to a lightweight silicone cap, is a do-it-yourself technique that lets couples proceed naturally and with dignity.
Reproduction pioneers of the 20th century would be amazed by how much has changed, though they’d recognize a process that adapts their path-breaking work.
As early as Sept. 26, 1938, Time magazine reported on a cervical insemination procedure “performed when the couple cannot afford the preferred intrauterine insemination treatment”:
“The patient lies on the examination table; a doctor or nurse inserts a speculum into the vagina; the semen sample is then placed into the cervix with a plastic catheter. Sometimes a sponge or cap is placed into the vagina before removing the speculum to keep the sperm near the cervix, and can be taken out about six hours later. Success rates for the intracervical insemination treatment are in the region of 5 – 10% per treatment cycle.”
A dozen years later, Dr. M. J. Whitelaw published research describing how pregnancy was achieved for couples “whose marriages were inexplicably sterile, using a plastic cervical cap filled with the husband’s semen applied to the cervix for 24 hours.” His 1950 report appeared in the first volume of Fertility and Sterility, a journal created for doctors in that emerging specialty.
Awkard, Uncomfortable Origins
While Dr. Whitelaw’s day-long procedure used a rigid plastic cap, other gynecologists of the time inserted a heavier version made of surgical steel. After husbands produced semen at the medical office, their wives had to recline with hips elevated for four to six hours before going home.
In the November 1985 issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing, two nurses described that decade’s first-stage technology for helping couples conceive:
“The most common method of artificial insemination is to draw the semen into a syringe attached to a thin plastic tube and to insert the semen into the upper vaginal/cervical area. An alternate method is to place a plastic cup over the cervix and introduce the semen around the cervix through a plastic tube attached to the cup…. Immediately after the insemination, the woman lies on the examining table with a pillow under her hips.”
The laborious, time-consuming efforts often failed. A 1983 medical textbook, “Clinical Gynecologic Endocrinology and Infertility,” reports pregnancy rates of 18 to 20 percent from vaginal, cervical and even uterine insemination approaches. The two nurses’ 1985 article also reflected the long odds:
“Individuals and couples need to know that their efforts at artificial insemination of the husband’s/partner’s sperm may take many months and the prognosis for conception is often poor.”
Encouraging Success Rates
In the current century, family practice physicians and gynecologists tell couples that holding a semen-filled cap against the cervical mucus greatly increases chances that sperm will swim into the uterus for fertilization – the basic idea described in Time magazine before World War II. The path-shortening technique addresses problems caused by a tilted cervix, poor cervical mucus, low sperm motility or production, an unfavorable vaginal environment or abnormal penis opening.
In contrast to the decades when steel, rubber or hard plastic cervical caps were the only choices, new-generation models are soft and don’t need custom fitting by a physician because side flanges adjust to varied cervical dimensions. Cervical fluid holds the cap in place, just as capillary action keeps contact lenses from slipping. Users resume normal activities, including exercise, at any time and then easily remove the cap after six to eight hours via an attached loop. The trial of hips held high to get pregnant is over forever.
After European use and American clinical trails, the U.S. Food and Drug Administration in 2000 approved the Oves Conception Cap for use here. And in 2007, it cleared prescription sales of a Conception Kit with a three-month supply of the same thimble-size cap, made of implant-grade silicone. Couples also get sperm collectors, ovulation predictors, conception timing wheels and other support materials.
Medical Studies Confirm Effectiveness
In addition to gaining easy, lower-cost access to a lightweight cervical cap for home use as a first step on the assisted reproductive technology continuum, couples can be encouraged by pregnancy success rates that are far different than in cap insemination’s early era.
Forty-four percent of Oves cap users become pregnant, according to a Thomas Jefferson University School of Medicine study published in May 1986 in the Journal of Reproductive Medicine. Among women with secondary infertility after at least one successful pregnancy, the success rate rises to 67 percent, according to a 1983 report by four researchers at Detroit Medical Center and Wayne State University, published in Fertility and Sterility. They also found a 43-percent pregnancy rate among women with primary infertility.
Along with solid reasons for optimism, couples begin assisted conception efforts with intimacy and dignity — keeping romance as part of starting or expanding a family.