Many couples facing infertility find that there are few satisfactory therapeutic options between timing ovulation and IVF. There is another lesser known category of treatment that couples can consider; cervical cap insemination. To use this technique, semen is collected and placed in a small flap that is inserted into the vagina and the cervix, which is the cervix. The sperm are kept next to the cervical mucus while being protected from the vaginal environment. Without this protection, the sperm dies a few minutes after intercourse. Closing the semen to the cervix allows any available sperm to swim to the uterus and fallopian tubes, where the egg will be. The cervical cap can be used to treat low sperm count, low sperm motility, oblique cervix and other common conditions.
Cervical caps have been used by gynecologists and urologists for decades and have been documented in the medical literature since the first edition of Fertility and Sterility in 1950. At that time, Dr. MJ Whitelaw wrote about a technique for insemination “using a plastic cervical cap.” It was filled with husband’s semen, which was applied to the cervix for 24 hours.” (1) This was done to treat oligospermia with low sperm count. At that time, other OB/GYNs were also inoculating cervical caps, but with a heavier container made of surgical steel, The women undergoing treatment had to lie in the doctor’s examination room for six hours with their hips raised.
Cervical cap vaccination was widely used in the 1970s and 1980s. It has been used for unexplained infertility as well as being effective in the treatment of low sperm count and oblique cervix. In 1983, Dr. Michael Diamond and colleagues found that women with primary infertility, defined as no previous pregnancy, had a 43% pregnancy rate within the first six months of cervical cap use. In women with secondary infertility and at least one pregnancy history, the pregnancy rate was 67% in the first six months of use. (2) Their method involved a cervical cap that is inserted into the cervix by the patient and then filled with semen using a catheter that fits into a small opening in the cap. The couples treated in this study generally had low sperm count and/or poor post-coital test results, but the women’s assessments were normal. Doctors in the study also offered cap vaccination as an option for couples who at the time had not completed a full evaluation that included diagnostic laparoscopy. This allowed patients to continue to conceive and use their entire cycle while still considering advanced options.
Eventually, with Invitro Fertilization (IVF) followed by Intra Cytoplasmic Sperm Injection (ICSI), cervical cap insemination began to fall by the wayside. During the economic boom of the 1990s, with more discretionary income, couples had access to numerous tests and procedures, even if their insurance did not cover them. Tests such as the Hamster Egg Penetration, Hypo-osmotic Swelling Test, and Antibody Test, which were popular a few years ago, are not very often requested by doctors today because of the value of the results obtained compared to the money spent. Developed to treat low sperm count, ICSI is now often used by clinicians with IVF. In the most recent data collected, the Society for Assisted Reproductive Technology (SART) reports that for 2006 ICSI use accounted for 62% of all IVF cycles. A study published in the New England Journal of Medicine in 2007 showed that over a decade, the rate of ICSI use increased fivefold, even though sperm quality parameters remained essentially the same over the same time period.
While the cost and use of high-tech treatments have skyrocketed in recent years, cervical cap and home insemination are quietly making a comeback. Couples interested in more cost-effective, natural methods are looking for other options for conceiving. At-home cervical cap insemination is a treatment option that can fit in a few places in a couple’s fertility planning. For couples just starting their fertility journey, home insemination can be used as a first step, especially when one or both partners are reluctant to spend too much time in the doctor’s office. For people who are trying to conceive for several cycles and are taking fertility drugs to increase ovulation, a cervical cap can add another valuable tool to their treatment plan. Finally, couples undergoing IVF treatment or who have had IVF in the past may want to try home insemination during their cycle away from more aggressive treatments. Single mothers of her choice can also benefit from this technique as an alternative insemination delivery system.
Cervical caps, also used for contraception to prevent pregnancy, are part of the Code of Federal Regulations (CFR). The current term for cervical cap devices used for insemination is the conception cap. Currently available for home insemination, the cervical cap is a modern upgrade of the old hard plastic or metal caps of the past. The newer version is made of soft implantable silicone and has flanges on the inside edge to create a one-size-fits-all head that does not need to be specially fitted. It can be worn during normal activities and allows a woman the freedom to go about her normal daily routine.
The clinical trial for FDA approval in 2007 was designed using couples diagnosed with infertility; many had also tried other methods such as IVF and IUI. The results were that 84% of patients found it easy to place the cervical cap on their cervix and 92% of patients found the instructions easy to understand. 24% of patients participating in the clinical trial became pregnant within the first month, including couples who had failed IVF and IUI attempts. (3)
The use of cervical caps has shown positive results in the past and has something important to contribute to the future of reproductive medicine. With the cost of healthcare expenses rising that the average consumer cannot afford, home cervical cap insemination can be an attractive option to continue family building in tough economic times.
1. White Law MJ. 1950. Use of the cervical cap to increase fertility in case of oligospermia. Fertility and Infertility. 1:33.
2. Diamond, MP, Christianson C. Daniell JF, Wentz AC. Pregnancy following use of a cervical cup for home artificial insemination using homologous semen. Fertility and Infertility. 1983 April; 39(4); 480-4.
3. Conception Kit clinical trials, Conceivex. 2006-2007