Practical advice for new parents

Artificial Insemination Overview

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Artificial insemination consists of a variety of techniques that entail placing sperm into the female genital tract. The sperm can be from a husband or partner or from a donor.

Various insemination procedures include intravaginal insemination, intracervical insemination, intrauterine insemination, intrafallopian insemination, and intraperitoneal insemination. The most common techniques are intrauterine, intracervical, and intravaginal insemination.

  • Artificial insemination is recommended for the following patients:

  • Women with mild endometriosis

  • Women with poor cervical mucus

  • Couples with unexplained infertility

  • Men who are unable to ejaculate inside their partner's vagina for reasons including ejaculation failure, retrograde ejaculation, or if the man is HIV positive (washed and prepared sperm can be placed in an HIV negative woman without risk of contracting the virus).

Before artificial insemination is recommended by a doctor, couples will undergo a complete medical review, including physical and internal examinations. Men will be asked to produce a semen sample for a semen analysis, and women may have to undergo a variety of tests that check for tubal obstruction and ovulation.

Both partners will be screened for HIV (AIDS), Hepatitis B and C, and German Measles (Rubella).

Intravaginal Insemination

Intravaginal insemination is primarily used when a female has normal ovulation and the male is unable to ejaculate into his partner's vagina, but can ejaculate by other means such as masturbation. For this procedure to be effective, timing is very important. Ovulation predictors that indicate urine LH surge provide an accurate time frame for when intravaginal insemination should be performed. Generally, the procedure is recommended about 24 hours after the surge.

The procedure entails the male partner collecting his semen in a sterile container. The semen is then placed into a sterile syringe and injected into the female's vagina. The advantage of this procedure is that it can be performed at home with the aid of items (ovulation predictor test, sterile container, and syringe) that can be purchased at a pharmacy or drug store. The success rate for intravaginal insemination ranges from 5 to 10 percent with each treatment cycle.

Intracervical Insemination

Intracervical insemination is utilized when a female doesn't ovulate on a regular basis and needs to take fertility drugs. Her cycle will be monitored with ultrasound scans, and blood tests will determine hormone levels to determine the optimum time for insemination. This procedure is not effective if there is cervical mucus hostility.

The five minute procedure includes a doctor placing the semen into the cervix with a catheter and then placing a cap into the vagina to keep the sperm near the cervix. The cap is then taken out about six hours later. Intracervical insemination has a success rate of about 5 to 10%.

Intrauterine Insemination

Intrauterine Insemination (IUI) is the most commonly used method of artificial insemination and is a less costly and easier procedure than in-vitro fertilization (IVF). This treatment is highly effective for certain groups of patients and has higher success rates than intravaginal and intracervical insemination because it combines placing good motile sperm near the Fallopial tubes with ovarian stimulation.

The procedure involves placing washed and prepared sperm in the uterus at the time of ovulation. In some cases, ovarian stimulation will be part of the process. This entails giving the female fertility drugs such as clomiphene to stimulate the ovaries to produce follicles. Evidence has proven that IUI used in combination with ovarian stimulation has higher success rates than if it is used alone. Complications of this procedure include multiple pregnancy and ovarian hyperstimulation syndrome. Success rate of IUI can be as high as 26% per cycle. Multiple gestation pregnancies occur in about 23 to 30% of successful intratuterine inseminations.

Intrafallopian and Intraperitoneal Insemination

Both the intrafallopian and intraperitoneal insemination procedures are not commonly used as they have not proven to have better results than intrauterine insemination.

The treatment steps are similar to IUI, but in the case of intrafallopian insemination, the sperm is injected into one fallopian tube and in the case of intraperitoneal insemination, the sperm is injected into the peritoneal cavity next to the entrance of the fallopian tube. Success rates for both procedures range from 5 to 30% depending on the cause of the infertility.