Among assisted reproductive techniques, insemination is given a special place. It allows you to conceive a child in the case when natural fertilization for some reason becomes impossible. We will tell you in this material about how insemination is carried out, to whom it is carried out and what is its effectiveness.
Features:
Insemination is the process of insemination. With natural intercourse, natural insemination occurs when sperm enters the woman's genital tract as a result of the ejaculation of her partner at the time of orgasm. Further, spermatozoa have a long way to go - to overcome the vagina with an acidic and rather aggressive environment, to overcome the cervix, the cervical canal. No more than a third of the male sex cells will reach the uterine cavity.
In the uterus, the environment for spermatozoa is more favorable, but they still have to pass through the fallopian tube, in the ampullar part of which an egg ready for fertilization awaits them. If difficulties arise at some stage, then not a single sperm cell may reach the egg and then pregnancy will not occur.
In some forms of infertility associated with immune factors, with endocrine disorders, with male factors, with pathologies of the cervix, insemination in a natural way is difficult. Therefore, artificial insemination can be applied. In this case, the sperm of a husband or a donor to a woman is injected into the cervix or into the uterine cavity using special devices, that is, the procedure takes place without intercourse.
The first experience of insemination was carried out in Italy in the 18th century. Then the British took up the "baton". In the 19th century, doctors in many European countries actively used this method of helping with infertility. In the middle of the last century, doctors learned not only to inject sperm closer to the cervix, but began to make intrauterine injections and even injections into the mouth of the fallopian tubes.
Insemination belongs to the category of methods of artificial insemination, but it has nothing to do with IVF (in vitro fertilization). The main difference is that during in vitro fertilization, the fusion of the sex cells of a man and a woman occurs outside the female body. Eggs and sperm go through this stage in a laboratory Petri dish under the vigilant control of embryologists, and after a few days the embryos are transferred into the uterine cavity.
During insemination, human intervention in the natural process consists only in the fact that the sperm is "helped" to overcome particularly difficult areas - the vagina and the cervical canal of the cervix. Thus, more male germ cells enter the uterine cavity and fallopian tube, and this increases the chances of pregnancy.
Fertilization itself takes place in a natural environment, provided by nature - in the wide part of the tube, from where the fertilized egg gradually moves into the uterine cavity. After about 8-9 days, under favorable conditions, the implantation of the descended ovum occurs and the development of pregnancy begins.
The differences between insemination and ICSI (introcytoplasmic sperm injection) are the same as with IVF in general. With ICSI, one selected sperm is injected with a thin needle under the oocyte membrane by hand. The whole process takes place outside the female body, in an embryological laboratory.
Quite often, intrauterine insemination is the first method that is prescribed to couples with some forms of infertility. Sometimes the treatment ends on it, since pregnancy occurs.
If insemination does not give a positive result, the possibility of IVF or IVF + ICSI is considered.
Kinds
According to the depth of ejaculate injection, there are vaginal, intracervical and intrauterine insemination. Depending on whose sex cells will be used to fertilize a woman, two types of insemination are distinguished:
- homologous - insemination, for which the sperm of the husband or the woman's permanent sexual partner is used;
- heterological - insemination, for which the sperm of an anonymous or other donor is used.
The procedure with donor sperm is performed when the sperm of a spouse or permanent partner is found unsuitable for fertilization due to a violation of sperm morphology, a small number of live and active sperm and other severe sperm analysis. Also, insemination with donor biomaterial is recommended to be carried out if a man has severe hereditary pathologies that can be inherited by a child. A woman who wants a child, but lives alone, without a husband, can also be inseminated at her request.
The procedure with the husband's sperm is carried out if the quality of the ejaculate is good enough for fertilization to occur, but not sufficient for natural conception through sexual intercourse, as well as for some female diseases.
Indications
Unlike in vitro fertilization, which theoretically can help a large group of infertile couples with a wide variety of reasons for reduced or lack of fertility, intrauterine insemination is indicated for a rather narrow group of patients. These include:
- women without a partner;
- married couples in which there is a male factor of infertility according to spermogram;
- couples in which the woman has minor pathologies of the organs of the reproductive system.
Male factors that may require insemination with donor sperm may be due to the absence of testicles at birth or due to injury or surgery. Also, donor material, in agreement with the spouses, is used in the event that a married couple has a genetic incompatibility or a man has extremely low sperm quality that does not lend itself to medical and surgical correction.
Insemination becomes a chance to become a dad for men who, for some reason, cannot carry out a full-fledged act, for example, with paralysis of the lower body, with damage to the spinal cord. Intrauterine sperm injection will help solve the problem of conceiving couples in which a man suffers from retrograde ejaculation (sperm enter the urinary tract as a result of a violation of the eruption process).
The donation of sperm with its subsequent cryopreservation for insemination may be required for men who are to undergo treatment for oncology, for example, a course of radiation therapy. The own germ cells can be severely damaged as a result of cancer treatment, and the frozen semen will remain unchanged and can be used for insemination at the request of the couple.
Among the female pathologies that prevent the onset of pregnancy in a natural way, but can be overcome through intrauterine insemination, include cervical or cervical factors of infertility, in which the passage of partner's sperm through the genital tract is difficult, with the immune factor of infertility, if a large amount of antisperm antibodies are produced, and also with moderate endometriosis and mild forms of menstrual irregularities.
Sometimes it is not possible to identify the true cause of infertility - according to the results of all examinations, both partners are somatically healthy. In this case, intrauterine insemination is also used as an experimental measure.
Insemination is recommended for women with vaginismus, in which the penetration of something into the vagina causes severe spasm, with scars on the cervix caused by previous operations on it or ruptures during a previous difficult birth.
Contraindications
For most assisted reproductive technologies and techniques, the list of contraindications established by orders of the Ministry of Health is almost identical. As in the case of IVF, a woman who currently has acute inflammatory pathologies or exacerbated chronic diseases will not be allowed to insemination. The ban applies to women with mental health problems who require regular or periodic use of psychostimulants.
In the presence of oncological diseases, any benign tumors at the time of the procedure, insemination will also be refused. If a woman is diagnosed with malformations of the uterus and tubes, if she suffers from obstruction of the fallopian tubes, if she has congenital anatomical anomalies of the uterus, vagina, tubes and ovaries, insemination is also denied, because pregnancy in these cases can pose a threat to the life and health of herself women.
It should be noted that insemination can be carried out with one tube or with partial obstruction of the fallopian tubes, but only according to individual indicators, that is, the decision on the expediency of the procedure is made taking into account the degree of obstruction and the chances of success.
Infectious diseases of the husband can also become a reason for refusal to perform the insemination procedure, since there is a possibility of infection of a woman at the time of the introduction of the husband's biomaterial. That is why, before insemination, it is necessary to conduct a thorough examination and hand over a rather impressive list of tests.
Training
If the couple was examined by a gynecologist and urologist and these specialists came to the conclusion that insemination is necessary for conception (the indications are indicated above), then the woman's attending physician gives her a referral for tests and examinations. Before insemination, a woman should do general urine and blood tests, a biochemical blood test, tests for sexually transmitted infections, a blood test for HIV, syphilis, blood group and Rh factor.
On the 5-6th day of the menstrual cycle, she should donate blood from a vein for the main hormones responsible for reproductive capabilities (prolactin, FSH, LH, testosterone, estradiol, etc.). A woman must undergo an ultrasound of the pelvic organs, take smears from the vagina and scrapings from the cervix. Also shown are colposcopy and hysteroscopy (if endometriosis is suspected). The patency of the fallopian tubes can be established by diagnostic laparoscopy or other methods.
A man should have a spermogram with a mandatory extended study for antisperm antibodies and various types of abnormalities in spermatogenesis. In addition, the man undergoes general blood and urine tests, does chest fluorography, donates blood for HIV, syphilis, genital infections, a smear from the urethra, donates blood for the group and Rh factor.
Intrauterine insemination is included in the program of state support for NRT (new reproductive technologies), and therefore it can be done both at your own expense and free of charge, under the compulsory medical insurance policy. In the first case, with a doctor's conclusion and analyzes, you can go to any clinic that provides a similar service. In the second case, you will have to wait about a month while the documents submitted by the attending physician to the commission of the Ministry of Health of the region are considered.
If a couple is allowed to do insemination at the expense of state or regional funds, they will be offered a list of clinics and hospitals that can carry out the procedure and are licensed to do so. It remains to choose one of them and go there with all the analyzes and documents to go through the quota procedure.
Order of conduct
To carry out intrauterine insemination, a woman does not have to go to the hospital. This procedure is quite simple and quick. It can be performed in a natural cycle or with the use of hormonal drugs that should stimulate a woman's ovulation (if there are violations of the ovulatory cycle). Whether or not ovarian stimulation is needed, the fertility doctor will decide, who will receive tests on the patient's hormonal background.
In the natural cycle, a woman does not have to take any hormonal drugs, which sometimes cause undesirable negative consequences in the female body. She will pay the first visit to the doctor after the end of menstruation, donate blood for hormones and will visit the doctor every two days to monitor follicle maturation through ultrasound. As soon as the dominant follicle increases to 18-20 mm, an insemination procedure will be prescribed.
Immediately after ovulation, which is perfectly monitored and determined by ultrasound, pre-purified and prepared sperm will be injected into the uterus using a long and thin catheter and a disposable syringe. This procedure is painless, takes no more than five minutes, and does not require anesthesia. For women with increased pain sensitivity, mild local anesthetics may be used.
If a woman has problems with her own ovulation, then the insemination protocol will be very similar to the IVF protocol. First, the woman will receive hormonal drugs that stimulate the maturation of the follicles. Up to 10-12 days of the menstrual cycle, growth will be observed through ultrasound. As soon as the size of the follicle reaches 16-20 mm, the doctor makes the patient a single hCG angle. This hormone stimulates the maturation of the egg and its release from the follicle approximately 36 hours after injection.
Immediately after ovulation, sperm will be injected into the uterine cavity through a catheter. During ovulation, the cervical canal opens slightly, which is why a thin catheter can be inserted into the uterus without problems without resorting to artificial instrumental expansion of the cervix. That is why the woman does not feel pain.
After the injection of sperm, the woman is advised to maintain a horizontal position of her body for at least 40 minutes, after which the doctor allows her to get dressed and leave the medical facility.
After stimulating ovulation from the first day, a woman is prescribed progesterone preparations, which help prepare the endometrium of the uterus for the upcoming (possible) implantation of the ovum. For this, drugs such as "Dyufaston", "Utrozhestan" are often used. The doctor will tell you in detail how to behave after the procedure.
Sperm before the introduction is cleaned of semen and other impurities by settling, washing, passing through a centrifuge. As a result, only concentrated ejaculate remains. The sperm is freed from immature, defective sperm with poor morphology, from dead and inactive cells. The remaining strong sperm should not live and should be injected as soon as possible. The purified sperm of the husband or donor is not subject to freezing, so purification is carried out immediately before administration.
Before donating sperm on the day of insemination, a man is recommended to abstain for 3-5 days, good nutrition, and no stress. Alcohol, antibiotics and hormonal drugs are prohibited 2-3 months before insemination. You should not take a hot bath, visit a bath or sauna. This will help prepare for the delivery of the biomaterial in the best possible way.
Recommendations
For a woman who has undergone the procedure of artificial intrauterine insemination, it is recommended to stay in bed or semi-bed rest for the first two days, do not take hot baths, do not swim, do not go to the bathhouse and do not sunbathe.You should get more rest, get good sleep and eat a balanced diet. Diets are not good for you.
If the doctor prescribes progesterone drugs, they should be taken in a clearly indicated dosage and in compliance with the frequency and scheme. It is unacceptable to skip the next pill or the introduction of a candle.
It is quite difficult to influence the probability of successful fertilization and implantation, or rather, almost unrealistic. These processes are not yet subject to man. But to increase the chances of success will help a calm psychological background, lack of stress, positive thinking.
If, after insemination, unusual discharge appears - bloody, greenish, gray or abundant yellow, you should immediately inform your doctor.
Do not exhaust yourself looking for early signs and symptoms of pregnancy - they may not be there. Therefore, doctors recommend to go to the diagnosis of pregnancy at the earliest a couple of days before the delay of the next menstruation. During these periods, you can make a blood test from a vein for the concentration in the plasma of chorionic gonadotropic hormone - hCG. Pregnancy tests, which are dipped in a jar of urine at home, are most reasonable to start using only on the first day of the delay and later.
A week after the start of the delay, if menstruation does not come, and the tests reveal signs of hCG, a confirmatory ultrasound examination should be done, which will accurately establish not only the fact of pregnancy, but also its features - the number of fetuses, the place of attachment of the ovum, the absence of signs of ectopic pregnancy and other pathologies.
Feelings after the procedure
Objectively, the sensations after intrauterine insemination are not much different from the sensations of a woman who had unprotected intercourse during ovulation. In other words, there will not be any special sensations for the days, which are so awaited and for which women so hope after the artificial infusion of sperm.
On the first day, a slight pulling pain is possible, which is almost imperceptible. These are the consequences of introducing a catheter into the uterine cavity.
If at this stage the lower abdomen is strongly pulled, a high temperature has risen, you need to call an ambulance, infection or air entering the uterine cavity is possible.
About 7-9 days after sperm injection, implantation may occur if fertilization has taken place. At the same time, some women note a slight increase in temperature, the appearance of aching pain in the lower back and small, non-abundant discharge from the genitals of a pink, cream or brownish hue. They are caused by the ingress of blood into the vaginal secretion from the damaged endometrium. The functional layer of the uterus is damaged when the ovum is introduced into it. This is called implantation bleeding.
It does not occur in every woman, and therefore you should not rely heavily on such a sign of pregnancy. In addition, implantation is not always successful, and pregnancy, without having time to begin, can be interrupted for a great variety of reasons, not all of which are known and understood by medicine in general and gynecology in particular.
If the pregnancy does start, from the moment of implantation, the level of the hormone hCG will begin to slowly accumulate in the body - it is produced by chorionic cells, with which the ovum "clings" to the wall of the uterus. This does not mean that you immediately start to feel sick, as some think. Toxicosis is also not for everyone and usually develops a little later.
Among the earliest signs of pregnancy, even before the delay, one can name an increase in breast sensitivity, a short-term but daily increase in body temperature in the afternoon or in the evenings up to 37.0-37.5 degrees. A woman may think that she has caught a cold, since a feeling of nasal congestion and frequent urination may well be added to the increase in temperature, although without pain (as with cystitis). This is how progesterone acts in the body, which begins to "accompany" pregnancy from its first hours and "preserve" the embryo.
There are women in whom all of these signs are absent even with the onset of pregnancy. And there are more sensitive women who intuitively feel that everything in the body now “works” in a new way. Before objective data of blood tests and ultrasound, it is better to stop worrying and relax.
Efficiency
Most gynecologists quite reasonably believe that regular sexual activity (at least 2-3 intercourses per week) has exactly the same chances of conception as a single injection of sperm through a catheter. If the sex life is irregular, then the chances of pregnancy are still increased by the procedure, but insignificantly - by no more than 11%.
The likelihood of a successful procedure is lower in women over 35 years old, since their oocytes are already in a state of natural aging, which implies a decrease in the quality of germ cells. Even if the sperm get to such eggs, they sometimes cannot fertilize them, and if intercourse does take place, then there is a high probability that implantation will not occur or the fertilized egg will be rejected.
According to WHO, the percentage of a positive result from the first intrauterine insemination does not exceed 13%. With the second attempt, the probability of getting pregnant increases slightly - up to 20%, with the third and fourth, the maximum percentage of positive results is observed - 25-27%. And then there is no increase in positive dynamics. The probability remains stable at the level of 20-22%.
In gynecology and reproductive medicine, it is believed that after the fourth attempt at artificial insemination, further application of the method is impractical - most likely, there are other reasons that prevent pregnancy, the couple needs another examination and, possibly, IVF.
The cost
The average cost of an intrauterine insemination procedure in Russia starts from 20 thousand rubles and can reach 60 thousand. The final cost depends on the region, on the protocol, on the need to use donor sperm. If stimulation of ovulation is planned, the procedure may rise in price three times from the minimum value.
Is the procedure at home real?
There are special kits for home insemination. It will be enough for a man and a woman to receive semen (by interrupted intercourse or masturbation) and inject it. But such insemination cannot be considered intrauterine. With home administration, only vaginal insemination is possible.
The kit includes a syringe with an extension cord that allows you to inject sperm as deep as possible into the vagina so that the sperm concentration is as high as possible. However, with cervical factor infertility or low motility of sperm, this will not help.
In addition to the syringe, the kit includes tests with high sensitivity to hCG. They can be applied as early as about 10 days after ovulation.
Doctors are rather skeptical about such sets, because all the manipulations that a couple are invited to do are easily carried out during natural intercourse.
Important questions
Many religions view fertilization with donor sperm with disapproval. In Orthodoxy and Islam, this is considered a violation of the sacrament of marriage, in fact, treason. Before you agree, think carefully about whether you will experience moral difficulties later. A spouse who agrees to insemination of his wife with donor sperm must know that the child will not be his family by genes and blood. And a woman should know that it is impossible to choose a donor, all sperm in cryobanks is stored as anonymous.
But patients will be able to get general information about the donor - age, eye color, height, hair color, occupation, education level. This will help to at least approximately choose a type close to the appearance of the spouse, who will have to raise the baby.
Unlike IVF, intrauterine insemination does not make it possible to make sure that the fetus has not inherited genetic diseases, that it does not have chromosomal abnormalities, because embryos are not selected, as is the case with in vitro fertilization at the stage of preimplantation diagnosis. The insemination procedure also does not allow you to find out the sex of the unborn child.
Pregnancy, if it occurs as a result of intrauterine sperm injection, proceeds without features. It is no different from pregnancy that results from natural intercourse. A woman will not need to go to the antenatal clinic more often, as well as undergo additional examinations beyond the generally accepted ones, as is the case with women after IVF.
Childbirth can occur both naturally and by caesarean section. A history of insemination is not an indication for caesarean section; it can be prescribed for other reasons and indications.
Reviews
There are not as many positive reviews on successful intrauterine insemination on thematic forums as we would like. Most often, women describe several unsuccessful attempts to get pregnant with this method, after which they still agreed to the IVF protocol, the effectiveness of which is usually somewhat higher.
On women's forums devoted to insemination, there are often men who offer sperm donation services at home for subsequent home administration of biomaterial using a special pharmacy kit. At the same time, men charge from 5 to 20 thousand rubles for their services.
Women who did manage to get pregnant after intrauterine insemination claim that this is a very convenient and painless way. Most received two semen infusions - the day before ovulation and on the day of ovulation. Personal stories prove that the chances are higher in women who have been given ovulation stimulation, however, it also increases the chances of twins, because more than one egg matures.
For what insemination is, see the next video.
