Artificial insemination with husband's sperm
For various fertility problems, many couples must opt for artificial insemination with semen from the couple.
This treatment is indicated when there is a decrease in the number or mobility of spermatozoa, and/or anomalies of sperm, difficulty of penetration of sperm in the uterine cavity due to problems of the cervix or presence of Antibodies against semen, unknown cause of infertility or sterility, ovulatory disorders, when there is no pregnancy after a process of four to six cycles of relationships with ovulation control, use of donor semen by severe male factor or desire of motherhood in a single woman.
Some of the causes in which it is necessary to carry out an artificial insemination with semen of the couple are: alterations in the formation or the anatomy of the Penis (hypospadias), or in the neck of the uterus (stenosis). It is also used to obtain pregnancy in couples where there is no apparent cause of infertility (unexplained infertility), with endometriosis or in case of a slight variation in the quality of sperm.
The artificial insemination procedure involves the introduction of spermatozoa into the reproductive system (the introduction of spermatozoa into the uterine cavity) of the woman at the time of ovulation.
In natural fertilization, sperm are deposited in the vagina at the time of sexual intercourse. Only a few of the sperm, deposited there, manage to penetrate into the uterus and reach the trunk where the fertilization of the ovum occurs.
In artificial insemination, on the other hand, the semen sample is taken to the laboratory where, by means of several specialized processes, the spermatozoa with the greatest potential of fertilization are selected, which will then be introduced deep into the uterus.
- Medical evaluation prior to the process of intrauterine insemination.
- Controlled ovarian stimulation (EOC) when applied (see informed consent for ovulation induction or stimulation).
- Preparation (training) of the semen sample in the laboratory.
- Intrauterine insemination.
- Post-insemination follow up to the pregnancy test.
1. Medical evaluation prior to intrauterine insemination
Prior to the insemination process, the following evaluations will be carried out:
Evaluation of the partner or husband when applying, which may include a medical consultation and physical examination (at medical discretion) and in all cases laboratory tests (in the case of tests for infectious diseases, these should be carried out within six Months prior to the procedure) that may include, but are not limited to:
- or Spermogram
- or blood group and RH.
- or HIV-1 and 2.
- or serological study for syphilis.
- or surface antigen for hepatitis B.
- or antibodies to hepatitis C.
- or Neisseria Gonorrhoeae and Chlamydia trachomatis in semen sample.
Women’s assessment, which may include the following:
- or medical history, reproductive and preconceptional
- or full physical exam.
- or Laboratory tests (in the case of some tests for infectious diseases These should be performed within six months prior to the procedure), which may include:
- Blood group and RH.
- Neisseria Gonorrhoeae and Chlamydia trachomatis
- HIV-1 and 2.
- Surface antigen for hepatitis B.
- Hepatitis C antibodies.
- Antibodies to varicella and rubella virus. Vaccination and postponement of the treatment cycle for three months is recommended in the absence.
- IgG antibodies to cytomegalovirus.
2. Controlled ovarian stimulation intrauterine insemination may be carried out during a natural cycle or after an ovarian stimulation process.
- The pregnancy rate is significantly higher in the stimulated cycles than in the spontaneous ones.
- The stimulation of the ovaries is done by the use of drugs whose action is similar to that of certain hormones produced by the woman. The choice of medication, as well as doses, is defined by the treating physician according to the needs and characteristics of each woman.
- The ovarian stimulation process is usually controlled by vaginal ultrasound that informs the number and size of developing follicles, sometimes supplemented by hormonal determinations in blood that may include estradiol, Progesterone, luteinizing hormone, among others.
- Once the follicles are adequately developed, other drugs are given to achieve the final maturation of the eggs and to schedule the most appropriate time to orient sexual intercourse, artificial insemination or recruitment for Fertility treatment.
- Although the results depend to a large extent on the age of the woman and the concurrent causes that have determined the indication of the treatment, a high percentage of women responds in a proper way.
3. Mobile sperm training.
The couple can bring the semen sample a few hours before the insemination directly from their home or take it in the institution. If possible, the man should have about 2 days of sexual abstinence. If the semen sample is brought from the house, it must be taken in sterile container (supplied by the institution) and transported at room temperature to the institution within the hour following the taking. In the case of semen samples críopreservated bodies of the husband or donor stored in the institution these should be thawed on the day of the procedure. Semen is processed in the laboratory to select the highest quality sperm for insemination.
4. Intrauterine insemination
Intrauterine insemination is an outpatient procedure that is performed without the need for analgesia or anesthesia. This procedure lasts about 15 minutes and consists of depositing the motile spermatozoa inside the uterine cavity.
A thin, soft plastic tube called a catheter is used for this purpose. It is introduced through the cervix with the help of a speculum; Once inside the cavity, sperm are deposited there.
Some women present after insemination a slight discharge of the inseminated liquid at the vaginal level, this is normal and should not worry, because the sperm will already be on the way for their encounter with the ovum in the trunk.
Some women also have poor bleeding and/or mild abdominal distension on the day of insemination or a day later.
5. Luteal phase support.
In some patients the administration of supplementary progesterone after insemination (support of the luteal phase) favors embryonic implantation and maintenance of pregnancy. The route of administration can be intramuscular, vaginal or oral according to the progesterone used and the conditions of the patient. The administration of progesterone is performed daily until pregnancy detection. If the woman is pregnant, the administration of progesterone is continued for at least six weeks.
The percentage of pregnancy in each attempt fluctuates between 5 to 18%, depending on factors such as:
- The number and mobility of spermatozoa in the initial semen sample.
- The quality of the ovarian response.
- The age of the woman.
- The infertility time of the couple.
The probability of pregnancy per cycle and the number of cycles to be performed depends on the diagnosis, age, sperm quality and number of follicles developed.
Generally, the pregnancy rate per insemination cycle oscillates about 15%. With respect to the number of cycles performed, the overall of the patients who are going to achieve gestation with IAH, 90% will do it in their first 3-4 cycles (accumulated rate of approximately 60%)
When artificial insemination is not successful, other techniques must be considered: more complex and more efficient assisted reproduction techniques such as in vitro fertilization.
If you need more information about this treatment.
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