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 or anomalies in them, the difficulty of penetration of sperm in the uterine cavity due to problems of the cervix or the presence of antibodies against semen, unknown causes of infertility or sterility, ovulatory disorders, when there is no pregnancy after a process of four to six cycles of sexual intercourse with ovulation control, use of donor semen by a severe male factor or desire of motherhood by a single woman.
Some of the causes for which it is necessary to carry out artificial insemination with the couple’s sperm are:
Abnormalities in the formation or the anatomy of the penis (hypospadias) or the cervix (stenosis).
It is also used to obtain pregnancy in couples with 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 woman’s reproductive system (the introduction of spermatozoa into the uterine cavity) at the time of ovulation.
In natural fertilization, sperm is deposited in the vagina during sexual intercourse. Only a low portion of the sperm penetrates the uterus and reaches the Fallopian tubes, where the ovum is fertilized.
In artificial insemination, on the other hand, the semen sample is taken to the laboratory where, utilizing several specialized processes, the sperm with the most significant potential of fertilization is selected, which will then be inserted deep into the uterus.
- Medical evaluation before the process of intrauterine insemination.
- Controlled ovarian stimulation (EOC) when applied (see informed consent for ovulation induction or stimulation)
- Preparation of the semen sample in the laboratory
- Intrauterine insemination
- A post-insemination follow-up to the pregnancy test
Medical evaluation prior to intrauterine insemination
Prior to the insemination process, the following evaluations will take place:
Assessment of the partner or husband, when applicable, may include medical consultation and physical examination (at medical discretion) and laboratory tests in every case (in the case of tests for infectious diseases, these should be carried out within six months before the procedure) the procedures may include, but are not limited to:
- Sperm analysis
- Blood group and RH.
- HIV-1 and 2.
- Serological study for syphilis.
- Surface antigen for hepatitis B.
- Hepatitis C antibodies
- Neisseria Gonorrhoeae and Chlamydia trachomatis in semen sample.
Women’s assessment, which may include the following:
- Medical, reproductive, and preconception history
- Full physical exam.
- Laboratory tests (in the case of some tests for infectious diseases, these should be performed within six months before 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 for varicella and rubella virus. Vaccination and postponement of the treatment cycle for three months are recommended in their absence.
- IgG antibodies to cytomegalovirus.
Controlled ovarian stimulation.
Intrauterine insemination may occur during a natural cycle or after ovarian stimulation.
- The pregnancy rate is significantly higher in stimulated cycles than in spontaneous.
- The stimulation of the ovaries is done using medications whose action is like that of certain hormones produced by the woman. The treating physician defines the choice of medicines and dosages according to the needs and characteristics of each woman.
- The ovarian stimulation process is usually controlled by vaginal ultrasound, which reports the number and size of developing follicles. Sometimes this may be supplemented by hormonal determinations in the blood, including estradiol, progesterone, and luteinizing hormone.
- 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 for sexual intercourse, artificial insemination, or retrieval 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 for treatment, a high percentage of women respond adequately.
Mobile sperm collection
The couple can bring the semen sample a few hours before the insemination directly from home or at the institution. If possible, the man should have approximately two days of sexual abstinence. Suppose the semen sample is brought from home. In that case, it must be in a sterile container (supplied by the institution) and transported at room temperature to the institution within the hour following its collection. In the case of semen samples cryopreserved from the husband or donor stored in the institution, these must be thawed on the day of the procedure. Semen is processed in the laboratory to select the highest quality sperm for insemination.
Intrauterine insemination is an outpatient procedure performed without requiring analgesia or anesthesia. This procedure lasts approximately 15 minutes and consists of depositing the motile spermatozoa in 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 is then deposited there.
Some women, after insemination, present a slight discharge of the inseminated liquid at the vaginal level; this is normal, and the couple should not worry because the sperm will already be on the way to their encounter with the ovum in the Fallopian tubes.
Some women also have light bleeding or mild abdominal distension on the day of insemination or a day later.
Luteal phase support.
In some patients, the administration of supplemental 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 patient’s conditions. The administration of progesterone is performed daily until pregnancy detection. If the woman is pregnant, the administration of progesterone will have to continue for at least six weeks.
The percentage of pregnancy in each attempt fluctuates between 5 to 18%, depending on factors such as:
- Number and mobility of spermatozoa in the initial semen sample
- Quality of the ovarian response
- Age of the woman
- Infertility period 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 the number of follicles developed.
Generally, the pregnancy rate per insemination cycle ranges from 15%. Concerning the number of cycles performed, of most 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 unsuccessful, 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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