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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, no pregnancy after a process of four to six cycles of sexual intercourse with ovulation control, use of donor semen by severe male factor or desire of motherhood by a single woman.

Some of the causes in 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 in the cervix (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 woman’s reproductive system (the introduction of spermatozoa into the uterine cavity) 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 the uterus and reach the Fallopian tubes where 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 sperm with the greatest potential of fertilization are selected, which will then be inserted deep into the uterus.

  1. Medical evaluation prior to the process of intrauterine insemination.
  2. Controlled ovarian stimulation (EOC) when applied (see informed consent for ovulation induction or stimulation)
  3. Preparation of the semen sample in the laboratory
  4. Intrauterine insemination
  5. 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 applicable 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:

  • 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 history, reproductive and preconceptional
  • Full physical exam.
  • 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.
    • Syphilis
    • Surface antigen for Hepatitis B.
    • Hepatitis C antibodies.
    • Antibodies for varicella and rubella virus. In their absence, vaccination and postponement of the treatment cycle for three months is recommended.
    • IgG antibodies to cytomegalovirus.

 

  1. 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 stimulated cycles than in spontaneous.
  • The stimulation of the ovaries is done using drugs whose action is like that of certain hormones produced by the woman. The choice of medication, as well as dosages, 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 reports the number and size of developing follicle. Sometimes this may be 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 for sexual intercourse, artificial insemination and 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 in a proper way.

 

  1. Mobile sperm collection

The couple can bring the semen sample a few hours before the insemination directly from home or take it in the institution. If possible, the man should have approximately 2 days of sexual abstinence. If the semen sample is brought from home, it must be taken in sterile container (supplied by the institution) and transported at room temperature to the institution within the hour following collection. In the case of semen samples cryopreserved from 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.

  1. Intrauterine insemination

Intrauterine insemination is an outpatient procedure that is performed without the need for 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 are deposited there.

Some women, after insemination, present 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 Fallopian tubes.

Some women also have light bleeding and/or mild abdominal distension on the day of insemination or a day later.

  1. 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:

  • 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 number of follicles developed.

Generally, the pregnancy rate per insemination cycle ranges about 15%. With respect to the number of cycles performed, 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 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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