Artificial insemination as a method of ART. Artificial insemination at home

We want to support married couples and single women who decide on a procedure such as intrauterine insemination(hereinafter referred to as VMI or AI). Unfortunately, not everything in life is always simple and smooth: some people experience loneliness when they have long wanted to find a family, while others experience illness, loss of loved ones, and other misfortunes. No need to think that it was you who were unlucky - everyone has some kind of trouble. And do not be ashamed that you have to go to the doctors - we do not hesitate to go to the doctor if, for example, we broke our leg in order to get rid of the pain and be able to walk in the future.

Just artificial insemination of a person, intrauterine insemination, going to doctors in order to have a child, is less familiar to us, that's all. This is less familiar to the people who surround us. Methods of artificial insemination (including intrauterine artificial insemination) in Moscow and the regions every year help everyone more couples. Artificial insemination- donor, or husband's sperm will give you the desired result - your child. However, if you are not ready or do not want to meet wariness, skepticism, and even ridicule from those around you - natural human reactions to something new and unusual - and do not feel confident in convincing people and achieving their understanding of the situation, then you probably should not tell loved ones that you have resorted to such a procedure as intrauterine artificial insemination.

Results after insemination - successful pregnancy- will delight you and your loved ones. Conceiving a child is an intimate, personal matter, and concerns only you. You can answer questions from loved ones in this way or smile mysteriously. The methods of artificial insemination used in this case are up to you, your spouse and your doctor.

The misfortune that has piled up is sometimes so depressing that complete despondency comes. But over time, you realize that the problem will not be solved by itself and life will not get better on its own. Artificial insemination of a human medical method treatment, there is nothing obscene in it. The problem of artificial insemination is largely contrived by people uninformed in this matter. If you are shown this procedure, artificial insemination - donor or husband's sperm - you need to think carefully about everything and act. Trouble must be overcome, not surrendered to it. There are always ways to solve a problem. Perhaps not always easy, not always easy to accept something psychologically, not always enough patience and will. Sometimes you just don't know how to solve a problem, or which way is best.

Artificial insemination. Indications:

couples where not everything is in order on the part of the man (sexual disorders or bad sperm)
single women (if there are no problems "on the female part")

Many single women really want to have a baby. But what if there is no suitable partner nearby? Women learn what is artificial insemination, who became pregnant after artificial insemination where artificial insemination is done, how much artificial insemination costs - in Moscow and the regions. Having clarified all the questions, women turn to a selected clinic where artificial insemination is performed. If intrauterine insemination is successful, after insemination comes long-awaited pregnancy. And it doesn't matter how much artificial insemination costs; result - new life, your child is in your arms. I would like to wish single women good luck and understanding and help from loved ones with raising a child.

On men's problems let's stop in more detail. Some problems in reproductive sphere are now found in men, including young men, quite often, and, unfortunately, are not always treatable. The problem of artificial insemination for men is quite acute. This is a heavy blow to male pride and just a human misfortune. Often this also disrupts the harmony in the pair.

It is completely pointless not to do anything in this situation, to get away from it - sooner or later the problem will have to be solved, somehow determine one's fate, and delay usually leads to the proliferation of problems.

In this situation, it is important to collect complete information, which can help you modern medicine where exactly and how successfully. It is also important to visit clinics and doctors in person to get answers to your questions and doubts. If artificial insemination is indicated for you, tests will help you choose the right treatment tactics.

I would like to mention separately that bad sperm is not a diagnosis, it is an analysis. If a man has not been examined and there is no conclusion about the diagnoses, the causes of bad sperm and the possibility of treatment, it is too early to make predictions whether pregnancy is possible naturally or need artificial intrauterine insemination, or another method of ART.

At serious pathologies sperm, if this cannot be corrected, insemination with the husband's sperm cannot help solve the problem. In these cases, medicine can only help with insemination with donor sperm or IVF / ICSI with husband's sperm.

The role and significance of a man in conception, if you have to resort to artificial methods, not only does not become lower, it becomes much higher and more responsible. Even if donor sperm is used, this is your child, thanks to you a new life is born, and he will be the way you raise him.

Artificial insemination (AI) - method assisted reproduction(along with IVF, IVF / ICSI), in which, as with other methods, some stage of the conception of a child occurs artificially.

General information

Insemination is the introduction of sperm into a woman's genital tract. by artificial means. The whole further process occurs naturally: the spermatozoa run from the uterus to the fallopian tubes, where they meet the mature egg that has left the ovaries and also entered the fallopian tubes, fertilizes it, and then the fertilized egg enters the uterus, where it attaches to the wall of the uterus and gives rise to pregnancy.

Insemination is carried out near the time of ovulation (the release of a mature egg from the ovary), approximately in the middle of the menstrual cycle.

Previously used the introduction of sperm into the vagina, but more successful is used in Lately the introduction of sperm into the uterus - the so-called intrauterine insemination (IUI).

With intrauterine insemination, the sperm is pre-treated, making it similar to the composition that the sperm acquires in the vagina on its way to the uterus during natural intercourse, and selecting the "squeeze" from the most fertile spermatozoa. The introduction of raw sperm directly into the uterus is unacceptable.

Artificial insemination. Indications

Insemination is performed on single women and is used to achieve pregnancy in spouses with barren marriage if the treatment is to achieve natural pregnancy was not crowned with success.

Artificial insemination. Results: Pregnancy as a result of insemination can occur in a woman only when there are no diseases that prevent pregnancy. In case of obstruction / absence of fallopian tubes, high endometriosis, absence of ovaries or uterus, insemination is not carried out.

As a method of assisted reproduction distinguish:

artificial insemination with husband's sperm (IISM)
artificial insemination with donor sperm (IISD)

Artificial insemination with husband's sperm (IISM)

ISIS are indicated and can overcome infertility only in those cases when the artificial introduction of sperm bypasses that / those obstacle / I, due to which / s pregnancy did not occur, namely:

at sexual disorders, vaginismus, irregular sexual life,
with cervical (cervical) factor of infertility, when the husband's spermatozoa die in the wife's vagina,
with slight deterioration in sperm quality compared to normal,
with infertility of unknown origin when the couple went through a full list of examinations, and the reason was not found, however, the use of IVF is seen as premature, insufficiently justified or too expensive.

In all cases except the first, it is assumed that the couple has undergone a full infertility examination according to complete list survey, and there is a conclusion about the causes of infertility. If a couple is indicated for artificial insemination, tests will help choose the right treatment.

All of the cases listed above are quite rare and account for only a small percentage of cases of infertility.

When inseminating with the husband's sperm, fresh (native) sperm is used, which is donated at the clinic immediately before insemination on the same day in a few hours. For insemination, the husband must be examined for at least all sexually transmitted infections.

The child born as a result of such insemination is genetically related to the woman and her husband.

Artificial insemination with donor sperm (IISD)

I believe that before resorting to IVF, it is worth taking advantage of the chance of AI with donor sperm (IISD). Why??

It is important to understand that if pregnancy does not occur from insemination with donor sperm, nothing will prevent IVF from being applied. If you first follow the path of IVF and pregnancy does not occur after several attempts, there is a risk that reproductive health and mental condition women as a result of IVF will worsen, and the use of insemination with donor sperm will then turn out to be inappropriate, that is, there will be no other way.

Insemination with donor sperm has advantages over IVF/ICSI:

there are no strong hormonal stimulations that can negatively affect health unborn child,
no transmission to next generations male infertility(possible transmission during IVF/ICSI has not been studied by medicine),
there is no risk to the health of the mother, unlike the IVF procedure.

IISD are applied:

with poor quality of the husband's sperm (as an alternative to IVF, IVF / ICSI) or the absence of a sexual partner / husband in a woman.

In this case, the sperm of an anonymous donor from the bank can be used. donor sperm clinics, or the sperm of a donor that you bring yourself - this may be the closest relative of the husband (brother, father), a person you know or unfamiliar, but who agrees to act as a donor.

The child born as a result of such insemination will be genetically related to the woman and the donor, but real father the child - officially and in fact - becomes the husband of the woman, if he exists. Doctors keep medical secrecy, and pregnancy after insemination is carried out as normal pregnancy. The donor has no paternity rights and obligations.

More about donors.

According to the order of the Ministry of Health of the Russian Federation, in order to avoid the transmission of infections medical institutions Only cryopreserved donor sperm that has been frozen and kept in quarantine for at least six months is allowed to use to detect latent infections.

Since the sperm of not every man can withstand freezing / thawing without a serious deterioration in its quality, only men whose sperm has this property (cryotolerant) are accepted as anonymous donors.

Anonymous donors are examined for all sexually transmitted infections, the absence of mental disorders and congenital malformations.

Other requirements for anonymous donors depend on the clinic: the most stringent requirements are genetic analyzes on potential heredity, the presence of 2 healthy children.

Carefully choose a clinic where to do artificial insemination! Clinics search and attract anonymous donors themselves. The number of donors whose sperm makes up a donor sperm bank may be only 2-3 people, or there may be dozens. About the donor, general data about appearance, nationality, blood type, the presence of their children, education and occupation are provided.

When inseminating with the sperm of a donor that you bring yourself, as an exception, not cryopreserved for half a year, but fresh sperm can also be used. If artificial insemination is carried out in this mode. The cost of the procedure will be lower, the waiting time will be reduced, and the likelihood of pregnancy after artificial insemination will also increase.

Insemination requires examination of the donor, which you bring yourself, at least for all sexually transmitted infections.

Where to do artificial insemination. official registration

Inseminations are carried out in clinics that deal with reproduction problems, in the same place where IVF is performed (see the list on the website). Insemination is carried out by a reproductive specialist (a separate specialization in gynecology) with the participation of an embryologist involved in sperm preparation.

For artificial insemination, an official agreement is signed with the clinic - consent to insemination, with passport data.

If a woman is officially married, then both the wife and the husband sign the official consent for insemination both for insemination with the husband's sperm and for insemination with the donor's sperm.

When carrying out insemination with the sperm of a donor whom you bring yourself, his official consent is also signed. At the same time, his passport data and passport data of spouses or a single woman for whom he/she agrees to become a donor are indicated.

Insemination procedure

Before carrying out insemination, a woman should be examined for sexually transmitted infections and an ultrasound scan should be done to exclude possible gynecological diseases that may be an obstacle to the onset or bearing of pregnancy.

Insemination is carried out near the time of ovulation - the release of a mature egg from the ovary, approximately in the middle of the menstrual cycle. Ideally, if in the time interval "a day before ovulation - a few hours after", since this is the most auspicious time for conception. Although insemination a day or two or three before ovulation can also lead to pregnancy.

In order to determine the time of ovulation with an accuracy of at least a day, and to make sure that the egg is mature, ultrasound monitoring is performed: from the beginning of the menstrual cycle in which AI is supposed to be performed, ultrasound is done several times to monitor the work of the ovaries and the growth of one or more follicles (oocytes). Follicle growth is usually 2 mm/day and ovulation occurs when the follicle reaches a size of 18-22 mm.

In addition to ultrasound, for exact definition ovulation time, use ovulation tests (similar to urine pregnancy tests) sold in pharmacies.

IS can be performed using hormonal stimulation of the ovaries. Hormonal stimulation is carried out with the same drugs as for IVF (see page "pharmacology in eco" >>>), but usually in significantly lower doses.

Stimulation can produce multiple follicles/eggs and some better quality, which increases the chance of pregnancy. It should be mentioned that drugs with active substance"clomiphene" (clostil, clostilbegit) refers to obsolete drugs with many side effects and less efficiency.

With a pre-ovulation size of the follicle / s, an ovulation provocateur can be prescribed - chorionic gonadotropin(hcg).

Two days after ovulation can be prescribed hormonal support the second phase of the cycle with duphaston, utrozhestan, which contributes to the onset and maintenance of pregnancy.

In addition to mature follicles / eggs an important factor for the onset of pregnancy is the thickness of the endometrium in the uterus at the time of ovulation. During ultrasound monitoring, the growth of the endometrium is also monitored, and if the growth is insufficient (by the time of ovulation it should be at least 9 mm), additional hormonal preparations for building up the endometrium (estrophem, proginova, divigel).

Insemination can be carried out without the appointment of any medications.

In one menstrual cycle, 1 or 2-3 inseminations can be carried out. It depends on whether one or more follicles / eggs mature and when each of them ovulates (follicles can ovulate with an interval of 1-2 days) and depending on how accurately you can predict the time of ovulation.

In the case of using cryopreserved donor sperm, 2-3 inseminations can be carried out with an interval of a day.

When fresh (native) semen is used, it should be assumed that for good quality sperm required sexual abstinence ideally 3-5 days. Therefore, insemination is carried out either 1 time - on the day of the expected ovulation, or 2 times with an interval of 2-3 days - for example, 2 days before ovulation, and a few hours before or after ovulation. Ultrasound monitoring is carried out until it is established that ovulation has occurred (!).

Preparation of sperm for AI takes about 2 hours: about an hour is spent on the so-called liquefaction, then the sperm must be processed without delay (otherwise its quality deteriorates). Processed semen can be stored for several hours without losing its quality. If cryopreserved sperm is used, then more time is required to thaw the sperm.

The procedure of insemination (sperm injection) itself takes several minutes, is carried out on gynecological chair.

Sperm is injected through a special catheter directly into the uterus. The procedure is painless, you can only feel a slight pull. After the procedure, you may feel some uterine tension (tonus) for several hours. After the introduction of sperm, you must remain on the chair in the same position for 15 minutes, then you can get up. A little fluid leakage is normal.

On the day of insemination, limit physical exercise and maintain the same mode as in critical days(menstruation). Since insemination directly interferes with the uterus, which increases the risk of infections, more thorough hygiene and caution should be observed. Mode of life in the following days - without restrictions.

Consults, conducts ultrasound monitoring, makes all appointments and conducts the actual insemination by the same doctor - a reproductive specialist. The embryologist is engaged in the storage and preparation of sperm for insemination.

Hormonal support for the second phase of the cycle with utrozhestan, duphaston does not allow menstruation to begin, even if pregnancy has not occurred. Therefore, if hormonal support is used, 2 weeks after ovulation, you need to take a blood test for pregnancy (blood for hCG).

When negative analysis support is canceled, in case of positive - support is continued until consultation with a doctor.

Cost of insemination

Artificial insemination. Price. The cost of AI consists of several components: the initial consultation with a doctor, the cost of ultrasound monitoring, the insemination procedure itself, the preparation of sperm for insemination, the cost of donor sperm (if sperm from the clinic’s donor sperm bank is used), the cost of the drugs used.

Thus, the cost of insemination depends on the chosen clinic, whether ovarian stimulation drugs and other drugs are used, whether a donor sperm bank is used.

In some clinics, when artificial insemination is carried out, the price is set for everything that is carried out during the cycle - for ultrasound monitoring and insemination, regardless of whether 1 or 2-3 procedures are required. There are clinics where payment is made for each type of service - separately for ultrasound monitoring, or even each ultrasound, separately - for each insemination procedure.

Therefore, when determining the cost of insemination in this clinic you should separately ask how much the entire necessary set of services costs.

The cost of donor sperm from the donor sperm bank is paid separately. Medicines are bought independently in a clinic or pharmacy, the cost modern drugs for stimulation is comparable to the cost medical services for insemination.

A higher price than other clinics for a "kit" or directly for the insemination procedure does not always mean that this clinic differs more high score. Carrying out insemination in clinics in Moscow and St. Petersburg on average costs several hundred euros per one menstrual cycle.

Artificial insemination. Who got pregnant? Probability of success and possible reasons for failure.

Pregnancy as a result of insemination occurs less frequently than during natural sexual activity in healthy couples, and than during IVF. That is, the probability of pregnancy in one cycle during insemination is less than 30%. Therefore, you should tune in to at least 3-4 cycles of insemination.

If pregnancy does not occur after 3-4 cycles of insemination, it is recommended to change the method of treatment or the donor.

This limitation is partly due to the fact that it is undesirable to stimulate the ovaries for more than 3-4 cycles, and partly because there are more effective method- IVF (however more expensive and less harmless to health). However, to carry out more than 3-4 cycles of insemination without the use of ovarian stimulation, imitating the natural sexual life may be quite reasonable.

Possible reasons for failure:

a) insemination is carried out not according to indications, there are obstacles to the onset of pregnancy,

b) the insemination was carried out insufficiently qualified or negligently,

c) bad luck.

More details about each of the reasons:

a) Indications.

If a woman has not been tested for fertility, it cannot be ruled out that she has diseases that prevent pregnancy. It is also important to understand that a mature and covulated follicle does not mean that a full-fledged, good-quality egg has matured. If a woman has hormonal disorders, ovarian dysfunction or her age over 35 - possible cause failure may be poor quality eggs.

It should be noted separately IISM with a decrease in sperm counts. To decide whether insemination is advisable, 2-3 spermograms are needed, since sperm counts can vary greatly. When preparing sperm for insemination, the embryologist gives an independent opinion on the quality of the sperm and the prognosis of how pregnancy is possible - it is important to know this conclusion to make a decision about further treatment if pregnancy does not occur.

b) The professionalism of doctors.

The whole scheme of actions for the insemination cycle is described above. Thus, the reason for failure may be:

delay in sperm preparation,
low quality biological media used in the processing of sperm in this clinic,
not accurate enough set time ovulation and insemination not at the optimal time, lack of verification that ovulation has occurred, the appointment of an ovulation provocateur with an undersized or overgrown follicle / s,
thin (undergrown) endometrium in the uterus.

If you feel negligence, contradictions in the actions of the doctor, you should think about changing the clinic or doctor.

c) Bad luck.

If you do not find reasons for failure in reasons a) and b) and have only done 1-2 cycles of insemination, most likely you are just not lucky yet.

You can apply ovarian stimulation, if it was absent, change stimulation drugs, carry out 2-3 inseminations in a cycle, if only 1 was carried out, increase the time of sexual abstinence for a man before donating sperm (up to 5 days). The absence of pregnancy during even several cycles of insemination does not mean that a woman cannot become pregnant during natural sexual activity with a healthy man.

Based on the information collected and the experience of those who have gone through insemination, consultations with many fertility doctors, try to understand whether it is worth resorting to AI in your case and how to do it all. Maybe AI is your chance!

Send your good stories! They will give real hope to those who are thinking and doubting or afraid of failure!

For various gynecological diseases, as well as during cesarean section, injections into the uterus can be used. They pursue several goals, which depend on the specific clinical situation. In some cases, they fight the inflammatory process, in others they shrink the uterus, in others, they lyse (dissolve) adhesions.

These manipulations are quite complicated, so they must be performed by a doctor. It also determines the need for their production, depending on the clinical situation and condition. reproductive health women.

Uterine injections for caesarean section

This operation always increases the risk of bleeding, including massive ones, which represent serious danger For female body. Therefore, preventive measures have been developed given state. To avoid the development of bleeding, intrauterine contraction drugs are most often administered. Usually this agent is oxytocin. In the dosages used, it has practically no side effects. Its advantageous difference from other means is the absence of an increase in the level blood pressure. This aspect is very important in obstetrics, since during pregnancy whole line pathological processes, in which it develops arterial hypertension(a condition with high blood pressure).

An injection into the uterus with oxytocin is performed in the period after the removal of the child until the separation of the placenta. The injected drug activates cell contraction smooth muscle, especially in the place where the placenta was attached. Therefore, against the background of its introduction, wrinkling occurs placental tissue and its prompt separation. In addition, the spiral arteries of the uterus are pinched during spasm of smooth muscle cells. This reduces the amount of blood flowing out and, accordingly, stops bleeding.

Some clinics may use enzaprost, which also shrinks the uterine wall, to achieve the same therapeutic result. This drug belongs to the group of prostaglandins (a special class of cells synthesized human body substances with different biological effects). However, there are reported cases of complications with its use. The most formidable of them is a pronounced rise in blood pressure, which most often occurs in women with increased risk development of hypertension. In this regard, modern obstetrics with the introduction of uterine injections during cesarean section recommends using only oxytocin, a drug with proven efficacy and high safety.

Detailed information about caesarean section can be found in this video:

Treatment of endometritis with uterine injections

Endometritis is a reaction of the uterus to the introduction into it pathogenic microorganisms. Therefore, their destruction will allow to cope with the developed inflammatory process. The best way to do this is to inject the drug directly into the lesion. With endometritis, it is the uterus. Therefore, with this disease, injections into the uterus are widely used. The essence of this procedure is the introduction of the drug directly into the uterine cavity. It looks like this:

The cervix is exposed with the help of mirrors;
A special PVC conductor (catheter) with a small diameter is inserted into its channel;
Injected through the catheter with a syringe medicinal solution. This must be done slowly so that the drug is evenly distributed in the tissues.

For injections into the uterus with endometritis, drugs from several groups can be used. On the one hand, these are antibiotics that disrupt the vital activity of microorganisms, leading to their death. On the other hand, for the treatment of endometritis, it is recommended to use anti-inflammatory injections into the uterus ( nonsteroidal drugs). Such therapy can be used for both acute and chronic damage to the uterus. The duration of treatment will depend on clinical improvement. Usually it is from 3 to 7 weeks.

It should be borne in mind that starting such treatment, you must first make the vagina clean. If it is inflamed, then there is a possibility of introducing an additional infection into the uterine cavity, which will negatively affect its condition. Therefore, intrauterine injections are always preceded by a stage microbiological research vagina, and if a pathology is detected, it must be treated (suppositories with antibiotics are administered).

For more information about endometritis, watch this video:

Treatment of adhesions with intrauterine injections

One form of infertility is uterine (Asherman's syndrome). Its cause is the formation of adhesions in the uterine cavity, which disrupt the process of moving spermatozoa to fallopian tube where fertilization normally occurs. Injections into the uterus allow you to eliminate the adhesions that have formed. For this, lysing agents are used. enzyme preparations. Their active ingredients dissolve connective tissue from which adhesions are formed. In addition, uterine receptors become more susceptible to hormonal influences.

With infertility, such injections are performed on days when there is no menstruation. It is best to do this before the onset of menstruation, so that the lysed residues are removed from the uterus. The number of procedures is determined by the severity of the underlying disease. Monitoring the effectiveness of the treatment is carried out using a hysteroscopic examination (visualization of the uterine cavity using endoscopic techniques). If its results are unsatisfactory, then in the next menstrual cycle, a new introduction of lysing drugs into the uterine cavity is carried out.

Non-developing pregnancy and intrauterine injections

It has now been proven that in non-developing pregnancy there is always an inflammatory process with varying degrees activity. In some cases, it is a consequence of an interrupted pregnancy, and in others it is the cause of its termination. In these situations for full recovery reproductive function is required to eliminate the inflammatory process. Nai best result can be achieved if you use an injection in the uterus. Dioxidin, an antibiotic and an anti-inflammatory agent, can be administered. One course of treatment includes 10 procedures. Their technique is no different from those that were carried out with endometritis.

You can learn more about non-developing pregnancy from this video:

The first injection of the uterine injection is performed immediately after the removal of the frozen gestational sac. In the process of its removal, damage to the integrity of the vessels occurs. Therefore, introduced medications immediately penetrate into vascular system and with blood flow evenly distributed throughout the uterus. When comparing further reproductive ability of such women with patients who were not injected with drugs into the uterine cavity, it was found positive impact this procedure. This was expressed as follows:

Rapid onset of pregnancy after an episode of non-developing;
The course of pregnancy with minimal complications or their complete absence;
Large percentage physiological childbirth(complications in childbirth did not differ from the general population).

Therefore, this method of treatment using injections into the uterus is the most effective. It is used in their practice by many obstetric and gynecological clinics.

Uterine injection as a stage of IVF in infertility

Non-standard uterine injection is the transfer of embryos as a stage of artificial insemination. After studying the genetic material of the cells that are supposed to be transferred, proceed directly to this stage. Fertilized eggs are collected from a plastic container with a special sterile syringe. The cervix is exposed with a speculum and inserted through cervical canal special catheter. The doctor presses the syringe plunger slowly so that there is no injury to the embryos.

After the procedure, the woman should continue to lie on the gynecological chair for 30-45 minutes. This is necessary for the adaptation of transplanted embryos to new conditions. If blastocysts remain in the syringe after replanting, they can be frozen for possible next attempts. All these actions are discussed with the woman, and she makes a decision, which the doctor then implements.

Frozen embryos are transferred in a similar manner. The procedure is performed after laboratory or ultrasound detection of ovulation. Wherein optimum time replanting is the interval from the 7th to the 10th day of the cycle. This avoids other steps that precede embryo transfer.

Thus, intrauterine injections can serve various purposes. But in all cases they are designed to maintain or improve reproductive function. The procedure practically does not lead to pain and is highly effective, therefore it is used within the framework of complex treatment obstetric and gynecological pathology, as well as a stage of in vitro fertilization.

Gynecology The introduction of drugs into the uterus, what is hydrotubation

The introduction of drugs into the uterus, what is hydrotubation

For the introduction of drugs into the uterine cavity, hydrotubation is used.

hydrotubation- this is the introduction of drugs into the uterine cavity and tubes to restore their patency. medicinal substances, getting under pressure into the pipes, soften scar tissue and physically affect the hearth.

Contraindications are the same as for pertubation.

Apparatus and tools: apparatus for blowing pipes with a 50 ml burette or a tip with an obturator and a Brown syringe, a vaginal mirror, a lifter, bullet forceps, two forceps.

Medicines for injection into the uterine cavity: 100 ml of a 0.5% solution of novocaine, 64-128 units of lidase, antibiotics (penicillin 200,000-400,000 units, streptomycin 500,000-1,000,000 units, etc.); lidase can be replaced with 50 mg hydrocortisone.

Hydrotubation technique

During the procedure, the patient lies in the gynecological chair. intestines and bladder emptied (enema a few hours before the manipulation). Pre-disinfection of the external genitalia.

Disinfection of the cervix and vagina. With the help of a mirror and a lift, the cervix is exposed. The anterior lip of the cervix is grasped with bullet forceps. Medicinal substances are administered using a Brown syringe or a tube blowing apparatus, to which a 50 ml glass burette is attached with rubber tubes. Its upper end is attached to the filter, the lower end to the tip. A negative pressure is created in the apparatus, and a sterile drug solution is sucked through the tip into a sterile burette. The rubber tube at the tip is clamped with a forceps. A tip with an obturator is inserted into the cervical canal and a warm 0.5% solution (37 °) of novocaine is gradually injected with medicines under pressure not exceeding 200 mm Hg. Art. The pressure in the burette is created by air coming from the air reservoir.

) represents gynecological manipulation during which the IUD is inserted into the uterine cavity.

This intervention is carried out on an outpatient basis. Before the introduction of the IUD, a standard examination is carried out to identify contraindications. The introduction of the IUD is carried out to achieve contraceptive effect both women who have given birth and those who have not given birth.

IUD installation is not performed in the following situations:

Acute inflammatory diseases of the pelvic organs.
Exacerbation of chronic inflammatory processes pelvic organs.
The presence of genital infections.
Uterine bleeding of unknown etiology.
Malignant tumors of the pelvic organs.
The presence of volumetric processes of the uterus (fibroids), leading to deformation of the uterine cavity.
Pregnancy.
Proven allergy to copper.
Anatomical and topographic features and malformations in which it is impossible to guarantee the correct location of the IUD in the uterine cavity.

The procedure for inserting an IUD is simple, it occurs 3-4 days after the onset of menstruation. Anesthesia is either not used or an anesthetic gel is applied to the cervix. The woman is located in the gynecological chair in a standard position. The vaginal cavity and the cervical area are treated with 3% hydrogen peroxide in order to remove elements menstrual flow and then twice with an antiseptic.

Preparation

Opening the package and checking horizontal position spirals.	Fixing the spiral in the conductor tube by moving the slider forward to the farthest position.	Measurement of the distance from the external os to the fundus of the uterus with a probe.
Introduction

Introduction of the guide tube through the cervical canal into the uterus (the index ring should be located 1.5–2 cm from the cervix).		Opening of the horizontal shoulders of the intrauterine device.
Fixation

Full release of the contraceptive by moving the slider as far down as possible. Removing the guide tube.	Cutting the threads (their length should be 2-3 cm from the external os of the uterus).	Correctly placed intrauterine device.

The cervix is grasped with bullet forceps and then a slight dilatation (dilation of the cervical canal) occurs. After that, a special instrument is inserted into the uterine cavity, which allows you to determine the length of the uterine cavity. This is important in order to correctly position the IUD in the cavity. The folded IUD is in a tube with distance marks. The doctor inserts the entire device into the uterine cavity and reaches the fundus. Next, the tube is pulled out, the spiral straightens and is fixed inside the uterus. At the end of the IUD there are synthetic threads called "antennae". They pass through the cervical canal and serve to easy removal Navy. The doctor evaluates their length and, if necessary, trims.

All manipulations to install the IUD usually do not take more than 5-7 minutes. At the end of the procedure, it is recommended to carry out ultrasonic control of the location of the IUD. After the installation is completed, it takes a short time bed rest. If during the manipulation or after it there are pain, shows the use of analgesics or antispasmodics.

Sexual intercourse is possible a few days after the installation of the spiral, provided that there is no active bleeding or pain.

Thus, the installation of the IUD is a frequent outpatient manipulation, subject to all the rules and installation techniques, it does not take much time and does not bring any pronounced discomfort to the woman.

Artificial insemination is, in fact, one of the ways reproductive technologies, which allows you to enter the seminal fluid of the husband into the woman's vagina (in some cases, it is used seminal fluid donor). Thus, insemination is carried out without sexual intercourse, since insemination is carried out in laboratory conditions. At the same time, all the sperm gets into the zone of the pharynx of the cervix, which cannot be said about natural process(in this case, only part of the sperm enters).

It turns out that artificial insemination at times increases the likelihood of conception. But this method of fertilization is effective only if the husband's or donor's sperm contains mobile live spermatozoa. To successfully conceive, a woman must be able to conceive a child and be healthy.

Women who decide to resort to this method of conception often ask how artificial insemination with sperm is carried out? Previously, several methods of insemination were used for fertilization and sperm was introduced into the vagina, directly into the uterus, into abdominal cavity. However, the method of introducing seminal fluid through the uterine cavity turned out to be the most effective, therefore, today only this method of fertilization is used, because the probability of becoming pregnant is much higher. Although the process of artificial insemination takes place through medical intervention, however, it is as close as possible to natural conception. In this process, only the introduction of seminal fluid into the uterine cavity is artificial, everything else happens naturally. On the territory of Russia, artificial insemination gained popularity in 1987.

The process of artificial insemination

Before holding this procedure a woman should be tested for sexually transmitted infections. Also, a woman, she must do an ultrasound to rule out gynecological diseases, as they can become an obstacle to conceiving or bearing a child.

In some cases, purified sperm is injected into a woman in a gynecological chair through a small catheter. Through the cervix, spermatozoa enter the uterine cavity. Although the procedure itself is painless, the woman may experience cold and discomfort associated with the introduction of a special catheter. After the procedure, you need to lie down for 30-45 minutes, and then you can start living ordinary life. But after the procedure, it is not recommended to make love and lift heavy objects.

After the procedure, the doctor may prescribe progesterone, which is best taken vaginally, as this pregnancy hormone causes drowsiness, and oral administration drowsiness worsens. If the artificial insemination attempt failed, then twelve days after the procedure, menstruation will occur. A pregnancy test can be done if menstruation has not occurred on the eighteenth day after the procedure.

Artificial insemination with sperm during the menstrual cycle is carried out 3 times: the day before ovulation, right on the day of ovulation, for a day later offensive ovulation. If donor sperm is used for fertilization, then in all three cases, sperm from one donor must be injected.

In the vaginal mirrors, the doctor exposes the cervix, collects sperm (half a milliliter) into a disposable syringe and injects half of the collected sperm into the cervical canal (located in the zone internal os). After that, the doctor removes the vaginal mirror, and puts the remaining sperm on the cervix with a plastic cap. After that, the woman remains in the gynecological chair for about 15 minutes, and removes the cap after a few hours on her own. It is not recommended to keep the cap on the cervix for more than ten hours. Sperm is introduced into the uterine cavity only if the patient has a cervical infertility factor.

If pregnancy does not occur after 2 cycles of artificial insemination, then the patient begins to stimulate ovulation using various existing methodologies. In addition, along with the seminal fluid of the spouse or donor, Shuvarsky tests are carried out. If a woman fails to become pregnant after six cycles of insemination, then the patient is re-examined in depth and the detected violations are corrected.