Introduction of sperm into the uterus. Intrauterine insemination: indications, advantages, types and implementation

Successfully practicing this procedure.

It is carried out on an outpatient basis after a series of tests and the written consent of both spouses or only the woman if she is not legally married.

What is intrauterine insemination?

The procedure involves inseminating a woman with the sperm of her sexual partner or donor without sexual contact.

IUI is performed without anesthesia, quickly and in most cases does not have serious consequences for the woman’s body.

During the procedure, a plastic tube is inserted into the cervical canal, through which sperm enter.

To do this, use seminal fluid directly taken from a man before IUI or pre-frozen. This does not affect the progress of insemination and the likelihood of conception.

However, according to preliminary studies conducted in 2001, the average pregnancy rate after the insemination procedure was 11.6%.

The advantage of the IUI method

The main advantages of intrauterine insemination with the sperm of a husband or donor are the following:

Availability. The procedure is one of the cheapest alternative methods of combating infertility;
No consequences for a woman after IUI;
Easy to carry out and does not require lengthy preparation;
Relatively high efficiency.

Due to the minimal physiological impact of insemination on the body, it is used as the first method to combat infertility, especially in cases where its cause is not established or when a man is diagnosed with “subfertility” (the term is very conditional, it refers to the temporary inability of a man to conceive a child with a specific woman).

Video: "What is the essence and what are the advantages of the intrauterine artificial insemination method?"

Indications and contraindications

Like any procedure associated with interference with the body’s vital functions, IUI has its own indications and contraindications.

In the case of insemination, they are not related to the technique, but to the potential danger of pregnancy for the woman’s body. The only absolute contraindication to the method itself is complete obstruction of the fallopian tubes. This is not due to the danger of IUI in these disorders, but to its ineffectiveness due to the inability to “deliver” sperm to the egg.

Obstruction is not a contraindication to other types of artificial insemination.

It is not recommended to plan pregnancy and childbirth if the woman has a history of cancer, inflammatory infections of any nature, especially sexually transmitted infections, or if they are affected by polyps or fibroids. If during the examination mental or general therapeutic abnormalities are revealed, they may become a reason for refusal to perform IUI.

The question of the appropriateness of using IUI and the potential harm to the female body is determined by the doctor after a series of studies.

Indications for the procedure are the following factors:

Low sperm activity in men. There are many reasons for this phenomenon: poor environment, stress, stress, past infections. As a result, morphologically normal sperm cannot reach the egg and die in the vagina;
Vaginismus in a woman. This term refers to involuntary contraction of the vaginal muscles and, as a result, the impossibility of sexual intercourse or its painfulness for a woman. In this case, in addition to IUI, other methods are possible - for example, working with a psychologist who will help identify the root of the problem and learn to relax during sexual contact;
Ejaculation disorders in men, erectile dysfunction. Impotence (temporary and absolute) is a fairly common phenomenon in the modern world. If it is impossible to resolve the problem in any other way, IUI is a highly effective and reliable solution;
Immunological incompatibility. In rare cases, antibodies to sperm are present in the mucous membrane of a woman’s cervical canal. In this case, the cells die before they can reach the egg as a result of the immune response;
Husband's cancer, the treatment of which involves the use of chemotherapy. This method significantly worsens the quality of sperm, so with such forecasts it is recommended to donate semen for freezing and fertilization in the future.

Video: "Indications for intrauterine insemination"

Tests before intrauterine insemination

Before the procedure, a man and a woman planning to conceive a child undergo all types of examinations recommended before pregnancy and in its early stages. A woman undergoes the following types of tests:

The husband must submit:

Spermogram. The analysis examines the man's seminal fluid, its volume, color, consistency, as well as the shape, motility and number of sperm. In this case, the concept of “norm” as such is absent; when diagnosing pathologies, it is customary to rely on WHO recommendations;
Tests for sexually transmitted infections.

Varieties

Insemination can be carried out with the sperm of the husband or donor, accompanied or not accompanied by hormonal stimulation (in this case it is called artificial).

The donor's sperm always goes through a freezing stage. It is stored in so-called “cassettes” for six months. This period is enough for a man to develop infections or other diseases that were not detected during the test. To carry out insemination on a married woman, the written consent of the spouse is required for the procedure.

Artificial insemination with stimulation of ovulation is produced by human choriogonadotropin and progesterone. It increases the effectiveness of IUI by increasing the number of maturing follicles, but can lead to hormonal imbalance or multiple pregnancies.

For these reasons, additional stimulation is not prescribed to young women with a regular cycle and persistent ovulation. Estradiol may be prescribed after the procedure. It provokes the formation of the placenta and the development of the corpus luteum (a former follicle that functions as a gland during pregnancy).

Hormonal stimulation significantly increases the cost of the procedure, therefore, when prescribing it in a medical center or private clinic if there are insufficient grounds, it makes sense to consult with other specialists.

Injection of sperm is possible directly into the woman's uterine cavity, into the cervix or into the vagina. The first method is most effective, especially for immunological factors of infertility and male subfertility.

Stages of the procedure

If a woman is prescribed hormonal stimulation, it is performed on days 3-5 of the cycle. Starting from this period, the doctor, using an ultrasound machine, periodically monitors the growth of the follicles and the maturation of the egg.

Normally, ovulation occurs on days 7-10 - the release of a mature cell from the follicle. It is during this period that insemination can most likely lead to a positive result.

When inseminating with the husband’s sperm, he must perform the following operations before donation:

abstain from sexual contact for 2-4 days;
urinate before sperm collection;
wash your hands and genitals;
Using masturbation method, collect sperm into a clean glass.

Semen is collected in a hospital setting, since it retains its characteristics only for 4 hours.

Preparing sperm for insemination includes purification (using a microscope, the most mobile spermatozoa that correspond to the morphological norm are determined and separated from the rest) and centrifugation, which allows the selected cells to be concentrated.

They are inserted into the woman's uterus, cervix or vagina using a catheter. The procedure does not normally cause any unpleasant or painful sensations. After the procedure, a cap is inserted into the vagina to prevent the leakage of seminal fluid.

A woman can try to perform IUI at home. The success of this event is unlikely; pregnancy occurs in 3% of cases. An intrauterine insemination kit can be purchased at medical centers.

Efficiency

This indicator is not the same for women of different ages and depends on the causes of infertility. On average it ranges from 3 to 25%. The following factors influence its growth:

patient's age;
number of procedures. The probability of conception is maximum when performing 6 cycles of IUI;
hormonal stimulation. Pregnancy after artificial insemination occurs 2-3 times more often;
intracavitary injection of seminal fluid (directly into the uterus);
identified causes of infertility.

A woman should have the right mindset during IUI and not be upset if it fails. The first insemination is rarely successful, while 6 cycles achieve success in 75% of cases.

Possible complications

Complications after IUI are rare, especially when the procedure is performed by competent specialists. However, in some cases the following side effects are observed:

pain reaction. Occurs when sperm enters the woman's abdominal cavity through the fallopian tubes;
hyperstimulation of the ovaries by hormones, which, in turn, causes insomnia, sweating, irritability;
multiple pregnancy;

Estimated price of artificial insemination

The IUI procedure is not currently performed free of charge and is available only in specialized centers. Most tests can be done in laboratories at hospitals or clinics for free.

The man must have his spermogram taken at the institution where the procedure is planned. The cost is 1,000-2,000 rubles.

How much artificial or natural insemination costs and what will be included in this procedure must be found out individually, since the price varies greatly in different medical centers.

On average, it can be 15,000-30,000 rubles. If donor sperm is used, the procedure will be 5,000-10,000 rubles more expensive.

A set of IUI procedures together with hormone stimulation, as well as control of egg maturation in the follicle (taking into account the cost of drugs) ranges from 60,000 to 80,000 rubles.

The price of individual stimulation is determined individually. For multiple IUI procedures, many centers provide significant discounts.

Such a service as sperm freezing is also provided by medical centers and clinics. Its price is 6,000-10,000 rubles.

Intrauterine insemination is a simple and effective way to combat infertility, recommended by WHO.

Unfortunately, its use cannot solve the problems that caused the inability to conceive naturally. Its use has expanded in recent years, and IUI is constantly being updated, increasing the chance of pregnancy.

Artificial insemination with sperm is performed when sexual intercourse is impossible or when sperm are inactive and cannot independently overcome the barrier properties of cervical mucus and reach the uterus. Carrying out artificial insemination is not a new method and is quite effective, since the technique has been perfected on millions of patients,

History of artificial insemination for pregnancy

The artificial insemination procedure is the introduction of sperm from a husband, partner or donor into a woman's genital tract with the aim of achieving pregnancy.

The history of artificial insemination for pregnancy has been known since ancient times. This technique has been used for over 200 years. It is known that the Arabs in the 14th century used this technique when cultivating Arabian horses. The first scientific article on the effect of low temperatures on human sperm - about sperm freezing - was published in the 18th century. A century later, ideas emerged about the possibility of creating a sperm bank. The first attempts to freeze sperm using dry ice showed that at a temperature of -79 ° C, sperm remain viable for 40 days. The first pregnancy and birth resulting from fertilization through artificial insemination with frozen sperm was obtained by Roger Bourges in 1953. Then, many years of searching for a method of preserving sperm led to the development of a technique for storing sperm in vessels with liquid nitrogen in sealed “straws”. This contributed to the creation of sperm banks. In our country, the introduction of artificial insemination techniques dates back to the 70-80s of the last century.

Carrying out vaginal and intrauterine artificial insemination

There are two methods of artificial insemination: vaginal (introducing sperm into the cervical canal) and intrauterine (injecting sperm directly into the uterus). Each method has its positive and negative sides. For example, the vaginal method is the simplest and can be performed by a qualified nurse. But the vaginal acidic environment is hostile to sperm, bacteria interfere with the linear progression of sperm, and vaginal white blood cells will eat most of the sperm in the first hour after its insertion.

Therefore, despite the technical simplicity, the effectiveness of this technique is no higher than the onset of pregnancy during natural sexual intercourse.

The introduction of sperm into the cervical canal brings the sperm closer to the target, but the barrier properties of the cervical (cervical) mucus stop half of the sperm on their way to the uterus, and here the sperm may encounter antisperm antibodies - an immune factor in female infertility. Antibodies in the cervical canal are in the highest concentration and they literally destroy sperm. If there is an immunological factor in the cervical canal, the only option left is intrauterine insemination.

Artificial intrauterine insemination brings sperm much closer to meeting the egg. But! Remember the danger of abortion: when instruments, even disposable ones, are inserted into the uterus, microbes from the vagina and cervical canal are introduced there, but they should not be there.

How to do artificial insemination

Before performing artificial insemination, it is necessary to conduct research into the factors of infertility. The main importance there is given to sexually transmitted infections, STIs, and bacterial vaginosis - a disorder of the vaginal microflora. In addition, it is necessary to comprehensively examine the uterus and ovaries for the presence of polyps in the uterus, fibroids, endometriosis, and ovarian tumor diseases. These diseases must be pre-treated. If the maturation of the egg is impaired, simultaneously with insemination, one of the methods of stimulating the growth of the egg is carried out - inducing ovulation. This helps to eliminate negative factors that can reduce the effectiveness of artificial insemination for infertility, and to carry out fertilization with greater efficiency.

The insertion of catheters into the uterus can cause painful contractions and cramping pain. This is exactly how the intrauterine device works. Such contractions can promote the release of sperm from the uterus, which not only ruins this attempt, but also reduces the effectiveness of subsequent attempts. Despite this, intrauterine insemination (IUI) is now the most commonly used method. Currently, the softest catheters are used, without grasping the cervix with surgical forceps, and antispasmodic (relieving spasms) drugs. In addition, an explanatory conversation is first conducted with the patient using hypnosis and meditation techniques to achieve maximum relaxation of all muscles. Then the cervical canal also relaxes to allow a soft catheter to be inserted into the uterus. The procedure is performed in a regular doctor's office, without surgery or anesthesia. The patient’s sensations are the same as during a routine gynecological examination.

Watch how artificial insemination is performed in the video below:

Oddly enough, the seminal fluid with which sperm enter the woman’s vagina during male orgasm and ejaculation (emission of sperm) during copulation is the most unsuitable environment for sperm, where they not only quickly die (two to eight hours after ejaculation) , but are also not able to quickly move linearly to meet the egg. In addition, seminal fluid is even toxic. If half a gram of seminal fluid is injected into any part of the female body, it will cause severe discomfort to the woman. The introduction of all the sperm into the uterus along with the seminal fluid is precisely the factor that causes strong cramping contractions of the uterus.

Being in the seminal fluid, sperm are completely incapable of fertilizing an egg. The motility and fertilizing ability of sperm can be increased by simply washing it in a physiological solution (0.9% sodium chloride solution). But the most perfect one is used - a cultural medium. This is a medium for culturing cells outside the human body, including eggs and sperm.

Artificial insemination (fertilization) using donor sperm

Insemination is carried out with the sperm of the husband or sexual partner with a normal spermogram. If a man has a decrease in the total number of sperm, a decrease in actively motile and normally formed sperm, and if the woman does not have a sexual partner, then donor sperm can be used. Material for fertilization with donor sperm is obtained from men under 35 years of age, physically and mentally healthy, without hereditary diseases in first-degree relatives (mother and father, brothers, sisters). When selecting donor sperm for artificial insemination, the group and Rhesus blood group, screening for STIs and sexually transmitted diseases are taken into account. At the request of the woman, the height, weight, eye and hair color of the donor are taken into account.

In the presence of an immunological factor of infertility - detection of antisperm antibodies - intrauterine insemination is recommended, combined with ovarian stimulation with follicle-stimulating hormone (FSH) preparations.

FSH in the follicular phase and the release of LH, which causes ovulation and the onset of the second phase of the cycle, in addition, perform very important functions. Early stimulation with FSH drugs helps the egg grow and form a protective zona pellucida, and then causes the follicle containing the egg to fill with follicular fluid, rich in female hormones - estrogens. Estrogens prepare the endometrium, the inner lining of the uterus and cervical mucus for the invasion of sperm. The endometrium thickens to 13-15 mm according to ultrasound.

Cervical mucus becomes more liquid and permeable to sperm chains. Following this, a surge of LH, the luteinizing hormone, causes not only ovulation, but also division of the egg, as a result of which the number of chromosomes is halved - from 46 (full set) to 23, which is absolutely necessary before fertilization, since sperm that can fertilize the egg also have half set of chromosomes. During fertilization, the halves are again folded into a whole, ensuring the manifestation of the hereditary characteristics of the mother and father in the new little person.

Due to the stimulation of egg growth with the help of FSH drugs and the induction of ovulation with LH drugs, not only ovulation occurs, but also much more.

After insemination with donor sperm, women are advised to lie down for three to four hours. Two days later, women who have undergone insemination are prescribed hormones for the second phase of the cycle in order to maintain a possible pregnancy as close to natural as possible in the earliest stages of its development. Instead of painful oil injections of progesterone, tablets of chemically produced natural progesterone, the hormone of the second phase of the cycle, are now used.

It was initially believed that by injecting washed “improved quality” sperm into the uterus, crossing the cervix with a barrier of cervical fluid and anti-sperm antibodies, a higher pregnancy rate could be achieved in a simpler way than in vitro fertilization.

This technique gives 20-30% of pregnancy rates. Each infertility patient undergoes a series of intrauterine insemination procedures using donor sperm along with ovarian stimulation.

Many couples undergo from 6 to 12 courses of intrauterine insemination and ovarian stimulation until they are completely mentally and physically exhausted. It would be better for such couples to refrain from so many attempts at artificial insemination with donor sperm and, if three courses of intrauterine insemination and ovarian stimulation did not produce results, turn to IVF.

Among the methods of overcoming infertility, artificial insemination stands out - a procedure that, unlike, allows one to achieve pregnancy with virtually no intervention in the woman’s body. This medical manipulation gives a real chance to become parents to many couples who in the recent past were considered infertile. How is artificial insemination performed and reviews about the procedure?

In contact with

A non-invasive procedure called insemination involves the introduction of a man's sperm into a woman's uterus using a special catheter and syringe.

Initially, doctors practiced various methods of introducing sperm into the body of the expectant mother. Insemination could be:

intracervical;
in the area of the fallopian tubes;
into the peritoneum;
intrauterine.

The last method was recognized as the most effective - it is used today in most cases.

But first the couple needs to get tested. An approximate list is presented in the table:

No.	For a man	For woman
1	Spermogram	Vaginal smear for flora, for the presence of urogenital infections
2	Blood test for Rh factor
3	Antibodies to hepatitis, HIV	Antibodies to hepatitis, HIV
4	Antibodies to cytomegalovirus	Antibodies to cytomegalovirus, herpes simplex virus
5	Urethral smear for urogenital infections	Coagulogram (test for blood clotting - after all, the procedure is still considered an intervention, although non-invasive, and complications are not excluded)
6		Pelvic ultrasound
7		Checking the patency of the fallopian tubes

Important: good patency of the pipes is a necessary condition for the manipulation. If one of them is clogged with adhesions or fluid, there is a high risk of complications - ectopic pregnancy. If both tubes are completely obstructed, insemination does not make sense: the egg will not meet the sperm.

The procedure is performed only if the woman has spontaneous (or hormone-stimulated) ovulation. In order to track the moment of ovulation, starting from the 8th-9th day of the cycle, the reproductive specialist performs folliculometry, observing the dominant follicle and choosing the time to administer a small dose of hCG. 24-36 hours after the hCG injection, the largest follicle bursts - the egg goes “on the hunt”. It is very important not to be late here.

This procedure, unfortunately, is not a panacea. Pregnancy with artificial insemination is possible if:

the man has subfertile sperm (i.e. there are few viable sperm or many of them have defects);
the man has been diagnosed with ejaculatory-sexual disorders;
a woman’s body actively produces sperm, which immediately kill sperm in the vagina, preventing them from reaching the egg;
the partner experiences vaginismus (involuntary contraction of the vaginal muscles, making normal sexual intercourse impossible).

The procedure helps to get rid of infertility also in cases where its causes could not be established. Good effectiveness is observed with so-called psychological infertility, when a woman’s body destroys sperm after normal sexual intercourse due to some internal problems that have “gone” to the subconscious level.

Note! Insemination will not allow you to acquire heirs if:

no ovulation;
pipes are missing or impassable;
woman's age is more than 39−40 years;
early ovarian exhaustion or menopause is observed; all eggs mature with defects.

After the necessary preliminary examinations have been carried out, the woman is prescribed a course of drugs - gonadotropins - to stimulate ovulation.

If there are no hormonal problems, the ovaries are working normally, the doctor simply tracks the day of the supposed rupture of the dominant follicle. An hCG injection is prescribed about a day before insemination, so that the follicle does not develop into a cyst and “releases” the egg.

Most often, the procedure is performed on days 12–14 of the cycle (at this time the periovulatory phase occurs). A couple of hours before the manipulation, the woman comes to the clinic, where she undergoes a control ultrasound, and sperm is collected from her husband.

Next, the husband is released, and the wife must come to the moment when the sperm is processed. The sperm is put through a centrifuge to purify it. If unprocessed sperm enters the uterus, it can cause severe allergic reactions, including anaphylactic shock.

Having prepared the sperm for artificial insemination, the doctor invites the woman to the operating room. You need to change into a disposable robe and cap, and replace your shoes with shoe covers.

The patient is located in a gynecological chair. Under ultrasound control, the doctor inserts a catheter into the uterus, at one end of which a syringe with sperm is attached. The infusion is made slowly to avoid reflex contraction of the uterine muscles. Then the catheter is removed, the woman remains in the chair for another 10 minutes, and after artificial insemination she rests in the room for half an hour.

Then you can go home or to work, and after 14 days do a test or donate blood for hCG.

The manipulation itself takes about 5 minutes. It is completely painless and does not require anesthesia, since the catheter is thin. The only “but”: those patients whose neck is very narrow or tortuous may need intramuscular injection of painkillers: no-shpa or ketorol. They will relax the muscles and facilitate the process of inserting the catheter.

To support the luteal phase, doctors prescribe medications with progesterone. Usually these are Utrozhestan or Duphaston capsules. They are inserted into the vagina to make the endometrium “lush” and to support the corpus luteum, without the normal functioning of which the embryo will not be established.

Price of the procedure

The price for artificial insemination is about 12-15 thousand rubles (this does not include hormones to stimulate ovulation and tests). For tests, you will have to add another 8 thousand for the wife and 3-4 thousand for the husband. Compared to the costs of IVF, this is very little.

The procedure is simple and rarely causes complications, since the intervention in the woman’s body is minimal. However, many are depressing statistics: according to research, only 11-15% of women who decide to carry it out succeed in becoming pregnant through insemination. The chances of having a child with IVF reach 45% (if the spouses are young and relatively healthy).

But the procedure can be repeated several times without interruption, as soon as the new egg matures, and the cost of artificial insemination is low. It is believed that it is advisable to perform insemination 3 times - after this, the effectiveness drops sharply.

Stages of the artificial insemination method, indications, preparation, chances of getting pregnant

Of all the ART methods, the closest to the natural process of conception is only artificial insemination (AI). The cost of this procedure compared to IVF is attractive, but it is not suitable for everyone.

lasts longer than IVF itself. It is done in reproductive centers around the world. Much experience has been accumulated in the methodology, and therefore it is widely used and brings the expected results.

The essence of AI is the introduction of purified sperm into the genital organs (internal) of a woman.

Historically, four options for insemination at the site of delivery of male germ cells have been formed:

In the vagina, closer to the cervix. Now this method is called “artificial insemination at home.” The effectiveness of the option is questionable, but there are women who managed to get pregnant this way.

Directly into the cervix. Nowadays it is used extremely rarely due to lack of effectiveness.

Into the uterine cavity. Today, this is the most used and effective method of artificial insemination. This will be discussed further.

Into the fallopian tubes.

As with all patients requiring reproductive assistance, when performing AI, doctors follow an individual approach. Indications, contraindications and physiological capabilities of the organisms of future parents are taken into account.

Therefore, artificial intrauterine insemination can take place in different ways:

with drug stimulation of the ovaries (efficiency increases, since 2-3 eggs mature at once in one cycle);
without stimulation - in a natural cycle.

Based on their sperm characteristics, it can be recommended.

For single women, clinics provide a special program, according to which the procedure is carried out for those who want to conceive, give birth and raise a child on their own (without the participation of a man).

Artificial insemination: indications

AI can be carried out with male and female factors.

For women, the indications for artificial insemination are as follows:

infertility of unknown origin;
endocervicitis;
sexual disorder – vaginismus – a condition in which natural sexual contact is impossible;
abnormal location of the uterus;
immunological incompatibility - the presence of antisperm antibodies in the mucus of the cervical canal;
violation of ovulatory function;
a woman's desire to become pregnant without intercourse.

Indications for artificial insemination for men:

impotence or lack of ejaculation;
male subfertility – decreased sperm activity;
retrograde ejaculation - sperm is thrown into the bladder during ejaculation;
small volume of ejaculate;
increased sperm viscosity;
hypospadias – congenital abnormal structure of the urethra;
chemotherapy.

AI Stages

Despite its mechanical simplicity, AI is a delicate and responsible work of a team of specialists - a gynecologist-reproductologist, clinic laboratory staff, and doctors of related specialties. The methodology involves a step-by-step and sequential approach.

Stages of artificial insemination:

Examination. At this stage, a thorough study of the health status of both partners, the identified causes of infertility is carried out, and a strategy for the procedure is determined.

Treatment. If any somatic and infectious diseases are detected, they are treated. Doctors take measures to improve the condition of a woman’s body, ensure the pregnancy is carried to term, and avoid possible complications during childbirth and the pregnancy itself. If necessary, treatment is prescribed to a man to improve sperm quality.

If the preparation plan provides for a stimulating effect on the ovaries, a hormonal simulation is performed.

Direct artificial insemination.

Determination of pregnancy by hCG monitoring. In the absence of pregnancy, the procedure, according to regulatory documents, is repeated up to 6–8 times. Although recently experts have come to the conclusion that if 3 attempts at AI were unsuccessful, then it is necessary to change tactics and consider the possibility of performing artificial insemination in a different way. For example, IVF, ICSI, PIXI, IMSI.

Preparing for artificial insemination

The effectiveness of artificial insemination depends on how accurate the diagnosis is. At this stage, doctors decide whether stimulation is needed and how to clean the sperm.

A woman's preparation includes:

detailed medical examination by a gynecologist, therapist, endocrinologist, cardiologist;
tests;
ultrasonic monitoring;
treatment of detected chronic diseases, including infections and inflammation of the genital organs;
study of the menstrual cycle (needed to determine the cyclicity and regularity of ovulation);
and the condition of the inner lining of the uterus;
after treatment, control tests are taken;
drug stimulation of the ovaries.

Depending on the individual characteristics of the couple, it can take a period from several weeks to six months.

Preparing a man:

consultation with a urologist;
tests for sexually transmitted infections;
analysis of prostate secretion;
Additionally, prostate massage may be prescribed;
treatment and correction of identified disorders.

On what day of the cycle is artificial insemination performed?

Carrying out artificial insemination is effective only in the periovulatory period - these are several days of the cycle during which the release of an egg (or eggs during stimulation) from the follicle is possible. Therefore, the phases of the menstrual cycle are monitored first. To do this, you can measure rectal temperature and build graphs, use ovulation tests. But the most accurate method of monitoring the development and maturation of the egg is ultrasound. Therefore, after critical days, ultrasound is performed quite often, every 1–3 days. The frequency of ultrasound may vary. The higher the degree of maturity of the female reproductive cell, the more often an ultrasound is performed (in order not to miss ovulation and to determine on what day of the cycle artificial insemination should begin).

The ideal option is to introduce sperm into the uterus during the periovulatory period 1–3 times. The first time it is administered a day - two days before ovulation, the second - directly on the day of ovulation. And if several follicles mature in the ovaries, they can burst at intervals of 1–2 days. Then the sperm is injected again. This increases the efficiency of the procedure as a whole.

One of the determining factors on which day of the cycle to perform artificial insemination is the origin of the sperm. If used, then it can be administered based only on ovulation. If you use fresh (native) sperm, then take into account the fact that high sperm quality can only be achieved if you abstain for at least 3 days. Therefore, sperm can be injected immediately after ovulation. It does not harm, as it has been proven to be viable for up to 7 days.

How does artificial insemination work?

On the appointed day, the couple arrives at the clinic. A woman undergoes an ultrasound. A man gives a sperm sample. Sperm cannot be introduced into the uterine cavity immediately without prior preparation. This is fraught with anaphylactic shock. This type of allergic reaction develops quite rarely, but its course threatens the patient’s life. Sperm preparation (purification and concentration of the viable fraction) takes about two hours.

How is artificial insemination performed? Quickly, painlessly, under sterile conditions. You don't have to worry about this. And the sensations will be minimal - only at the moment the flexible thin catheter passes the cervical canal of the uterus.

The woman moves into the gynecological chair. Speculums provide access to the cervix. Prepared spermatozoa along with the medium are drawn into a syringe and connected to a catheter. With a slight movement of the catheter, they penetrate the uterine cavity and carefully inject the prepared suspension of the “best” sperm from a syringe. On the first day - that's it. The manipulation is completed. And the woman remains in a horizontal position for 15–25 minutes. After which he returns to everyday life.

At a certain time, the manipulation is repeated 1-2 more times. Follicle monitoring continues until ovulation. And after two weeks, the effectiveness of insemination is assessed - the level of the pregnancy hormone - human chorionic gonadotropin - is determined. If pregnancy is not confirmed, AI is repeated in the next cycle.

Efficiency and chances of getting pregnant

The chance of getting pregnant with artificial insemination is higher in women under 30 years of age, with patency of both fallopian tubes and normal ovulatory function. The average effectiveness of one procedure is 18%. This is slightly more than during natural sexual intercourse. The quality of the sperm used plays a significant role in the positive outcome of AI.

Some fertility clinics claim success rates as high as 28%.

Seventy-eight percent of women succeed in becoming pregnant in the first three cycles of insemination. The effectiveness of subsequent procedures decreases sharply. That is why doctors rationally change the tactics of artificial insemination and recommend other IVF methods after three attempts at insemination.

It should also be mentioned that the chances of artificial insemination increase in stimulated cycles.

In recent years, an increasing number of married couples have needed assisted reproductive technologies. Just a few decades ago, despite certain problems, women and men remained childless. Nowadays medicine is developing at a very fast pace. Therefore, if you cannot get pregnant for a long time, you should use a method such as insemination. For those who succeeded the first time, this article will tell you. You will learn about the procedure and how it is carried out, and you will also be able to read reviews from patients who have gone through this stage.

Assisted intrauterine insemination

Artificial insemination is the process of introducing the sperm of her partner into the cavity of a woman’s reproductive organ. This moment is the only thing that happens artificially. After this, all processes are carried out naturally.

Insemination can be performed with the sperm of the husband or a donor. The material is taken fresh or frozen. Modern medicine and the experience of doctors allow a couple to conceive a child even in the most seemingly hopeless situations.

Indications for surgery

The insemination procedure is indicated for couples who cannot conceive a child on their own within a year, and both partners do not have any pathologies. Usually in this case they talk about infertility of unknown origin. Also, indications for insemination will be the following situations:

decreased sperm quality or sperm motility in a man;
erectile dysfunction;
irregular sex life or sexual disorders;
cervical factor of infertility (production of antisperm bodies in the partner’s cervical canal);
age factor (both men and women);
anatomical features of the structure of the genital organs;
impossibility of sexual intercourse without protection (in case of HIV infection in a woman);
the desire to conceive a child without a husband, and so on.

Insemination with sperm is usually carried out in private clinics dealing with assisted reproductive technologies. The procedure requires some preparation and has several stages. Let's look at them.

Exploratory survey

Artificial insemination involves diagnosing both partners. A man must have a spermogram so that specialists can sensibly assess the condition of the sperm. If unsatisfactory results are obtained during the procedure, additional manipulations will be applied. The partner is also examined for the presence of sexually transmitted infections, undergoes a blood test and fluorography.

A woman faces more diagnostics than a man. The patient undergoes ultrasound diagnostics, tests to determine genital tract infections, and provides fluorography. Also, the expectant mother needs to examine her hormonal levels and determine the ovular reserve. Depending on the results obtained, further tactics for working with the couple are chosen.

Initial stage: stimulation or natural cycle?

Before insemination, some women are prescribed hormonal medications. They must be taken in a strictly prescribed dose.

The doctor designates the days when the medicine is administered. It can be in the form of tablets or injections. Hormonal stimulation of the ovaries is needed for women with ovulation disorders, as well as for those patients who have a reduced ovarian reserve. A decrease in the number of eggs may be an individual feature or a consequence of ovarian resections. A decrease is also observed in women approaching 40 years of age.

Both during stimulation and in the natural cycle, the patient is prescribed folliculometry. The woman regularly visits an ultrasound specialist who measures the follicles. Attention is also paid to the condition of the endometrium. If the mucous layer grows poorly, the patient is prescribed additional medications.

Important point

When it is discovered that the follicle has reached the appropriate size, it is time to act. Depending on when ovulation occurs, insemination is scheduled a few days in advance or a couple of hours later. Much depends on the condition of the sperm. If fresh material is used, its administration can occur no more than once every 3-5 days. Therefore, the couple is offered two options:

insemination 3 days before ovulation and a few hours after it;
injection of the material once directly at the time of follicle rupture.

Which method is better and more effective has not yet been determined. Much depends on the health of the partners and the indications for which insemination is performed. Those who succeed the first time with a single injection are not advised to decide on a double injection. And vice versa. The situation is different with frozen sperm or donor material.

Another variant

Insemination by a donor always involves preliminary freezing of the material. Such sperm, after thawing, can be injected in several portions. The effectiveness of this method is slightly higher than fertilization with fresh material.

A partner in a married couple can also freeze sperm. You don't have to become a donor to do this. You need to discuss this issue with a reproductive specialist. During the process, its quality improves, only the best, fastest and healthy sperm are selected. Pathological cells are removed from the material. As a result of manipulation, a so-called concentrate is obtained.

Material introduction process

This procedure takes no more than half an hour. The woman sits in her usual position. A thin catheter is inserted into the cervical canal through the vagina. A syringe with the collected material is attached to the other end of the tube. The contents of the injection are delivered to the uterus. After this, the catheter is removed, and the patient is advised to lie down for another 15 minutes.

On the day of insemination, a woman is prohibited from straining and lifting heavy objects. Rest is recommended. There are no restrictions on the mode for the next day. However, you need to maintain personal hygiene, since after insemination there is a risk of infection.

On the first and second days from the transfer of material, a woman may experience a nagging painful sensation in the lower abdomen. Doctors do not advise taking medications. If the pain seems unbearable to you, then you need to seek medical help. Some patients may also experience slight bleeding. They are associated with minor and possible trauma to the mucous membrane. The discharge goes away on its own and does not require the use of additional medications.

Diagnosis of pregnancy

After insemination is performed, pregnancy should occur within a few hours. After this time, the egg becomes incapacitated. But at this moment the woman still has no way of knowing about her new position. Some patients are prescribed hormonal support. Drugs are always needed in a cycle with stimulation and sometimes in a natural one.

The post-insemination test will show the correct result after 10-14 days. If a woman has undergone stimulation and been given an injection of human chorionic gonadotropin, she can see a positive test immediately after the procedure. However, he does not talk about pregnancy. The reagent on the strip only shows the presence of hCG in the body.

Ultrasound can most accurately confirm or refute pregnancy. But this may not be earlier than 3-4 weeks after the procedure. Some modern devices allow you to get results within 2 weeks.

Insemination: who got it right the first time?

There are statistics of couples who performed such manipulation. The chance of pregnancy ranges from 2 to 30 percent. Whereas in a natural cycle, without assisted reproductive methods, in healthy spouses it is 60%.

A favorable outcome on the first try usually occurs under the following conditions:

the age of both partners is in the range from 20 to 30 years;
the woman does not have any hormonal diseases;
the man and woman have no history of genital tract infections;
partners lead a healthy lifestyle and prefer proper nutrition;
the duration of unsuccessful attempts to conceive a child is less than five years;
no previous ovarian stimulation or gynecological surgery had been performed.

Despite these parameters, success can be achieved in other cases.