Preparing for insemination for men and women. Indications and contraindications

Among assisted reproductive techniques, a special place is given to insemination. It allows you to conceive a child in cases where natural fertilization for some reason becomes impossible. We will tell you in this material how insemination is carried out, to whom it is performed and what its effectiveness is.

Peculiarities

Insemination is the process of insemination. During natural sexual intercourse, natural insemination occurs when sperm enters the woman’s genital tract as a result of her partner’s ejaculation at the moment of orgasm. Next, the sperm have a long way to go - to overcome the vagina with an acidic and rather aggressive environment, to overcome the cervix, cervical canal. No more than a third of a man’s reproductive cells will reach the uterine cavity.

In the uterus, the environment for sperm is more favorable, but they still have to pass through the fallopian tube, in the ampullary part of which an egg ready for fertilization awaits them. If at some stage difficulties arise, then not a single sperm may reach the egg and then pregnancy will not occur.

In some forms of infertility associated with immune factors, with endocrine disorders, with male factors, with pathologies of the cervix, insemination naturally is difficult. Therefore, artificial insemination can be used. In this case, the sperm of the husband or donor is injected into the woman’s cervix or uterine cavity using special devices, that is, the procedure takes place without sexual intercourse.

The first experience of insemination was carried out in Italy back in the 18th century. Then the British took up the baton. In the 19th century, doctors in many European countries actively used this method of helping with infertility. In the middle of the last century, doctors learned not only to inject sperm closer to the cervix, but also began to make intrauterine insertions and even insertions into the mouths of the fallopian tubes.

Insemination belongs to the category of techniques artificial insemination, but has nothing in common with IVF (in vitro fertilization). The main difference is that when in vitro fertilization the fusion of sex cells between a man and a woman occurs outside female body. Eggs and sperm go through this stage in a laboratory Petri dish under the constant supervision of embryologists, and after a few days the embryos are transferred into the uterine cavity.

During insemination, human intervention in natural process The only thing is that the sperm is “helped” to overcome particularly difficult areas - the vagina and the cervical canal of the cervix. Thus, into the uterine cavity and fallopian tube hits larger number male reproductive cells, and this increases the chances of pregnancy.

Fertilization itself occurs in natural environment provided by nature - in the wide part of the tube, from where the fertilized egg gradually moves into the uterine cavity. After about 8-9 days at favorable conditions implantation of the descended ovum and the development of pregnancy begins.

The differences between insemination and ICSI (introcytoplasmic sperm injection) are the same as from IVF in general. During ICSI, one selected sperm is manually inserted with a thin needle under the membranes of the egg. The whole process takes place outside the female body, in an embryological laboratory.

Quite often, intrauterine insemination is the first method that is prescribed to couples with some forms of infertility. Sometimes treatment ends there, as pregnancy occurs.

If insemination does not give positive result, the possibility of IVF or IVF + ICSI is being considered.

Kinds

Based on the depth of ejaculate injection, vaginal, intracervical and intrauterine insemination are distinguished. Depending on whose germ cells will be used to fertilize a woman, there are two types of insemination:

homologous– insemination, for which the sperm of the husband or the woman’s regular sexual partner is used;
heterological– insemination, for which the sperm of an anonymous or other donor is used.

The procedure with donor sperm is carried out when the sperm of the spouse or permanent partner recognized as unsuitable for fertilization due to impaired sperm morphology, a small number of live and active sperm, and others severe violations spermograms. Insemination with donor biomaterial is also recommended if a man has severe hereditary pathologies, which can be inherited by the child. A woman who wants a child, but lives alone, without a husband, can also undergo insemination if she wishes.

The procedure with the husband's sperm is carried out if the quality of the ejaculate is good enough for fertilization to occur, but not sufficient for natural conception through sexual intercourse, as well as in case of some female diseases.

Indications

Unlike in vitro fertilization, which theoretically can help large group infertile couples With a variety of reasons for decreased or absent fertility, intrauterine insemination is indicated for a fairly narrow group of patients. These include:

women without a partner;
married couples in which there is a male factor of infertility according to the spermogram;
couples in which the woman has minor pathologies organs of the reproductive system.

Male factors that may require insemination donor sperm, can be caused by the absence of testicles from birth or due to injury or surgery. Also, donor material, in agreement with the spouses, is used if married couple genetic incompatibility has been identified or the man is extremely low quality sperm, which is not amenable to medical and surgical correction.

Insemination becomes a chance to become a father for men who, for some reason, cannot perform a full-fledged act, for example, with paralysis of the lower body, with injury spinal cord. Intrauterine injection of sperm will help solve the problem of conception for couples in which the man suffers from retrograde ejaculation (sperm enters the urinary tract as a result of disruption of the eruption process).

Donation of sperm followed by its cryopreservation for insemination may be required for men who are undergoing a course of treatment for oncology, for example, a course radiation therapy. Your own reproductive cells may be severely damaged as a result of cancer treatment, but frozen sperm will remain unchanged and can be used for insemination if the couple wishes.

To the number female pathologies, which prevent pregnancy from occurring naturally, but can be overcome through intrauterine insemination, include cervical or cervical factors of infertility, in which the passage of the partner’s sperm through the genital tract is difficult, with an immune factor of infertility, if produced a large number of antisperm antibodies, as well as for moderate endometriosis and mild forms of menstrual irregularities.

Sometimes reveal the real reason infertility is not possible - according to the results of all examinations, both partners are somatically healthy. In this case, intrauterine insemination is also used as an experimental measure.

Insemination is recommended for women with vaginismus, in which the insertion of something into the vagina causes severe spasms, with scarring on the cervix caused by previous operations on the cervix or ruptures during a previous difficult birth.

Contraindications

For most auxiliary reproductive technologies and methods, the list of contraindications established by orders of the Ministry of Health is almost identical. As in the case of IVF, a woman who has currently there are acute inflammatory pathologies or chronic diseases have worsened. The ban applies to women with disabilities mental health that require regular or periodic use of psychostimulants.

In the presence of cancer, any benign tumors at the time of the procedure, insemination will also be denied. If a woman is diagnosed with malformations of the uterus and tubes, if she suffers from obstruction of the fallopian tubes, if she has congenital anatomical anomalies of the uterus, vagina, tubes and ovaries, insemination is also denied, because pregnancy in these cases can pose a danger to life and health women.

It should be noted that with one tube or with partial obstruction of the fallopian tubes, insemination can be carried out, but only according to individual indicators, that is, the decision on the advisability of the procedure is made taking into account the degree of obstruction and the chances of success.

Infectious diseases of the husband can also cause refusal to perform the insemination procedure, since there is a possibility of infection of the woman at the time of introduction of the husband’s biomaterial. That is why before insemination it is necessary to carry out thorough examination and undergo a fairly impressive list of tests.

Preparation

If the couple was examined by a gynecologist and urologist and these specialists came to the conclusion that insemination is necessary for conception (indications are indicated above), then the woman’s attending physician gives her a referral for tests and examinations. Before insemination, a woman should undergo general urine and blood tests, a biochemical blood test, tests for sexually transmitted infections, a blood test for HIV, syphilis, blood type and Rh factor.

On the 5-6th day of the menstrual cycle, she should donate blood from a vein for the main hormones responsible for reproductive capabilities (prolactin, FSH, LH, testosterone, estradiol, etc.). A woman must undergo an ultrasound of the pelvic organs, smears from the vagina and scrapings from the cervix. Colposcopy and hysteroscopy are also indicated (if endometriosis is suspected). Tubal patency can be determined by diagnostic laparoscopy or other methods.

A man should have a spermogram with mandatory extended testing for antisperm antibodies and different kinds deviations in spermatogenesis. In addition, the man undergoes general blood and urine tests, and undergoes fluorography of organs chest, donates blood for HIV, syphilis, sexually transmitted infections, urethral smear, donates blood for group and Rh factor.

Intrauterine insemination is included in the state support program for NRT (new reproductive technologies), and therefore you can do it either at your own expense or free of charge, under the compulsory medical insurance policy. In the first case, with a doctor’s report and tests, you can go to any clinic that provides a similar service. In the second case, you will have to wait about a month until the documents submitted by the attending physician to the regional Ministry of Health commission are reviewed.

If a couple is allowed to undergo insemination at the expense of government or regional funds, she will be offered a list of clinics and hospitals that can perform the procedure and have the appropriate license to do so. All you have to do is choose one of them and go there with all the tests and documents to complete the quota procedure.

Order of conduct

To undergo intrauterine insemination, a woman does not have to go to the hospital. This procedure is quite simple and quick. It can be produced in natural cycle or with the use of hormonal drugs that should stimulate ovulation in a woman (if there are violations ovulatory cycle). Whether ovarian stimulation is necessary or not will be decided by a fertility specialist who will receive tests about hormonal background patients.

Ovulation calculator

Cycle duration

Duration of menstruation

Menstruation
Ovulation
High probability conception

Specify the first day last menstrual period

In a natural cycle, a woman will not have to take any hormonal drugs, which sometimes cause unwanted effects in the female body. Negative consequences. She will make her first visit to the doctor after the end of menstruation, donate blood for hormones and will visit the doctor every two days so that follicle maturation is monitored through ultrasound. As soon as the dominant follicle increases to 18-20 mm, an insemination procedure will be prescribed.

Immediately after ovulation, which is perfectly monitored and determined by ultrasound, pre-cleaned and prepared sperm will be introduced into the uterus using a long and thin catheter and a disposable syringe. This procedure is painless, takes no more than five minutes, and does not require anesthesia. For women with increased pain sensitivity may use mild local anesthetics.

If a woman has problems with own ovulation, then the insemination protocol will be very similar to the IVF protocol. First, the woman will receive hormonal drugs that stimulate the maturation of follicles. Up to the 10-12th day of the menstrual cycle, growth will be observed through ultrasound. As soon as the size of the follicle reaches 16-20 mm, the doctor gives the patient a single angle of hCG. This hormone stimulates the maturation of the egg and its release from the follicle approximately 36 hours after the injection.

Immediately after ovulation, sperm will be injected into the uterine cavity through a catheter. During the period of ovulation, the cervical canal opens slightly, which is why a thin catheter can be passed into the uterus without any problems, without resorting to artificial instrumental dilatation of the cervix. This is why the woman does not experience pain.

After stimulating ovulation from the first day, the woman is prescribed progesterone preparations, which help prepare the endometrium of the uterus for the upcoming (possible) implantation of the fertilized egg. For this purpose, drugs such as Duphaston and Utrozhestan are often used. The doctor will tell you in detail how to behave after the procedure.

Before injection, sperm is cleared of seminal fluid and other impurities by settling, washing, and passing through a centrifuge. As a result, only concentrated ejaculate remains. Sperm is freed from immature, defective sperm with poor morphology, from dead and inactive cells. The remaining strong sperm should not live, so they should be injected as quickly as possible. Purified sperm from a husband or donor cannot be frozen, so purification is carried out immediately before injection.

Before donating sperm on the day of insemination, a man is advised to sexual abstinence for 3-5 days, good nutrition, no stress. Alcohol, antibiotics and hormonal drugs are prohibited 2-3 months before insemination. Not worth taking hot bath, visit a bathhouse or sauna. This will help you prepare for the biomaterial in the best possible way.

A woman who has undergone artificial intrauterine insemination is recommended to remain in bed or semi-bed rest for the first two days, not to take hot baths, not to swim, not to go to the bathhouse, and not to sunbathe. You should rest more, get good sleep and eat a balanced diet. Diets won't do any good.

If the doctor prescribes progesterone drugs, they should be taken in a clearly indicated dosage and in compliance with the frequency and schedule. It is unacceptable to skip another tablet or insertion of a suppository.

It is quite difficult, or rather, almost impossible to influence the likelihood of successful fertilization and implantation. These processes are not yet subject to human control. But a calm psychological background, lack of stress, and positive thinking will help increase your chances of success.

If after insemination there appear unusual discharge– bloody, greenish, gray or profusely yellow, you should immediately report this to your doctor.

Don't bother yourself with searching early signs and symptoms of pregnancy - they may not exist. Therefore, doctors recommend going to diagnose pregnancy at the earliest a couple of days before the next menstruation is missed. During this time, you can do a blood test from a vein to determine the plasma concentration of human chorionic gonadotropin hormone - hCG. It is best to start using pregnancy tests that are dipped into a jar of urine at home only on the first day of your pregnancy and later.

A week after the start of the delay, if menstruation does not come, and tests reveal signs of hCG, a confirmatory test should be done ultrasonography, which will accurately establish not only the fact of pregnancy, but also its features - the number of fetuses, the place of attachment of the fertilized egg, the absence of signs ectopic pregnancy and other pathologies.

Feelings after the procedure

Objectively, the sensations after intrauterine insemination are not much different from the sensations of a woman who had unprotected intercourse during the period of ovulation. In other words, there will not be any special sensations on the days that women so expect and hope for after an artificial infusion of sperm.

On the first day there may be a slight nagging pain, which is almost imperceptible. These are the consequences of inserting a catheter into the uterine cavity.

If at this stage there is a strong pull in the lower abdomen, the heat, you need to call " Ambulance", infection or air entering the uterine cavity is possible.

Approximately 7-9 days after the injection of sperm, implantation can occur if fertilization has taken place. However, some women note slight increase temperature, the appearance of aching pain in the lower back and slight light discharge from the genitals of a pink, cream or brownish hue. They are caused by blood entering the vaginal secretion from the damaged endometrium. Functional layer The uterus is damaged when the fertilized egg is inserted into it. This phenomenon is called implantation bleeding.

This does not happen to every woman, and therefore you should not rely heavily on such a sign of pregnancy. In addition, implantation is not always successful, and pregnancy, before it has time to begin, can be interrupted for a great variety of reasons, not all of which are known and understood by medicine in general and gynecology in particular.

If pregnancy does begin, from the moment of implantation the level will begin to slowly accumulate in the body. hCG hormone– it is produced by chorion cells, with which the fertilized egg “clings” to the wall of the uterus. This does not mean that you will immediately begin to feel sick, as some people think. Toxicosis also does not happen to everyone and usually develops a little later.

Among the earliest signs of pregnancy, even before the delay, are increased breast sensitivity, a short-term but daily increase in body temperature in the afternoon or in the evenings to 37.0-37.5 degrees. A woman may think that she has a cold, since a rise in temperature may well be accompanied by a feeling of nasal congestion and frequent urination, although without pain (as with cystitis). This is how progesterone acts in the body, which begins to “accompany” pregnancy from its first hours and “protect” the embryo.

There are women who do not have all of these signs even after pregnancy. And there are more sensitive women who intuitively feel that everything in the body now “works” in a new way. Until objective data from blood tests and ultrasounds is available, it is better to stop worrying and relax.

Efficiency

Most gynecologists quite reasonably believe that regular sex life(at least 2-3 sexual intercourse per week) has exactly the same chances of conception as a one-time injection of sperm through a catheter. If sex life is irregular, then the procedure still increases the chances of pregnancy, but only slightly - no more than 11%.

The likelihood of a successful procedure is lower in women over 35 years of age, since their oocytes are already in a state of natural aging, which implies a decrease in the quality of the germ cells. Even if sperm get to such eggs, they sometimes cannot fertilize them, and if intercourse does take place, then there is a high probability that implantation will not occur or the fertilized egg will be rejected.

According to WHO, the percentage of positive results from the first time of intrauterine insemination does not exceed 13%. On the second attempt, the probability of getting pregnant increases slightly - up to 20%; on the third and fourth attempts, the maximum percentage of positive results is observed - 25-27%. And then there is no increase in positive dynamics. The probability remains stable at 20-22%.

In gynecology and reproductive medicine, it is believed that after the fourth attempt artificial insemination further use of the method is inappropriate - most likely, there are other reasons that prevent pregnancy, the couple needs another examination and, possibly, IVF.

Price

average cost Intrauterine insemination procedures in Russia start from 20 thousand rubles and can reach 60 thousand. The final cost depends on the region, the protocol, and the need to use donor sperm. If ovulation stimulation is planned, the procedure may rise in price by three times the minimum value.

Is the procedure at home possible?

There are special kits for insemination at home. It will be enough for a man and a woman to obtain sperm (through interrupted intercourse or masturbation) and insert it. But such insemination cannot be considered intrauterine. For home administration, only vaginal insemination is possible.

The kit includes a syringe with an extension, which allows you to inject sperm as deep as possible into the vagina so that the concentration of sperm is as high as possible. However, this will not help with cervical factor infertility or low sperm motility.

In addition to the syringe, the kit includes tests with high sensitivity to hCG. They can be used approximately 10 days after ovulation.

Doctors are quite skeptical about such kits, because all the manipulations that the couple is asked to do can be easily carried out during natural sexual intercourse.

Important questions

Many religions frown upon fertilization with donor sperm. In Orthodoxy and Islam, this is considered a violation of the sacrament of marriage, in fact, treason. Before agreeing, think carefully about whether you will then experience moral difficulties. The husband who agrees to inseminate his wife with donor sperm must know that the child will not be his own by genes and blood. And a woman should know that it is impossible to choose a donor; all sperm in cryobanks is stored as anonymous.

But patients will be able to get general information about the donor - age, eye color, height, hair color, occupation, level of education. This will help to at least approximately select a type close to the appearance of the spouse who will have to raise the baby.

Unlike IVF, intrauterine insemination does not make it possible to ensure that the fetus has not inherited genetic diseases that he does not have chromosomal abnormalities, because embryos are not selected, as happens during in vitro fertilization at the stage of preimplantation diagnosis. The insemination procedure also does not allow one to know the sex of the unborn child.

Pregnancy, if it occurs as a result of intrauterine injection of sperm, proceeds without any special features. It is no different from pregnancy that occurs as a result of natural sexual intercourse. A woman will not need to go to appointments more often antenatal clinic, and also pass additional examinations beyond the generally accepted, as happens with women after IVF.

Childbirth can occur either naturally or by caesarean section. A history of insemination is not an indication for caesarean section, it may be prescribed for other reasons and indications.

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 it is the most used and effective method 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 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 in 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 locations 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 irregular structure 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 inflammations 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 for a married couple it can take anywhere from a few 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 most precise method control over 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 married 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 certain times, the manipulation is repeated 1-2 more times. Follicle monitoring continues until ovulation. And after two weeks, they evaluate the effectiveness of insemination - determine the level of pregnancy hormone - human chorionic gonadotropin person. 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.

If a couple decides to use artificial insemination, the first thing they need to do is find a suitable clinic reproductive health, second - go through everything necessary procedures to decide whether the couple can use this reproductive method, the third - in case of a positive answer, either proceed with artificial insemination or first undergo the necessary treatment.

How to prepare for artificial insemination: basic steps

Choosing a clinic

Here, each couple is guided by criteria that are important to them. Some choose by price (lower/higher), some by the reputation of the clinic, some by recommendations from friends, some go to this particular doctor and it doesn’t matter to him where he works.

Procedures for decision making

In the clinic, the decision to carry out artificial insemination is made after the woman and man have undergone certain procedures:

examination by a therapist to assess the health status of women and men, identifying the presence or absence of any diseases;
laboratory tests, namely donating blood for HIV, for the Wasserman reaction, to determine the group and Rh factor, as well as taking vaginal smear in a woman and a smear from the urethra in a man;
functional diagnostic testing: in a woman - to characterize the menstrual cycle and the expected time of ovulation (measured rectal temperature for at least three menstrual cycles, are carried out additional research: colpocytology, tubal patency, dynamic determination of cervical number, postcoital test); in a man - to characterize sperm (a spermogram is done).

Preparing for artificial insemination

A woman’s preparation follows a certain pattern.

On the third to fifth day of the cycle, the ovaries are stimulated with hormonal drugs. On the sixth to tenth day, the doctor regularly monitors the growth of the endometrium and follicles. He does this using ultrasound once every 24 or 48 hours.

As soon as the doctor sees that the follicles are mature and estradiol has reached the required level, the woman stops taking stimulant drugs, she is injected with Chorionic Gonadotropin to induce ovulation, which occurs after the injection 37-40 hours later. The ovaries react to stimulation either very strongly (hyperstimulation) or very weakly (then the doctor may recommend stopping everything and making the next attempt).

On the second day after the injection that causes ovulation, insemination is carried out. This is also when the man donates sperm. This process also has its own rules. Before donating sperm, a man needs to abstain sexually for two to six days, but no more. To clean the urethra, you also need to urinate, wash your hands, and then donate the sperm into a special tube. When the sperm has liquefied, it is specially prepared: the sperm are cleaned from the seminal fluid, cellular waste is removed, and the sperm most suitable for fertilization are selected.

Insemination procedure

Insemination is carried out on a regular gynecological chair. The woman should relax so as not to feel any pain, except perhaps the cold from the catheter, with the help of which sperm are introduced into the uterine cavity. Then you need to lie down for 30-40 minutes and that’s it, you can return to your usual way of life (except you can’t carry heavy objects and make violent love). The doctor may also prescribe the pregnancy hormone progesterone.

Don't lose heart

If this time nothing worked out and after 12-15 days the woman begins her period, she must not lose heart, pull herself together, wait for the next period and prepare for the second artificial insemination. You have six attempts and only when after the sixth you do not get pregnant, move on to another method of fertilization.

The need to have a child is natural for any woman. However, there are many difficulties that can arise even during the period of conception. To increase the likelihood of successful fertilization, you can use artificial insemination. This procedure can even be performed.

Benefits of the procedure

In general, home artificial insemination is a procedure in which artificial insemination is carried out using a syringe or similar device. Unlike other options for artificial insemination, the fusion of sperm and egg occurs inside the female body. When applied, fertilization occurs in laboratory conditions, in which case the eggs are first collected.

Artificial insemination can confidently be called more in a natural way. Because of this, the likelihood of successful fertilization is much higher. In addition, this procedure is much safer and cheaper than other artificial insemination options, and is accessible to absolutely everyone.

The described procedure has a significant advantage even over natural process, that is, before insemination through sexual contact. During normal sexual intercourse, only a small amount of semen enters the uterine cavity, and therefore the likelihood that the sperm will reach the egg is very small. During insemination with a syringe, all the seminal fluid enters the uterus, which is why the female sex cell can be fertilized even after the first time.

The presented method can be used by absolutely everyone, since it has virtually no contraindications. Due to its effectiveness, artificial insemination can be prescribed to people who have certain diseases, preventing natural conception. The procedure can also be used by those who want to increase the likelihood of successful fertilization, even in the absence of any pathologies.

Overall, the benefits of artificial insemination cannot be underestimated, and therefore it is not surprising that this method is often used as an alternative to natural or artificial insemination.

Preparation for the procedure

Despite the fact that insemination is not a complicated procedure, its preparation should be treated extremely responsibly and competently. Otherwise, the likelihood of a positive outcome is significantly reduced.

First of all, preparation for artificial insemination involves medical checkup. It is necessary to undergo it not only for the woman, but also for her partner, since he will act as a sperm donor. The examination is recommended to be carried out no more than 1 year before the proposed procedure. Comprehensive diagnostics the body can take up to 6 months and involves a huge number of tests and procedures.

The main ones are:

Ultrasound of the pelvic organs
tests for the presence of sexually transmitted infections
spermogram
hepatitis test
general urine and blood tests

In addition, during the diagnostic period, the most suitable expected date of conception is determined. To do this, a woman’s menstrual cycle is studied in detail, which is necessary in order to find out the most optimal moment for fertilization. If a woman has certain menstrual problems, she is prescribed hormone therapy aimed at restoration normal function reproductive organs.

After diagnosis and specific appointment temporary period fertilization, it is important to ensure the presence necessary tools for surgery. You can purchase the necessary items separately, but at the moment there are special kits created specifically for insemination at home.

They include the following tools:

FSH test
syringe
catheter
gynecological speculum
pipette
hygiene products

It is also recommended to purchase additional cotton swabs, clean towels and disinfectants. Immediately before the operation, you should visit the bath or shower and thoroughly wash your genitals. This will eliminate the possibility of infection.

In general, preparation for the procedure should be as thorough as possible, since the likelihood of pregnancy depends on this.

Use of ovulation tests

As already noted, it is extremely important to choose the appropriate period of time for insemination. Highest probability success occurs at the moment of ovulation - the process during which the egg is released from the ovaries and moves towards the uterus.

Insemination kits usually include tests for hormones that stimulate follicle function, as well as tests to determine the optimal date for the procedure. To get pregnant, you need to perform insemination a few days before the expected date of ovulation. The procedure must be repeated after 2 days. The operation can be repeated every 48 hours.

You need to do an ovulation test 2 times, with 1 week between tests. On what day of the menstrual cycle the analysis is performed is not a fundamentally important indicator.

To perform the analysis, you need to collect urine in a special container. Determining ovulation is best done using urine fluid collected in the morning, since it contains the most hormones. Place the test strip in the container and wait 10 minutes. If the line that appears is lighter or matches the registration line, the test can be considered positive.

Undoubtedly, determining ovulation using a special test is a very important procedure that has a significant impact on the success of the operation.

Stages of fertilization

After completing the preparatory measures described above, you can proceed directly to the procedure. Artificial insemination is carried out in several stages, at each of which it is necessary to demonstrate maximum caution and attentiveness.

The main stages of insemination:

Collection of material. First of all, you need to prepare the seminal fluid. Ejaculation must be performed in a special container. It is important to remember that the lifespan of sperm is insignificant, and therefore, when stored in the refrigerator, seminal fluid can be used for fertilization no more than 2 hours after receipt. It is not recommended to transport sperm, even in a special container, as this affects its properties.
. To simplify the collection of seminal fluid with a syringe and its further injection into the genital organ, it is recommended to keep it warm for some time. Also, during this period of time, you should cover the container to darken the seed, since exposure to direct sunlight has an adverse effect. Negative influence on the condition of spermatozoa. It is very important not to shake the resulting material. It takes 10-20 minutes to liquefy.
Insemination. Next, you need to draw seminal fluid into a pre-prepared syringe and inject its contents into the vaginal cavity. It is recommended to relax as much as possible. To increase the likelihood of fertilization, the instrument should be placed deeper, but you should not try to reach directly to the uterus, as this is extremely difficult, especially since this can injure the genital organ. The plunger should be pressed in one smooth, slow motion.
The final stage. After injection of the seed, you need to remove the gynecological speculum, if it was used during insemination. You should remain lying on your back for approximately 30-40 minutes. This is necessary for the sperm to reach the uterine cavity, which increases the possibility of pregnancy. For convenience, you can put a pillow under you, after placing a towel on top.

One of the modern assisted reproductive techniques is intrauterine insemination. This is the name for the artificial (outside of sexual intercourse) introduction of sperm into the uterine cavity to increase the likelihood of pregnancy. Despite its rather long history and ease of implementation, this method firmly occupies its niche in treatment certain types. To increase the effectiveness of the procedure, it is necessary to carefully approach the determination of indications and preliminary examination of partners.

Historical reference

Initially, artificial insemination with the introduction of sperm into the vagina was used to inseminate a dog in 1780 by the Italian Lazaro Spalazzi. Published information about obtaining normal and viable offspring inspired the Scottish surgeon John Hunter, practicing in London, in 1790. On his recommendation, a man suffering from hypospadias collected sperm, which was injected into his wife’s vagina. This was the first documented successful attempt at insemination that resulted in a woman becoming pregnant.

Since the second half of the 19th century, artificial insemination has become quite widely used to treat infertility in many European countries. Initially, native sperm was injected into the woman posterior arch vagina. Subsequently, techniques were developed involving cervical irrigation, intracervical administration, and the use of a special cervical cap.

In the 1960s Methods for extracting enriched and purified portions of sperm have been developed. This gave impetus further development reproductive technologies. To increase the likelihood of conception, sperm began to be injected directly into the uterine cavity and even into the mouths of the fallopian tubes. The method of intraperitoneal insemination was also used, when a portion of prepared sperm was placed directly to the ovary using a puncture of the pouch of Douglas.

Even the subsequent introduction of complex invasive and extracorporeal reproductive technologies did not lead to the loss of relevance of artificial insemination. Currently, intrauterine sperm injection is mainly used, and this technique often becomes the first and successful way to help infertile couples.

Indications for intrauterine insemination

Artificial intrauterine insemination can only be used in a certain group of infertile couples. Determination of indications and contraindications with a forecast of the effectiveness of the procedure is carried out after examination of both sexual partners. But in some cases, a reproductive health assessment is required only for the woman. This happens if you want to get pregnant out of wedlock or if a man has insurmountable obstacles to spermatogenesis (the absence of both testicles for some reason).

In the Russian Federation, when deciding on the advisability of insemination with the sperm of a husband or donor, they rely on Order of the Ministry of Health of the Russian Federation No. 67 of February 26, 2003. Testimony from the woman and from her sexual partner (husband) are distinguished.

Intrauterine insemination with frozen donor sperm is used when the husband has hereditary diseases with an unfavorable medical-genetic prognosis and for sexual-ejaculatory disorders if they are not amenable to therapy. Another indication is that a woman does not have a permanent sexual partner.

Intrauterine insemination with husband's sperm (native, pre-prepared or cryopreserved) is carried out for cervical factor infertility, vaginismus, infertility unknown origin, ovulatory dysfunction, mild degree. The male factor is moderate ejaculatory-sexual disorders and the presence of subfertile sperm.

Like others auxiliary techniques, insemination is not carried out in the presence of active inflammatory process, infectious disease or malignant tumor any localization. Reasons for refusal may also include some mental and somatic diseases, if they are a contraindication to pregnancy. Insemination cannot be used in the presence of severe developmental defects and pathologies of the uterus that prevent bearing a child.

Methodology

Intrauterine insemination does not require the woman to be hospitalized. Depending on the type of infertility, the procedure is performed during a woman’s natural or stimulated cycle. The protocol for hormonal stimulation of hyperovulation is determined by the doctor and is most often similar to that in preparation for.

A thorough examination of partners is carried out in advance to identify the most probable cause infertility. Attempts are necessarily made to treat and correct identified deviations with repeated monitoring of the results. Only after this can a decision be made on the need for insemination with an assessment of the need to use donor frozen sperm.

There are several stages of the procedure:

using a protocol for stimulating hyperovulation in a woman (if necessary);
and laboratory monitoring of the onset of natural or stimulated ovulation;
collection of sperm from a sexual partner or defrosting of cryopreserved sperm of a donor (or husband) is carried out during the periovulatory period;
preparing sperm for insemination;
injection of the resulting portion of the material through the cervical canal into the uterus using a syringe with an attached thin catheter.

The intrauterine insemination procedure itself is short and painless. To facilitate access and provide visual control, the doctor usually uses vaginal speculum. The cervix usually does not require additional dilation; the small diameter of the catheter allows it to be passed through the cervical canal, which is slightly open during ovulation, without much difficulty. However, sometimes the use of small diameter cervical dilators is required. For insemination, semi-rigid or flexible catheters with a “memory” effect are currently used.

Intrauterine sperm injection is performed without the use of any means of visualizing the position of the catheter tip. During the procedure, the doctor focuses on his sensations when passing through the cervical canal and pressing the syringe plunger. Upon completion of the injection of the entire portion of prepared sperm, the catheter is carefully removed. After intrauterine insemination, it is advisable for a woman to lie on her back for 30 minutes. At the same time, the doctor must monitor the appearance of signs of a severe vasovagal reaction and anaphylaxis, providing emergency assistance if necessary.

Sperm preparation

Intrauterine insemination is a simple, painless and non-invasive way to increase the chances of fertilization of an ovulating egg. In this case, sperm do not have to survive in the acidic and not always favorable environment of the vagina and independently penetrate through the cervical canal of the cervix. Therefore, even insufficiently active male germ cells have the opportunity to participate in fertilization. And a high concentration of sperm artificially created in the uterine cavity significantly increases the likelihood of conception.

When performing intrauterine insemination, the sperm of a woman's sexual partner or frozen biological material from a donor is used. The choice depends on the quality of the ejaculate, the presence of contraindications to the use of the husband’s biomaterial (for example, in the presence of severe genetic abnormalities) and other criteria. Special requirements There is no need to collect native sperm. But it is advisable to obtain ejaculate at a medical institution for its fastest and most gentle transportation to the laboratory.

The sperm intended for insemination undergoes a short preliminary preparation. Usually it lasts no more than 3 hours. Preparation is necessary to select viable sperm and obtain the most purified material possible before introducing it into the uterine cavity. Sperm taken from a sexual partner or donor is examined in accordance with WHO standards to clarify the quantity and quality of sperm and assess the prospects of its use for insemination (we wrote about the main method of sperm analysis in our article “”). After this, the native ejaculate is left for 30 minutes to naturally liquefy, and the thawed sample can be immediately processed.

To prepare sperm, one of the following methods can be used:

floating, based on the active movement of motile and viable sperm on the surface of the washing medium;
washing with drugs to increase sperm motility (pentoxifyllines, methylxanthines);
centrifugation of a diluted sperm sample to create a density gradient;
filtration of a washed and centrifuged portion of ejaculate through glass fiber.

The choice of method for preparing the material depends on the content of morphologically normal and mature germ cells, as well as on the class of their motility. In any case, the sperm processing technique used for intrauterine insemination should ensure maximum complete removal seminal plasma. This is necessary to prevent the development anaphylactic shock and other undesirable reactions from the woman’s body. Along with the seminal plasma, antigenic proteins (proteins) and prostaglandins are removed.

It is also important to free the ejaculate from dead, immature and immobile sperm, leukocytes, bacteria and impurities epithelial cells. Competent preliminary preparation provides sperm protection against the formation of free radicals oxygen and maintains the stability of the genetic material of cells. As a result of processing, the specialist receives a sample with the maximum concentration of sperm suitable for fertilization. It cannot be stored and must be used the same day.

Artificial insemination at home

Sometimes intrauterine insemination is performed at home, in which case the couple uses special set and native fresh ejaculate. But sperm is not introduced into the uterine cavity in order to avoid infection and the development of anaphylaxis. Therefore, this procedure is actually vaginal. The kit for intrauterine insemination at home most often includes urinary tests for, FSH and hCG levels, a syringe and an extension for it, a vaginal speculum, and disposable gloves. The sperm is drawn into a syringe and inserted deep into the vagina through an extension. This allows you to create high concentration sperm near the cervix.

After the procedure, the woman must maintain horizontal position with the pelvis elevated for at least 30 minutes to avoid leakage of sperm. Orgasm increases the likelihood of pregnancy, because it promotes contraction of the vaginal walls and changes the patency of the cervical canal.

The kit also includes highly sensitive pregnancy tests. They make it possible to detect a specific increase in the level of hCG in the urine already on the 11th day after insemination. At negative result and delayed menstruation, the test is repeated after 5-7 days.

Efficiency of the method

According to the European Society of Human Reproduction and Embryology, the prognosis for pregnancy after a single intrauterine insemination is up to 12%. However, repeating the procedure in the same cycle only slightly increases the likelihood of conception. The effectiveness of insemination is most strongly influenced by the time it is carried out; it is advisable to carry out the procedure as close as possible to the time of ovulation. Depending on the individual characteristics, the periovulatory period begins already on the 12th day of the ovarian-menstrual cycle or falls on the 14th – 16th days. Therefore, it is very important to determine the time of expected ovulation as accurately as possible.

To plan the date of insemination, the results of transvaginal ultrasound monitoring of follicle maturation and dynamic monitoring of the level of luteinizing hormone in the urine are used. The same studies allow you to choose the time for injection of drugs based on human chorionic gonadotropin - the main trigger of ovulation during the stimulating protocol. Ovulation usually occurs 40-45 hours after the urinary peak in luteinizing hormone levels. It is during this period that it is advisable to carry out intrauterine insemination.

The success of the procedure is influenced by the type of infertility, the parameters of the sperm used during insemination, and the age of the partners. The condition of the fallopian tubes, the thickness and functional usefulness of the endometrium in the current cycle are also important. To make a preliminary prediction of insemination, sometimes on the day of the procedure, a woman undergoes a three-dimensional ultrasound to determine the volume of the endometrium. A volume of 2 ml or more is considered sufficient for implantation of the fertilized egg.

The stronger the fertility of the sperm used for artificial insemination, the higher the chance of a successful pregnancy. The most important parameters are sperm motility with the possibility of their targeted movement, correct morphological structure and maturity of germ cells.

Insemination is indicated for mild to moderate male factor infertility, when no more than 30% of abnormal or inactive sperm are found in the ejaculate (according to WHO standards). To assess the prospects of using sperm for intrauterine injection, the sample obtained after processing is analyzed. And most important indicator this is the total number of motile sperm.

Risks and possible complications

Intrauterine insemination is a minimally invasive reproductive technique. In the vast majority of cases, it does not cause the woman any obvious discomfort and passes without complications. However, the risk of developing various adverse events still exists.

Possible complications of this procedure include:

pain in the lower abdomen immediately after the introduction of prepared sperm, which is most often associated with the reaction of the cervix to the endocervical advancement of the catheter and to mechanical irritation of tissues;
vasovagal reaction of varying severity - this condition is associated with a reflex reaction to manipulation of the cervix, which causes dilation peripheral vessels, decreased heart rate and decreased blood pressure;
general allergic reaction to compounds contained in washing media, the most common allergens are benzylpenicillin and bovine serum albumin;
ovarian hyperstimulation syndrome, if insemination was carried out against the background of provocation of superovulation;
infection of the uterine cavity and pelvic organs(less than 0.2% chance) due to insertion of a catheter or use of cervical dilators.

Separately, complications associated with pregnancy occurring after insemination are distinguished. These include multiple pregnancy(when using a protocol with stimulation of hyperovulation), and spontaneous abortion in the early stages.

Intrauterine insemination may not give a positive result in the first reproductive cycle. The procedure can be repeated up to 4 times, it will not have any effect on the woman’s body negative impact and won't be the reason severe complications. If the method is ineffective, the issue of IVF is resolved.