Intrauterine insemination - what is this method and when is it used. How the method of assisted reproduction is distinguished

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

This intervention is performed on an outpatient basis. Before insertion of the IUD, a standard examination is performed to identify contraindications. The introduction of an IUD is carried out to achieve contraceptive effect, both parous and nulliparous women.

IUD installation is not performed in following situations:

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

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

Preparation

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

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

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

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

All procedures for installing an IUD usually do not take more than 5-7 minutes. At the end of the procedure, it is recommended to carry out ultrasound control of the location of the IUD. After installation is complete, a short installation period is required. bed rest. If pain occurs during or after the manipulation, the use of analgesics or antispasmodics is indicated.

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

Thus, the installation of an IUD is a frequent outpatient procedure; if all rules and installation techniques are followed, it does not take much time and does not bring any significant discomfort to the woman.

INTRAUTERINE DEVICES (IUD), contraceptives inserted into the cavity.

One of the most effective and acceptable methods of birth control for women who have regular sex life. Even in ancient times, nomadic tribes prevented pregnancy in camels before long journeys by introducing small foreign bodies- pebbles. Attempts to extend this method of contraception to people for a long time were constrained by a significant number of complications. Foreign bodies made of bone, gold, silver caused inflammatory processes in the uterus, disrupted the menstrual cycle and often caused uterine perforation. The problem was resolved with the advent of synthetic materials that are biologically inert to human tissue.

Types of intrauterine devices

There are over 50 types of intrauterine devices (spirals, arcs, loops, springs, etc.), among which the most commonly used are the Lipps polyethylene loop, T-shaped contraceptives containing copper (Cu T-200) or copper and silver, and T --shaped contraceptive Alza-T containing progesterone. Copper-containing and progesterone-containing products can also have the form of the number 7. All of them reliably protect against conception and provide a 95-98% guarantee of pregnancy prevention, do not cause concern, and can be left in the uterus for a long period of time (different for each contraceptive depending on the materials and inclusions ) without frequent and special medical supervision and do not require other precautions.

In those few cases where an unwanted conception does occur, IUDs do not provide harmful effects on pregnancy, childbirth and child health. IUDs have significant advantages over other contraceptives: their use does not require burdensome, sometimes special, preparation before and after sexual intercourse; the female body receives biologically active substances, found in sperm; the high reliability of the method dramatically increases a woman’s sexuality. Most scientists consider the basis of the Navy's actions to be fast track eggs through the fallopian tubes into the uterine cavity (about 5 - 7 times faster than usual), as a result of which the egg does not have time to acquire those qualities that would allow it to penetrate the uterine wall for further development. In addition, the walls of the uterus themselves are not yet prepared for such implantation.

Insertion of intrauterine devices

IUDs are inserted by an obstetrician-gynecologist after a preliminary examination of the woman (bacterioscopy of smears from the cervical canal, vagina and urethra is performed for flora and degree of purity, clinical analysis blood and urine) on the 5th - 7th day of the menstrual cycle; after an uncomplicated artificial termination of pregnancy (see Abortion) - immediately or after the next menstruation; after uncomplicated childbirth - after 2 - 3 months. The introduction of an IUD to women who have suffered inflammatory diseases of the uterus and appendages is carried out 6 - 10 months after treatment, provided there is no exacerbation; for women with a scar on the uterus after caesarean section- 3 - 6 months after surgery, taking into account the course postoperative period. The insertion of an IUD is contraindicated in acute and subacute inflammatory diseases of the female genital organs (see Inflammatory diseases of the genital organs), the presence benign tumors and neoplasms of the female genital organs, uterine malformations, isthmicocervical insufficiency, cervical erosions, menstrual disorders, blood coagulation system.

After insertion of the IUD, it is necessary to observe sexual rest for 7 to 10 days. Control examinations are carried out one week after administration, after the first one, after 3 months, then once every 6 months. Some women, immediately after the introduction of a contraceptive, may experience pain in the lower abdomen, which stops after a few hours or days on its own; in 9 - 16%, spontaneous expulsion of the contraceptive is possible. In case of possible complications ( constant pain, bleeding, inflammatory diseases of the female genital organs, extremely rarely, perforation of the uterus) you should urgently consult a doctor. In the absence of complications, the IUD can be located in the uterine cavity long time depending on the spiral and the substances included in it. With longer use, the properties of the material from which they are made change, and their contraceptive ability decreases. Progesterone-containing products are removed after one year, because by this time progesterone ceases to be released. Before re-inserting the IUD, it is recommended to take a break for 2-4 months, during which it is advisable to use other contraceptives.

Contraindications for the use of intrauterine devices

Navy cannot be used in the following cases:

if the risk of infection is too high various infections and their subsequent sexual transmission;
women suffering from inflammatory diseases of various pelvic organs, as well as post-abortion or postpartum endometritis ;
with purulent acute cervicitis , at chlamydia or gonorrheal infection ;
pregnant women, as well as persons who may be suspected of being pregnant.

In this case, intrauterine devices can be used as postcoital contraceptive within five days following unprotected sexual intercourse. However, IUD is prohibited from use by women who have been diagnosed with endometrial cancer, occur vaginal bleeding pathological nature, as well as persons who have been diagnosed uterine cancer.

The choice of IUD should be especially careful for women suffering from leukorrhea without cervicitis or severe vaginal infection in the stage of relapse, purulent infectious cervicitis . Also, intrauterine contraceptives are not recommended for childless women who are susceptible to great risk become infected with sexually transmitted diseases infectious diseases. Other relative contraindication for IUD use - availability AIDS or other diseases leading to immune system into an unstable condition, as well as illness anemia, although IUDs that include progestins can significantly reduce menstrual blood loss. Intrauterine devices are not recommended for women with painful or heavy menstruation, a small uterus, cervical stenosis, or people who have already had one .

Before introducing intrauterine contraceptives, it is advisable to carry out a gynecological examination, which can reveal contraindications to the use of the IUD such as the pathological structure of the uterus or the presence biomes.

Principles of intrauterine device insertion

If pregnancy is excluded, then intrauterine devices can be inserted at any period of the menstrual cycle. In cases where pregnancy is suspected, it is recommended to wait until the next menstrual cycle. Most often, intrauterine devices are inserted into a woman’s uterus for 3-8 days, at the very beginning of the menstrual cycle or after a certain period after. After giving birth, it is recommended to wait several months before introducing intrauterine contraceptives.

An IUD is inserted in the following situations in the absence of pregnancy:

In the first ten minutes after birth, since subsequently inserting an IUD is already risky due to uterine contractions and there is a significant risk of expulsion
Six months after childbirth, if a new pregnancy is excluded, and the woman during this entire period either refused sexual intercourse or was used during contacts. condom , or the woman used vaginal spermicides
Immediately after an abortion, if it was done earlier than 12 weeks after conception, if an artificial legal or spontaneous abortion is not characterized by complications
Any day menstrual period if the presence of pregnancy is completely excluded, and the woman has previously constantly used any contraceptives

IUD insertion and prophylactic antibiotic therapy

Currently antibiotics for prophylactic purposes are prescribed in cases where a woman is at high risk of contracting sexually transmitted infections. If antibiotic therapy is prescribed, the following factors must be considered:

During this period, a woman should not suffer from infectious diseases of an acute nature, and also have no contraindications to the use of antibiotics and the insertion of an IUD.
Internal reception recommended doxycycline
During breastfeeding, a woman is recommended to take erythromycin

Typically, intrauterine devices are inserted immediately after physiological birth, if they passed without complications, and uterine contractions are normal character, and there should be no risk of uterine bleeding. After delivery of the placenta, intrauterine devices are sequentially inserted manually, their insertion is convenient and safe, and there is no risk of infection. To prevent the development of inflammatory complications, it is necessary to strictly follow the rules of asepsis, which include the mandatory use of long sterile gloves.

This technique for inserting the IUD has by-effect This is an overestimated rate of expulsion of intrauterine contraceptives. At the same time, the probability of occurrence of expulsion frequency in copper-containing IUDs is significantly lower than the same indicator when using a Lipps loop; therefore, further explanations concern only the Sorr r-T 380A products.

Probability of expulsion decreases in the following cases:

if an intrauterine device is inserted into the uterus within the first ten minutes after exit placenta ;
it is necessary to manually free the uterine cavity from blood clots accumulated in it;
intrauterine devices must be inserted manually into the uterine cavity;
The IUD should be placed at the bottom of the uterus, high in its cavity;
The IUD must be inserted experienced doctor;
It is necessary to administer intravenously a drug that causes uterine contractions.

If Sorre r-T 380A threads are administered immediately after childbirth, it is recommended to leave them directly in the uterine cavity. If a woman cannot palpate independently, then the position of the IUD named Sorre r -T 380A is determined by the method of probing the intrauterine cavity. It should be borne in mind that within a month after the previous birth, the onset of a new pregnancy is considered unlikely. If the IUD threads can be palpated during probing, the doctor can easily remove them from the intrauterine cavity and subsequently from the cervix without much difficulty. In all other cases, intrauterine devices, the presence of which is confirmed by probing, can already be left in the uterine cavity without any fear.

Many women immediately after insertion of intrauterine devices note nausea or significant pain, so it is recommended to come to medical clinic together with a spouse or partner, who can accompany the woman home after the procedure.

After the introduction of uterine products, it is necessary to check the position of their threads even before you are about to leave the doctor's office. Learn to independently determine the length of the threads; they usually protrude two centimeters from the external os in the cervix. If, when palpating already inserted IUDs, you can feel their plastic parts, or palpation becomes impossible, the risk of unwanted pregnancy. It is recommended to check the threads regularly for several months after inserting the IUD into the uterine cavity, and if a violation of their position is detected, it is recommended to use additional contraceptives before the next visit to the doctor.

Do not forget about the possibility of developing various inflammatory processes, as well as the risk of infection. For pain in the lower abdomen, fever, various secretions from the vagina, consult a specialist immediately. Remember that such inflammatory diseases are a direct path to or chronic pelvic pain.

Be sure to monitor all changes in menstruation and irregularities menstrual cycle, contact your gynecologist promptly if you have the slightest concern due to poor health. Pay attention to symptoms such as heavy vaginal discharge. mucous membranes or bloody discharge , increased pain during menstruation, the occurrence menstrual bleeding . Remember that the IUD can be removed at any time, just consult a doctor. Do not forget that unpleasant symptoms when using this method of birth control usually appear in the first two to three months after the introduction of intrauterine devices, and then for many women they go away.

Do not try remove the IUD yourself, since safe removal of the intrauterine contraceptive device is possible only by an experienced doctor and only in a sterile clinical environment. Always watch for the following signs:

delayed menstruation- this fact may indicate pregnancy;
the occurrence of bleeding or spotting;
the appearance of pain in the lower abdomen, as well as pain during sexual intercourse;
Availability pathological discharge, infections and inflammatory processes;
general malaise, including symptoms such as chills, fever, weakness;
inability to palpate the IUD threads, their lengthening or shortening.

Complications when using intrauterine devices

Among all cases of IUD extraction, 5-15% immediate cause This fact is the appearance of spotting or bleeding, especially in the first year of using these means to prevent unwanted pregnancy. Symptoms for removing an IUD may include: general weakness, pale skin, discharge blood clots in the period between two menstruation, persistent and prolonged bleeding. In any case, if there is bleeding, it is recommended to remove the intrauterine contraceptive device, even if its insertion is not the cause of the problem.

If any problems arise of various nature, adhere to the following recommendations:

even before entering intrauterine contraception it is necessary to carry out probing with the utmost care, it is important to choose the right probe of the right size;
if severe pain occurs during insertion of the IUD in the subsequent two-day period, as well as during menstruation, it is recommended to remove this intrauterine device; if the pain is not very strong, then you can relieve it with aspirin ;
if partial expulsion of the intrauterine contraceptive device occurs, it must be removed, and then in the absence of pregnancy, if inflammatory processes are not observed, it is recommended to install a new IUD;
in case of inflammatory diseases in a woman of the pelvic organs, it is necessary to remove the IUD, carry out appropriate treatment for at least three months, and then insert a new contraceptive intrauterine device into the uterus;
in case of occurrence severe pain immediately after administration, in case of loss of consciousness, cardiac arrest, convulsions, vaso-vagal reactions must be administered intramuscularly atropine and any painkiller to maintain heart tone, in severe cases the IUD should be removed;
if the presence of an IUD in the uterine cavity causes discomfort due to big size, it can be safely removed and replaced with a smaller intrauterine contraceptive;
in case of spontaneous abortion, you must first diagnose pregnancy, then remove the IUD, then evacuate the uterine cavity, ruling out ectopic pregnancy; if diagnosed ectopic pregnancy, the woman needs to be directed to urgent surgery;
If the intrauterine contraceptive device does not open properly, the IUD must be removed and then a new device must be easily inserted.

Complications when using an IUD include spontaneous expulsion of the intrauterine device, which occurs in approximately 2-8% of cases. as a rule, this occurs in the first year of use. Its symptoms are: unusual vaginal discharge , the occurrence of pain in the lower abdomen, the appearance of intermenstrual bleeding. After sexual intercourse, during expulsion, bleeding and signs of dyspareunia , you should pay attention to the elongation of the threads, as well as the sensation of the intrauterine device in the cervix or in the uterine cavity. Remember that expulsion can not only cause discomfort in a woman, but also be a direct cause of irritation to the penis of her partner.

If you do not observe direct symptoms of expulsion, pay attention to its possible indirect consequences, including the inability to palpate internal threads, pregnancy, and delayed menstruation.

The following objective signs of expulsion can be identified:

location of the IUD in the vagina or cervical canal;
in the case of partial expulsion, elongation of the IUD threads is observed;
with full expulsion, the IUD threads are not visualized;
During probing, X-ray or ultrasound examination of the abdomen and pelvic organs, IUDs are not detected.

If partial expulsion is diagnosed, then the intrauterine contraceptive device must be removed, then if there is no inflammatory process and pregnancy has not occurred, then a new IUD can be inserted immediately after removal of the old one, or wait until the next menstrual period. If complete expulsion is observed and no contraindications are identified, another uterine contraceptive can be introduced. Statistics show that expulsion of intrauterine devices containing progestins is the least likely to occur.

Often women complain about the gradual shortening of the threads, the inability to palpate, as well as the fact that an increase in the length of the threads leads to irritation spouse or partner. These facts indicate either expulsion of the IUD or their transition into the abdominal cavity, so an examination is necessary to determine the position of the threads. Best Method - ultrasonography, allowing you to view the location of the threads with great accuracy.

To restore the normal position of the displaced IUD threads, a spiral is often used. IN in rare cases the cervical canal is examined using narrow forceps, thanks to which an experienced doctor can easily determine the location of the intrauterine contraceptive threads. Such products can not only be felt, but also quickly removed with various medical instruments, including hooks and forceps used for hysteroscopy .

If the IUD threads are located in the internal space of the uterus, it is recommended to remove this contraceptive and then insert a new one - of this variety or another type.

About 30% of cases of unwanted pregnancy during the use of intrauterine contraceptives are directly related to the expulsion of the IUD, but pregnancy occurs even if such a device is present in the uterine cavity. If pregnancy does occur, urgent removal of the intrauterine contraceptive is required, either by pulling the threads or by gentle traction .

in this case the risk doubles miscarriage ;
the risk of developing an ectopic pregnancy increases;
In case of spontaneous miscarriage, the risk of subsequent infection increases significantly.

In the case of IUD insertion, the frequency of uterine perforation ranges from 0.04-1.2%, and this indicator is directly related to the shape and type of intrauterine contraceptives, the technique of their insertion, anatomical features uterine cavity, the position of the IUD, as well as the competence of the doctor. With perforation of the uterus, pain occurs during the insertion of intrauterine contraceptives, then a gradual disappearance of the threads is observed, regular uterine bleeding , and then the possible onset of pregnancy follows.

Quite often, diagnosis is significantly difficult, since external signs of uterine perforation may be completely absent. The development of this fact may be indicated by such objective reasons as the absence of threads inside the cervical canal, the inability to remove this intrauterine contraceptive device even if it is detected, the identification of a displaced IUD during a hysteroscopic, ultrasound or x-ray examination.

The cause of perforation of the neck of the vest is often the expulsion of the IUD. During a gynecological examination, the gynecologist detects a contraceptive in any of the vaginal vaults. If perforation of the cervix develops, the IUD must first be transferred into the intrauterine space and then removed this remedy narrow forceps from the cervix. In the case when an intrauterine contraceptive device is implanted into the cervix, the IUD is removed using conventional techniques. If this contraceptive is located outside the uterine cavity, it is removed by laparotomy or laparoscopic method . A diagnosed pregnancy can be maintained if desired, even if the exact location of the IUD has not been established.

Complications with IUD use include exacerbations chronic diseases uterine cavity. Acute inflammatory processes in women who have given birth occur in 1.5-7% among women who have given birth, and among nulliparous women this indicator is approximately 10%. The presence of inflammatory processes during the use of an IUD quite often becomes a consequence various infections which are usually sexually transmitted, including gonorrhea And chlamydia . The risk of infection when using intrauterine devices is much higher than when using other methods of contraception. In any case, when diagnosing various inflammatory diseases, the intrauterine contraceptive device must be immediately removed, then treated with suitable drugs for two weeks. antibacterial drugs, and subsequently a follow-up examination is necessary.

If the IUD is in the uterine cavity, treatment of inflammatory processes in organs located in the pelvic area is not recommended, since the intrauterine contraceptive must first be removed. Otherwise, there is a very high probability of developing abscesses, sepsis, peritonitis, as well as obstruction of the fallopian tubes. Before introducing a new intrauterine contraceptive device, after eliminating the inflammatory process and its cause, it is recommended to wait three months.

Method of inserting intrauterine devices

Modern technique insertion of the IUD is quite simple; it is performed only in aseptic conditions of the outpatient clinic. The doctor must first perform a thorough gynecological examination in order to accurately exclude the possibility of the patient’s pregnancy and ensure the absence of inflammatory processes, as well as identify the presence of uterine perforation. If the uterus is located retrograde , a more precise study will be required.

The cervix and vagina need to be treated antiseptic solution, including a solution of iodine or benzalkonium chloride. Sensitive women will require intracervical anesthesia, after which cervical forceps must be applied to the cervix, upper lip, and then slowly close them. Next, a uterine probe is carefully inserted into the uterine cavity; when it reaches the bottom of the uterine cavity, a sterile cotton swab is applied to the cervix, which is removed simultaneously with the probe itself.

The intrauterine contraceptive device is inserted into the guidewire, and then the prepared structure is inserted into the uterine cavity through the cervical canal. The gynecologist must perform each action very slowly, using maximum caution. When the intrauterine contraceptive is inserted, all that remains is to trim its threads, and the patient can be advised to palpate the IUD threads immediately in order to know the standard for the location of this contraceptive. In this case, it will be easier for the woman to subsequently identify expulsion if it occurs.

Method of removing intrauterine devices

The time for removing the IUD depends on the type and type of intrauterine contraceptive device, but, as a rule, this device must be removed after three to four years. It is easiest to remove the IUD during the onset of menstruation, since in this case such a procedure is performed relatively easily and as painlessly as possible. The IUD should be removed slowly constant light traction, if natural resistance occurs, you need to probe the uterine cavity, then correctly rotate the probe 90° to dilate the cervix.

IN difficult cases will be required special expanders And preliminary paracervical blockade , expansion is often carried out using kelp . Cervical forceps may be placed on the cervix to hold it securely and allow the uterus to realign. Narrow forceps will help identify IUD threads if it is impossible to visualize them; special ones can be used to examine the internal cavity of the uterus hooks , alligator tongs or Nowak curette . If the patient used the IUD for longer than the prescribed period, it is necessary to take into account the possibility of the intrauterine contraceptive growing into the wall of the cavity itself, as well as a significant narrowing of the cervical canal. Modern techniques for removing an IUD include pain relief. First, the gynecologist must perform paracervical anesthesia by injecting the patient with a lidocaine solution. This action must be performed only in the treatment room, where in a difficult case it will be possible to provide assistance to the patient at any time. emergency assistance, if needed. Paracervical anesthesia is currently used to remove intrauterine devices from previously nulliparous women, as well as at the risk of vasovagal reactions.

Doctors are recommended to carry out the following stages of paracervical blockade in this way:

Before the procedure, it is necessary to examine the patient using special mirrors and then examine it bimanual way;
the mucous membrane of the cervix and vagina must be cleaned with an antiseptic solution;
During the procedure, it is recommended to ask the patient if she has any complaints of dizziness, nausea, tingling in the labia area, ringing in the ears;
treat the cervix, apply forceps to the upper lip, injecting the patient directly into the lip with a solution of lidocaine in the required proportions;
after entering local anesthetic you need to insert the needle into connective tissue under the mucous membrane;
Five minutes after the blockade is completed, you can proceed directly to removing the IUD.

: use knowledge for health

Insemination with sperm is prescribed for a woman who has not yet reached the age of thirty and who has both fallopian tubes in a physiological state. The procedure is significantly cheaper than in vitro fertilization, so it is quite widely used for some problems with conception.

Exist following forms artificial insemination: This is a procedure using the husband's sperm, as well as a procedure using donor sperm.
The first type is resorted to when the husband suffers from impotence, if ejaculation does not occur at all, if there are very few or no healthy sperm in the ejaculate. In addition, if the partner suffers from vaginismus or certain cervical diseases.
The second type is used if the woman is healthy, but there are no live sperm in her husband’s sperm. Or in the case when the husband is a carrier of genes for serious diseases.

Before the sperm is introduced, it is treated in a special way. First, wait until the sperm liquefies. This usually happens twenty to thirty minutes after receiving it. Then it is passed through a centrifuge, settled and damaged and low-quality sperm are screened out using special methods. Thus, treated sperm increases the chances of successful fertilization.
All of the above procedures are carried out only if the woman has completely healthy fallopian tubes with unimpaired patency. Some scientists believe that if fertilization does not occur after three to four procedures, then further attempts are useless and in vitro fertilization should be performed.

You will also need to consult a therapist and receive from him a paper with a conclusion about general condition health. And one of the main tests is the spouse’s spermogram. He will also need to do the same blood tests and sometimes an analysis of the contents from the urethra is prescribed.

In almost all cases, before insemination with her husband’s sperm, the woman undergoes superovulation stimulation. Such treatment is carried out to ripen as many eggs as possible. This will increase the possibility of conceiving the first time. Medications For this treatment, they are prescribed by a doctor based on the individual characteristics of a woman’s body and her hormonal level.
In some clinics, insemination is performed three times in a row. Before ovulation, during ovulation and immediately after it. This technique increases the chance of successful conception. In addition, immediately after the procedure, the cervix is closed with a special device that prevents sperm from leaking out and the woman spends about half an hour (forty minutes) in a lying position.

Despite the fact that this procedure belongs to assisted reproductive technologies, it is very similar to conventional conception. To inject sperm into a woman’s body, a device made of synthetic, flexible and completely safe components is used. After the introduction of sperm into the woman’s body, all other “actions” occur only naturally. The fastest sperm penetrate the fallopian tubes, from there closer to the ovaries, where one of them connects with the egg.
observed on average in fifteen percent of the inhabitants of our planet. This means that approximately eight percent of marriages are infertile. But today there is evidence that the number of people suffering from this disease has doubled. We can talk about infertility when a married couple lives a normal sex life for a year, does not use contraception and does not conceive.

On the territory of the Russian Federation, more than five million representatives of the fair sex suffer from this problem. At the same time, they could get pregnant if they came for a consultation with a gynecologist and they were selected suitable treatment. At the same time, many women do not visit doctors at all and rely on self-healing. The later a woman consults a doctor about infertility, the less chance of successful treatment and pregnancy.

For half a year thorough examinations Doctors must determine the cause of infertility and prescribe appropriate treatment. Tests for hormone levels are also carried out ultrasound examination internal genital organs, an x-ray may be prescribed. In special cases, an examination of the internal genital organs is carried out using a laparoscope. It is imperative to check the quality of the partner’s seed material, since in half of the cases doctors are faced with male infertility.

One of the available and proven methods of treating infertility is artificial insemination. Insemination is indicated for all women who do not suffer from tubal obstruction but having problems conceiving.

At the Ukrainian Scientific and Practical Center for Obstetrics, which is located in the city of Kharkov, they conducted a study of the effectiveness various methods preparing sperm for artificial insemination.

To carry out a successful procedure, one of the main factors is high-quality ejaculate. One of the components of the ejaculate is a substance that significantly reduces the ability to fertilize, affecting certain components of the sperm head. This component is called acrosin, and the more active it is, the higher the chance of fertilization.

Scientists have studied two main ways to prepare sperm for insemination: the method flotation and method centrifugation. The experiment used sperm from fifty-eight men in childbearing age. Each of them had no sexual intercourse for three days before collecting the ejaculate. The sperm was poured into Petri dishes and left to liquefy for an hour. After this, the sperm was stained, and all dishes were divided into three groups: the first was studied in in kind, the second was prepared by flotation, the third was passed through a centrifuge.

Wherein large quantity a substance that suppresses sperm activity was present in untreated sperm. There was slightly less of this substance in the sperm that went through flotation, and in the one that was passed through a centrifuge, there was very little of it.
Wherein highest activity acrosin was observed in centrifuged sperm, and the lowest was observed in sperm that was used in its natural form.
Thus, scientists came to the conclusion that to increase the chances of successful insemination, sperm centrifugation should be performed.

According to some sources, the first artificial insemination was carried out at the end of the eighteenth century. Since then, doctors have had many new opportunities to increase the effectiveness of the procedure, but its principle has remained the same.
Insemination with donor sperm is prescribed in cases where the husband's sperm is completely unsuitable for fertilization, if he does not ejaculate, if he suffers from severe hereditary diseases. Also, a similar procedure is used to impregnate women who prefer same-sex marriage or those who do not have a partner at all.

Insemination with donor sperm is not prescribed in cases where a woman has inflammatory processes in the acute form when she has a non-physiological uterus or diseases that are incompatible with bearing a healthy fetus, blockage of the fallopian tubes, as well as mental illnesses, general or oncological illnesses, for which doctors prohibit giving birth and becoming pregnant.
But if only one fallopian tube is normal, a woman can try to become pregnant using this procedure.

In clinics that provide such treatment, there is a sperm bank. In it you can select sperm from a donor who matches your appearance, age and other indicators. Usually in such cases frozen sperm is used. This makes it possible to avoid infecting the woman with severe infectious diseases, and also allows for ethical precautions to be taken to prevent the woman and the donor from meeting. A similar procedure is carried out both with and without preliminary hormonal preparation.

Artificial insemination is a real chance infertile couples to achieve parental happiness or an unnatural procedure, the chances of success of which are negligible?

Motherhood is the greatest happiness and joy for a woman, her calling and the most natural state. When, for some objective reasons, a woman cannot become a mother, then she comes to the rescue artificial insemination. What is it, what methods of artificial insemination exist, what are the features of the procedure, as well as other issues that concern women will be discussed in this article.

The importance of artificial insemination

Artificial insemination is modern method solving the problem of infertility, when conceiving a child cannot occur naturally. The artificial insemination procedure can be performed for a number of reasons, in which both one or both partners are infertile.

The main indications for artificial insemination are:

polycystic ovary syndrome
endometriosis
low quality of the partner’s sperm, which can manifest itself in low sperm motility, low concentration and a large number of pathological units
hormonal infertility
tubal infertility
infertility, the causes of which are not established

Thanks to progress in medicine, hundreds of thousands of infertile couples can finally experience the joy of motherhood and fatherhood, because artificial insemination makes it possible to have children with forms of infertility that in the past put an end to reproductive function.

Video: In vitro conception

Artificial insemination methods

When it comes to artificial insemination, many people think about the common and popular IVF procedure. In fact, there are several methods of artificially solving the problem of infertility:

ISM is a method in which the sperm of her husband is transferred into a woman’s uterus. This technique applies in cases where reproductive functions women are not impaired and she cannot become a mother due to the low quality of her husband’s sperm or when the mucus in a woman’s vagina is an aggressive environment for the existence of sperm and they die without reaching the egg

ISD - if the husband’s sperm is unsuitable for conception or he is completely infertile, then the spouses are offered the method of artificial insemination with donor sperm. The procedure itself this method practically no different from the previous one: the woman is also injected with sperm into the uterus, but the sperm donor is not her husband

GIFT - when the cause of infertility lies in the fact that the woman’s egg does not come out fallopian tube for fertilization, the method of intratubal transfer of gametes is effective. It consists of transferring an egg previously taken from a woman into the fallopian tube, connected artificially With male sperm. Male reproductive cells can belong to both the spouse and the donor

ZIFT is a method in which a fertilized egg is introduced into the uterus prepared by hormones. First, a healthy egg suitable for conception is taken from a woman by puncture of the ovary and fertilized outside of the female body spermatozoa. The embryo is then inserted through the cervix

ICSI - effective method artificial insemination, which involves fertilizing an egg with a sperm using a very thin needle. Through a puncture of the testicles, the most active sperm is removed and implanted into the egg

IVF is the most common type of artificial fertilization of an egg outside the woman’s body, after which the embryo is implanted into the uterus

IVF method of fertilization

In Vitro Fertilization- modern reproductive technology, which is most often used not only in our country, but throughout the world. What explains such popularity of the method? Firstly, this technique gives the most good results; secondly, with the help of IVF it is possible to achieve pregnancy even in very difficult cases of infertility, when both partners have serious problems reproductive function.

Artificial insemination procedure

IVF requires multiple eggs. But since only one egg can be formed in a woman’s body during one cycle, the amount of egg production is stimulated by hormones.

When an ultrasound determines that the ovary is enlarged and eggs have formed in it, they are removed. After this, the oocytes are washed from the follicular fluid and placed in an incubator, where the eggs are kept until artificial insemination.

If it is not possible to obtain eggs from a woman, then donor eggs are used.

On the same day, sperm are collected, which are obtained by masturbation or interrupted sexual intercourse. Spermatozoa are isolated from the resulting sperm and the most active ones are selected. After this, add to the test tube with eggs required amount active sperm, calculated at 100-200 thousand per egg. It is also possible to use donor sperm.

Within 2-3 hours, the sperm fertilizes the egg. Next, the resulting embryo is placed in a favorable environment, where it remains for 2 to 6 days. All this time, the necessary vitamins, physiological ions, substrates and amino acids are introduced into the test tube. After this, the embryos are directly transferred into the uterus, which is carried out in a matter of minutes on a gynecological chair.

If a woman cannot carry a pregnancy herself, then they resort to surrogacy.

Video: In vitro fertilization. Komarovsky

In vitro fertilization pros and cons

Although IVF opens up the possibility of having children for people suffering from infertility, this procedure can also have Negative consequences, which sometimes become deplorable:

hormonal imbalance
ovarian hyperstimulation
fetal malformations
multiple pregnancy, in which it is necessary to kill “extra” embryos for the survival of at least one or two

In addition, the IVF procedure is an expensive undertaking that not everyone can afford, and sometimes childless couples have to give up any hopes of becoming parents, since the amount is simply unaffordable for them.

On the other hand, in society there is a prejudiced attitude towards the procedure of artificial insemination - “test tube children” are mistakenly mistaken for inferior and developmentally delayed.

Today, the IVF procedure is being improved in many ways. New technologies are used, the exact dosage of hormones is established, which ensures necessary processes and at the same time causes the least harm to the woman’s body.

It is also important that it is extremely rare that a large number of embryos are placed into the uterine cavity, usually only two, which prevents the need to eliminate an extra embryo. And the joy of motherhood itself exceeds everything possible risks and undesirable consequences that the IVF procedure may cause.

How much does artificial insemination cost?

The price of the issue depends on the method of artificial insemination. It may vary in various clinics, but on average the price list looks like this:

IGO from 28 to 40 thousand rubles
IVF from 40 to 100 thousand rubles
ICSI from 100 to 150 thousand rubles

Other methods of artificial insemination are not common in Russia due to lower efficiency.

Artificial insemination of single women

For women who do not have a partner to conceive a child, but desperately want to have a child, the procedure of artificial insemination will help. During this procedure, active donor sperm are placed into the woman's uterus, after which the egg is fertilized.

Immediately before the procedure, the woman undergoes examinations and tests, and, if necessary, hormonal stimulation is performed.

Artificial insemination at home

The artificial insemination procedure can also be performed at home. Its essence lies in the fact that a dose of sperm obtained during ejaculation is injected into the woman’s uterus using a syringe and catheter. Thanks to this manipulation, the chance of fertilization increases significantly, because all the sperm are sent to the egg, whereas during natural fertilization, part of the seed is poured out and neutralized by the vaginal mucus, without even entering the uterus.

To carry out artificial insemination at home, you need sterile:

syringe
catheter
gynecological speculum
pipette
disinfectant
tampons
towel
gynecological gloves

It is important to carry out the procedure during ovulation, which can be determined using a special test.

The problem of artificial insemination

Detailed instructions on how artificial insemination is carried out at home can be obtained from a gynecologist, but it is important to understand that the implementation of such important process at home may carry the risk of introducing various infections into the uterine cavity, due to the possible unsterility of the devices used.

Artificial insemination: reviews

Having analyzed the reviews of women who decided to undergo artificial insemination, several key aspects of the procedure can be identified:

pregnancy does not always occur. There are couples who decided to undergo IVF five or six times in a row, but never achieved their desired goal.
Many infertile women are concerned moral aspect, because the problem of artificial insemination still causes debate in various circles, especially from the church, which considers such events unnatural, and condemns families without children, since they must bear their cross and not go against the will of God

artificial insemination is a colossal burden on a woman’s body, both morally and physically
despite the problems they face married couples However, those who decide to undergo artificial insemination, the positive result and the joy of having a child exceed all the risks and negative aspects, and many are stopped only by the cost of the procedure from having a child artificially again.

Video: Types of artificial insemination

Artificial abortion (abortus arteficialis) - termination of pregnancy when the fetus is not yet viable. This operation can only be performed by a doctor and only in a hospital setting.
Contraindications for surgery induced abortion:
1) gonorrhea - acute and subacute; 2) acute and subacute vulvovaginitis and bartholinitis of any origin, as well as boils on the genitals; 3) erosion in the presence of purulent discharge from the cervix; 4) inflammatory processes of the appendages and pelvic tissue; 5) all local pyogenic and general acute infectious diseases.
Technique of artificial abortion operation. Termination of pregnancy up to 12 weeks (and in nulliparous women up to 10 weeks) is carried out by curettage of the uterine mucosa (abrasio s. excochleatio mucosae uteri) with preliminary dilatation of the cervix. An indispensable requirement before this operation is the examination of smears from the vagina and cervical canal. If gonococci are detected in the cervix or streptococci in the vagina, the operation is postponed and appropriate treatment is prescribed.
Preparation for the operation itself: bowel cleansing with an enema on the day of surgery, shaving hair from the pubis and external genitalia, bowel movement Bladder(the patient can urinate on her own). Soft brush Wash the lower abdomen, womb, inner thighs, perineum and buttocks with soap. Under the stream aqueous solution chloramine (1:1000) or furatsilin (1:5000) from Esmarch's mug, thoroughly wash the external genitalia, after which the vagina is douched with the same solution and then the genital slit is washed again, forcing the patient to push.
Immediately before the operation, the obstetrician performs internal research to determine the position and size of the uterus and the condition of the appendages. After a bimanual examination, the genitals and adjacent parts of the body are finally treated with 5% iodine tincture.
To scrape the uterine mucosa, the following tools are needed: speculums - spoon-shaped, short, and side (during anesthesia), a lift, a set of dilators, 3-4 curettes, 2 forceps, an abortion forceps, 4 pairs of bullet forceps, probes, including a uterine one.
Usually operated under local anesthesia novocaine or a solution of morphine (1% - 1 ml) or pantopon (2% - 1 ml) is injected under the skin half an hour before surgery. In rare cases, with very hypersensitivity pregnant woman has to give general anesthesia(ether).
Local anesthesia is performed as follows. They expose the cervix with mirrors and use bullet forceps; The vaginal vaults should be well exposed, for which you should use side mirrors and a lift.

Figure: Anesthesia for abortion. The neck is retracted.

After disinfection of the cervix and fornix with iodine tincture, a 0.5% solution of novocaine with the addition of adrenaline 1:1000 (1 drop per 10-20 ml of novocaine solution) is administered as a superficial injection at the border of the transition of the cervix into the fornix. 3-4 such injections are made to a depth of 1 cm on each side, forming a closed ring around the neck; in this case, the needle should feel the uterine tissue. After these superficial injections, deep, up to 2-3 cm, injections are made with a long, thin needle. The needle is injected without a syringe (to check whether the needle has entered the vessels) and immersed directly into the parametrium.

Figure: Anesthesia for abortion. The progress of the needle in the parametrium is visible.

Three injections are made on each side, and sufficient quantity novocaine solution, especially at the posterolateral wall of the uterus (in the area of the ganglion cervicale). With this method of pain relief, the operation, especially its most painful moment - dilatation of the cervix, is painless, easy and almost bloodless. For such anesthesia, 60-80 ml of novocaine solution is required.
At the end of anesthesia, the anterior lip of the cervix is grasped with bullet forceps. We recommend that novice doctors also use a second pair of bullet forceps to grasp the back lip. After this, the lift is removed. The cervical canal is lubricated with 5% iodine tincture. The spoon-shaped mirror is replaced by a short one. The cervix is brought down almost to the entrance to the vagina. Then the uterine cavity is probed and measured with a graduated probe. Probing clarifies the data of bimanual examination. The probe must be inserted freely, without force, easily holding it with two or three fingers.
The main stages of the further course of the operation are the expansion of the cervical canal and emptying of the uterus itself.
Hegar dilators are most often used to widen the cervical canal. It is enough to have numbers from 4 to 15, preferably with half numbers (the numbers correspond to the thickness of the expander in millimeters). The dilators are inserted into the cervix in numerical order and each one is left in the canal for half a minute and then quickly replaced with the next one. Starting from No. 8-9, expansion is usually more difficult, resistance is clearly felt internal pharynx. You must be careful at all times and monitor the direction of the dilator (its direction depends on the position of the uterus) so as not to perforate the cervix. Typically, expansion is carried out to No. 12 of the dilator during pregnancy no higher than 8 weeks and to No. 14 during pregnancy from 8 to 12 weeks. The dilator should be inserted as shown in the figure.

Figure: a – Hegar dilators; b – insertion of dilators into the cervical canal.

Expansion should not be done too quickly, as this leads to numerous tears in the neck, which subsequently causes scars and narrowing.
After dilation of the cervical canal is completed, a large curette is inserted into the uterine cavity, which should be held as shown in the figure.

Figure: Curettage of the uterine lining. The anterior lip is captured with bullet forceps and strongly stretched until the angle between it and the uterus is straightened. A curette is inserted into the uterus.

Figure: Position of the curette in the hand when curettage of the uterine mucosa (I. L. Braude). a – insertion of a curette; hold easily between two fingers; b – removal of the curette; hold with your whole hand.

The curette is advanced to the very bottom, and the walls of the uterus are scraped in turn, turning the curette in the desired direction, but without removing it each time. Already with the first movements of the curette, parts appear from the outer opening of the neck ovum. As separated tissue accumulates in the uterus, the curette can be removed, and large parts of the fertilized egg are removed with it. It’s even better to insert a loop-shaped forceps into the uterine cavity, open it slightly there and grab the parts of the fertilized egg that fall between the jaws. It is often possible to immediately capture most of the ovum, which greatly facilitates subsequent manipulation of the curette. Emptying the uterus is completed by repeated curettage with a sharp curette, and then with a small curette (for control) of the corners of the uterus.
As the contents are removed, a decrease in the uterine cavity is clearly felt due to contraction of its muscles; the surgeon feels a characteristic “crunching” sound, indicating that the curette is sliding over these muscles. At the same time, parts of the fertilized egg stop leaving the uterus and “foam” appears - the remains of blood mixed with air. All these signs indicate the final emptying of the uterus, and the operation can be completed. The last movements of the curette check the cervical canal.
Some authors, however, believe that one should not achieve a “crunch” when curettage of the uterus. K.K. Skrobansky wrote about this: “it is quite good to separate the entire chorion, but it is completely in vain and even harmful to separate the entire decidua right down to the muscle.”
Some authors suggest finishing curettage of the uterine and cervical mucosa under the control of fingers inserted into the posterior fornix.

Figure: Curettage of the uterine mucosa and cervical canal; control through the posterior fornix.

We use this method only for flabby uterine muscles to avoid perforation.
At the end of curettage, the uterine cavity is drained with a strip of gauze folded in 3-4 layers (1 cm wide, 12 cm long), inserted into the uterus with long tweezers.
A second strip of the same type, moistened by one third with 5% iodine tincture, is used to wipe the cervical canal; the strips are removed immediately. The vagina and cervix are dried with balls on a forceps, the bullet forceps are removed, the injection sites are lubricated with iodine, and the operation is over.
Complications of an induced abortion operation can be: a) bleeding, b) perforation of the uterine walls, c) inflammatory and septic diseases, d) amenorrhea and infertility.
Bleeding may depend on particles of the fertilized egg remaining in the uterus, from insufficient contraction of the uterine muscles (hypotonia), and in rare cases - from low attachment placenta (chorion). In the first case, bleeding usually does not begin immediately after curettage, but several hours or days later. Treatment consists of repeated curettage; first, you can try hot (40°) vaginal douching with iodine (½-1 teaspoon of 5% iodine tincture per 1 liter of water).
In other cases, bleeding occurs during the operation itself, can be significant and requires immediate assistance. For hypotension during an abortion, we successfully insert an ethereal tampon into the uterine cavity for 5-10 minutes, followed by injection of pituitrin into the cervix. With low placental attachment and with minor hypotonic bleeding, it is good to use tamponade of the cervix and lower part of the uterine cavity. The end of the tampon is moistened with ether or alcohol and left for 3-6 hours.
If, as a result of hypotension, the uterus is stretched and filled with blood clots, massage can be used; and squeeze out the contents with both hands, as shown in the figure.

Figure: Bimanual squeezing of uterine contents.

Perforation of the uterine walls (perforatio uteri sub abortum) during induced abortion is rare; but also these isolated cases should not take place: curettage of the uterus - a serious operation; it must be done carefully.
The causes of perforation may be degenerative or scar changes the walls of the uterus, as well as improper use of instruments during surgery. Perforation can be made with any instrument, but pointed forceps and small curettes are especially dangerous.

Figure: Perforation of the uterus with a forceps. The wound is lacerated (I. L. Braude).

Figure: Perforation of the uterus with a small curette. Puncture wound (I. L. Braude).

Perforation of the uterus can be isolated - without damage to neighboring organs, or with damage to them. Most often, the omentum is captured through the perforation, then the intestinal loops.
In most cases, uterine perforation requires laparotomy; the latter is certainly indicated if injury to neighboring organs caused by a sharp instrument is suspected. Sometimes suturing the perforation hole is acceptable. But if perforation of the uterus caused by a non-sharp instrument (probe, dilator) is noticed in time and the emptying of the uterus is completed, then the patient can be treated conservatively (ice on the stomach, antibiotics, opium orally).
If the perforation hole is decided to be sutured, then it is necessary to expand it, and the uterus should be emptied this way or through a special incision; only after this the hole is sutured. If there is a significant rupture with crushing tissue, supravaginal amputation or complete extirpation of the uterus is performed.
A frequent complication after an induced abortion - infection - can arise from pushing instruments above the internal os of those pathogenic microorganisms that were in the vagina or in the lower part of the cervical canal. As is known, up to 25% of women at the beginning of pregnancy are carriers (in the vagina) of staphylococci and up to 10% of streptococci.
With gonorrheal endocervicitis, there is a danger of pushing gonococci from the cervical canal into the uterine cavity. From here they can easily penetrate the pipes and abdominal cavity, causing acute inflammation appendages (acute salpingitis), acute exudative pelveoperitonitis or even general peritonitis. Tears of the neck when it expands, large wound surface in the uterus after curettage of the mucous membrane, they can be an entry point for pyogenic infection of parametritis post abortum.
More serious are septic complications after abortion (sepsis, septicemia, pyaemia), which, however, occur much less frequently than local inflammatory diseases.
A frequent consequence of undergoing uterine curettage may be amenorrhea, which develops either due to insufficient endometrial regeneration or due to a violation hormonal influences ovary (hormonal injury after abortion).