Insemination contraindications. What is artificial insemination? Artificial insemination with ovulation stimulation

All large quantity married couples in last years need assisted reproductive technology. A few decades ago, with some problems, women and men remained childless. Now medicine is developing at a very fast pace. So if you can't for a long time to become pregnant, it is worth using a method such as insemination. Who succeeded the first time, the presented article will tell you. You will learn about the procedure and how it is carried out, and you will also be able to read the reviews of patients who have passed this stage.

Assisted intrauterine insemination

artificial insemination is the process of insertion into the cavity reproductive organ a woman's sperm from her partner. This moment- the only thing that happens artificially. After that, all processes are carried out naturally.

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

Indications for the operation

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

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

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

Exploratory survey

Artificial insemination involves the diagnosis of both partners. A man must pass a spermogram so that specialists can reasonably assess the condition of sperm. If unsatisfactory results are obtained during the procedure, additional manipulations will be applied. Also, the partner is examined for the presence of sexual infections, takes a blood test and fluorography.

The woman is to big diagnostics than a man. The patient undergoes ultrasound diagnostics, tests to determine genital tract infections, and provides fluorography. Also expectant mother needs to be explored hormonal background, determine ovular reserve. Depending on the results obtained, further tactics of working with the couple are chosen.

Initial stage: stimulation or natural cycle?

Before insemination, some women are prescribed hormonal drugs. You need to take them in a strictly prescribed dose.

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

Both during stimulation and natural cycle, the patient is prescribed folliculometry. The woman regularly visits a specialist ultrasound diagnostics, which measures the follicles. Attention is also drawn to the state of the endometrium. If slime layer grows poorly, then the patient is prescribed additional medications.

Important point

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

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

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

Another variant

Insemination by a donor always involves pre-freezing of the material. Such sperm after thawing can be introduced in several portions. Efficiency this method slightly higher than fertilization with fresh material.

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

Material introduction process

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

On the day of insemination, a woman is forbidden to strain and lift heavy objects. Rest recommended. There are no restrictions for the next day. However, personal hygiene must be observed, since after insemination there is a risk of infection.

On the first and second days from the transfer of the material, a woman may experience pulling pain in the lower abdomen. Doctors do not advise taking medications. If the pain seems unbearable to you, then you need to seek medical care. Also, some patients may have minor spotting. They are associated with a small and the possibility of trauma to the mucous membrane. Allocations pass independently and do not require the use of additional drugs.

Pregnancy diagnostics

After insemination, pregnancy should occur within a few hours. After this time, the egg becomes incapacitated. But at this moment, the woman still cannot find out about her new position. Some patients are given hormonal support. Preparations are always needed in a cycle with stimulation and sometimes in a natural one.

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

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

Insemination: who succeeded the first time?

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

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

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

Despite these parameters, success can be in other cases.

One of the first methods of assisted reproductive technology was artificial insemination. Tested back in 1790, she successfully copes with the task assigned to her today, allowing many childless couples to conceive a baby.

Artificial insemination is a manipulation in which the internal genital organs of the patient are introduced seminal fluid. Natural insemination occurs during intimacy. artificial procedure carried out in a clinic, it excludes sexual intercourse.

The artificial insemination procedure is used as an alternative to in vitro fertilization. These methods are fundamentally different from each other. After all, the IVF method involves the fertilization of an egg with a sperm cell outside the woman's body in a laboratory. Whereas with AI, conception occurs in vivo- V female body. Depending on which infertility factor is identified, the doctor will recommend that the woman undergo artificial insemination or IVF.

Appointment of AI is possible in two cases:

feminine or male infertility caused by disease reproductive system;
The desire of a woman who does not have a permanent sexual partner to become a mother.

Consider what indications for insemination women have.

vaginismus

Pathology caused by spasms vaginal muscles that occur during any penetration into the vagina. During intimacy, a gynecological procedure, or even the use of a tampon, a woman experiences pain that is provoked by muscle contractions.

Endocervicitis

The disease is caused by inflammatory processes occurring in the mucous membrane of the uterine cervix. They can call her infectious lesions, trauma to the genitals, non-compliance with personal hygiene, hormonal disbalance and other factors.

Incompatibility

The immune system of a woman sees a danger in her husband's sperm, perceiving them as foreign agents. Immunity instantly attacks aliens, so most often they do not even have time to even “run” to the egg.

Operations on the cervix

After any surgical intervention scars form on the tissues. The remaining "passage" through which the representatives of the seminal fluid must move depends on their size and quantity. If it is too small, the sperm will not be able to pass the “obstacle” and meet the egg.

Abnormal location of the genitals

The structure of a healthy female reproductive system is completely subordinated to possible conception. If the location of the organs or their shape does not correspond to the norm, the spermatozoa will not be able to perform the functions assigned to them by nature.

Estrogen deficiency

Protection for a very vulnerable female reproductive system from pathogenic microflora, infections and bacteria is thick and viscous mucus, which is located on the cervix. It does not allow spermatozoa to penetrate beyond the prescribed border, excluding conception. However, healthy woman by the time ovulation occurs, the mucus begins to change consistency, becoming less viscous. On the day of ovulation, it is so “thinned” that seminal fluid easily overcomes all obstacles, following the intended route.

The main reason for this "behavior" of uterine mucus is the increased production of estrogen at the time of ovulation. With hormonal disorders right amount hormones do not enter the body, so there is no one to influence the concentration of mucus.

Unexplained infertility

If after the diagnostic measures It was not possible to find out the cause of infertility, the doctor suggests an IUI (intrauterine insemination). It is difficult to say exactly how effective this technique will be in this case: sometimes, after several unsuccessful attempts, a couple is sent to IVF.

Violation of ovulatory function

Conception can only occur in ovulation period. If for some reason it does not occur, a woman cannot become a mother without an appropriate medical adjustment.

male factor

The technique of artificial insemination is also shown for male problems:

With varicocele;
teratozoospermia;
azoospermia;

Availability genetic diseases spouses have another indicator to conduct AI.

Insemination with sperm is not prescribed in the following cases:

A woman has an inflammatory process in the pelvic organs;
There are sexually transmitted diseases;
Complete obstruction of the fallopian tubes or their absence.

Husband's or donor's sperm?

From the one whose sperm will be used in AI, there are two types of procedures:

homologous;
Heterological.

If the man is healthy, homologous artificial insemination is performed with the husband's sperm (IISM). When a woman's spouse has pathological disorders reproductive health or the patient does not have a permanent sexual partner, heterologous insemination is used donor sperm(IISD).

The technique for performing the procedure remains the same, regardless of whether donor sperm or freshly collected biological material was used.

Preparation

Before artificial insemination, the couple must undergo thorough examination which includes consultation narrow specialists And laboratory research. Such a detailed examination of the condition of the female and male body is needed to maximize the chances of a successful procedure and a successful pregnancy.

Preparation for artificial insemination begins with a visit to narrow specialists:

therapist;
Gynecologist;
Andrologist;
Urologist;
mammologist;
Endocrinologist.

If diseases are detected, the doctor will prescribe additional consultations of specialists and appropriate treatment. Be sure to take tests before insemination. Their results will allow us to assess the general condition of the patient and exclude dangerous pathologies.

Before the procedure, the following laboratory tests are carried out:

General blood analysis;
Analysis of urine;
Biochemistry of blood;
Study for STIs;
On sex hormones;
On the Rh factor.

Spermogram allows you to evaluate the quality of spermatozoa and the possibility of their use.

According to indications, the following procedures are carried out:

Hysterosalpingography;
Laparoscopy;
Bisterosalpingoscopy;
Biopsy of the endometrium.

Also, before the AI procedure, an ultrasound examination of the uterus and fallopian tubes, ovaries, kidneys, mammary glands and heart is prescribed. Particularly important are indications ultrasound at . The essence of the study is to track the maturation of follicles and the onset of ovulation for several months.

When preparing for AI, the partner should give up alcohol and cigarettes. It is also important to refrain from intimacy 3-4 days before insemination.

How is the insemination procedure

Artificial insemination is carried out by four methods:

intravaginal;
Intrauterine;
in-line;
Intrauterine intraperitoneal.

The intravaginal method is the simplest, requiring little preparation. He looks like natural process insemination. Fresh sperm or frozen donor biological material is used.

The procedure is being carried out in the following way. The woman is in gynecological chair or on a special table. Expanding speculums are inserted into her vagina, which allow easier access to uterine cervix. The doctor collects the prepared sperm into a syringe with a blunt tip, brings it as close as possible to the cervix and “injects” it onto the mucous membrane. The instruments are removed, and the woman remains lying on her back for 1 hour to prevent leakage of seminal fluid. The procedure is then considered completed and the patient is sent home.

The intrauterine method is considered more effective. After dilating the vagina with the help of speculums, semen is drawn into a syringe, to which a thin and long insemination catheter is attached. It is injected into the uterine cavity through the cervix, and then the sperm is squeezed out of the syringe.

The procedure involves the use of purified sperm. Fresh sperm most often cause a strong contraction of the muscles of the uterus, and the chances of conception are reduced. A severe allergic reaction is also possible.

The intratubal method of insemination consists in the introduction of purified sperm into the fallopian tubes, where the egg is located.

The intrauterine intraperitoneal procedure involves the introduction into the uterine cavity under slight pressure of a special liquid with purified spermatozoa. This method "guarantees" the penetration of the solution into abdominal cavity through the fallopian tubes. Therefore, the chances of conception increase, because the flow of seminal fluid passes along the entire path of the egg.

This AI technique is performed if the woman has no cause for infertility or previous techniques have been ineffective.

Does artificial insemination hurt? No, the procedure is painless. Some women may feel some discomfort during the insertion of the speculum, which will disappear immediately after insertion. For patients with vaginismus, the procedure is done by first plunging it into a drug-induced sleep.

Depending on the factor that caused infertility, artificial insemination is carried out with a focus on natural biological rhythms women or with ovarian stimulation. Consider their features.

In the natural cycle

Artificial insemination in the natural cycle is carried out during the periovulatory period. This is the time when the egg leaves the follicle and moves to the uterus. Therefore, before the procedure, it is extremely important to calculate the day of the cycle when a woman will ovulate. Calculations can be carried out in several ways: measure rectal temperature Or use ovulation tests. However, the most effective way determining ovulation is considered an ultrasound, which is done at intervals of 1-3 days, so as not to miss the "X day". This series of studies is called folliculometry.

Ideally, if artificial intrauterine insemination is performed several times. The first procedure - a day or two before the expected ovulation, and the second - directly on the "X day". To increase the chance of conception, AI may be performed again after ovulation.

With ovarian stimulation

Insemination with ovarian stimulation is indicated for women with menstrual cycle. Before it is carried out, the patient takes a number of hormonal drugs that "build" the desired concentration of hormones.

Stimulation of ovulation leads to maturation maximum number follicles, therefore, increase the chances of an attack on conception.

The procedure is carried out under strict ultrasound control, may be accompanied by side effects such as ovarian hyperstimulation.

Feelings after the procedure

The processes occurring in the uterine cavity after artificial insemination are no different from natural insemination. The chances of pregnancy occurring are approximately 15-20%. Moreover, according to statistics, they increase when the procedure is performed a second time.

If your stomach hurts 3-4 hours after insemination, you should not worry: the symptom is caused by irritation of the walls of the uterus and will pass on its own. And here vaginal discharge after the procedure should not be. If white discharge appears after insemination, this means that some of the injected seminal fluid has leaked out, reducing the likelihood of conception.

The assessment of the success of the procedure carried out on the 10th day after insemination. You can also do this at 14 dpo. However, the appearance spotting from the vagina, which are accompanied pulling pains in the lower abdomen, indicate that conception did not take place.

The first signs of pregnancy after insemination are no different from those that a woman feels during natural conception: morning sickness, general malaise, lack of menstruation. You can confirm "pregnant" symptoms with a pregnancy test or a blood test for hCG.

How much does artificial insemination cost

Each clinic sets its own cost for the procedure. Some calculate the total amount, regardless of the number of manipulations performed (from 20,000 to 25,000 rubles). Others indicate the cost specific procedure, and at the end of the process, the total price is calculated.

The AI procedure can be done under compulsory health insurance for free.

Artificial insemination at home

Without medical control artificial insemination makes sense only if the woman is healthy and uses donor sperm. The fact is that only the vaginal procedure can be performed at home. Intrauterine insemination without ultrasound guidance can not be done. Therefore, the use of this method at home in the treatment of infertility is meaningless.

Insemination the process of entering the male seminal fluid is called ( sperm) in the female reproductive tract. Other favorable conditions after insemination, one of the male germ cells ( sperm) will merge with the female reproductive cell ( ovum), that is, the process of fertilization will occur. In the future, an embryo will begin to develop from a fertilized egg ( fetus).

If the described process occurs during natural intercourse, we are talking about natural ( natural) insemination. At the same time, artificial insemination can be used to develop pregnancy.
In this case, pre-obtained male seminal fluid is injected into the female genital tract. by artificial means (by using special devices and technician), which can also lead to artificial insemination eggs and pregnancy. Sexual intimacy ( sexual contact) is excluded.

How is artificial insemination different from IVF and ICSI?

Artificial insemination and IVF ( in vitro fertilization) are two completely different procedures performed in order to achieve pregnancy. The essence of artificial insemination has been described previously ( male seminal fluid is injected into the female genital tract, which fertilizes the egg in the woman's body).

During in vitro fertilization, the process of fusion of male and female germ cells occurs outside the body of the expectant mother. Pre-obtained eggs are placed in a test tube, where they are created optimal conditions that support their livelihoods. Then pre-obtained male germ cells are added to the same test tube ( spermatozoa). Through certain time one of the sperm enters the egg and fertilizes it. After that, the fertilized egg is injected into the uterine cavity and attached to its walls. Further pregnancy develops as usual.

One of the varieties in vitro fertilization is an intracytoplasmic sperm injection procedure ( ICSI). Its essence lies in the fact that a pre-selected and prepared sperm is injected directly into the female germ cell, which increases the chances of their successful fusion. If fertilization is successful, the fertilized egg is also placed in the uterine cavity, after which a normal pregnancy begins to develop.

Is it possible to choose the sex of a child with artificial insemination?

It is impossible to choose or predetermine the sex of a child with artificial insemination. The fact is that the sex of the unborn child is determined only when the male and female germ cells merge. The first sex cells in developing embryo begin to appear at the fifth week of pregnancy, while the external and internal genital organs are laid only at the 7th week prenatal development. Since the process of artificial insemination only controls the process of introducing seminal fluid into the mother's body, and not the process of fusion of germ cells, the doctor cannot predict or determine which particular spermatozoon will fertilize the egg. That is why it is impossible to somehow influence the sex of the unborn child with this procedure.

Indications for artificial insemination with husband's sperm ( homologous insemination) or donor ( heterologous insemination)

The need for artificial insemination may be due to various diseases of a man or woman, as well as the desire of patients. Depending on whose seminal fluid ( sperm) will be introduced into the genitals of a woman, homologous and heterologous insemination is isolated.

They speak of the homologous method in cases where the seminal fluid of the husband or the woman's permanent sexual partner is used during the procedure.
If the woman does not have a permanent sexual partner, and also if his sperm cannot be used for fertilization ( because of various diseases or anomalies), donor sperm can be injected into the uterine cavity. In this case, we are talking about heterologous insemination.

It is worth noting that regardless of whose seminal fluid is used for fertilization, the technique for performing the procedure does not change.

Testimony from a woman infertility)

The procedure can be performed both if the woman has diseases that make natural insemination impossible, and under other circumstances.

Indications for artificial insemination by a woman are:

Vaginismus. This is a disease of a woman in which the penetration of something into the vagina causes severe spasm ( reduction) muscles, which is accompanied by severe pain. Pain can occur both during sexual intercourse and when using hygienic tampons. It is extremely difficult or even impossible for such women to conceive a child naturally, as a result of which they may resort to artificial insemination. During the procedure, a woman can be put into a medical sleep, as a result of which she will not experience any pain.
Endocervicitis. This is an inflammatory disease in which the mucous membrane of the cervical canal is affected. The cause of the pathology can be various infections, injuries, hormonal disorders, non-compliance with personal hygiene rules, and so on. As a result of development inflammatory process a woman may experience pain during intercourse. Moreover, it can impede the passage of spermatozoa into the uterine cavity, resulting in the likelihood of pregnancy when natural insemination will decrease significantly.
Immunological incompatibility of the couple. The essence of this pathology lies in the fact that the body of a particular woman ( that is, her the immune system, which normally provides protection against the invasion of foreign bacteria, viruses and other agents) begins to produce antibodies against the sperm of her sexual partner ( husband). At the same time, during natural insemination, spermatozoa will die before they can reach the egg and fertilize it.
Operations in the region of the cervix. After surgery, scars may remain on the cervix, which can prevent the passage of sperm.
Anomalies in the development and / or location of the female genital organs. As a result improper development there may be violations of the shape and location of the uterus, cervix and / or fallopian tubes. All this can impede the process of sperm entering the egg, thereby leading to infertility.
With a lack of estrogen. Under normal conditions, cervical mucus is located in the cervical region, which prevents the penetration of infectious agents, as well as spermatozoa ( during natural intercourse) into the uterine cavity. during ovulation ( when the egg matures, that is, it becomes ready for fertilization and moves into the fallopian tube) stands out a large number of estrogen ( female sex hormones). Estrogens change the properties of cervical mucus, making it less thick and more stretchable, which makes it easier for sperm to pass into the uterine cavity. With a lack of estrogen, the mucus will remain thick all the time, as a result of which the spermatozoa will not be able to reach the egg and fertilize it.
Unexplained infertility. If, after a full examination of a woman and her sexual partner, it is not possible to identify the cause of infertility, the doctor may also advise resorting to artificial insemination. For some couples, this may lead to pregnancy, while others may require more effective methods (e.g. in vitro fertilization).
Lack of a permanent sexual partner. If a woman is living on her own but wants to have a baby, she can also have an artificial insemination procedure in which her egg is fertilized with the sperm of another man ( donor).

Is artificial insemination indicated for obstruction of the fallopian tubes or with one passable tube?

With this pathology, there is a complete or partial overlap of the lumen of the fallopian tubes, in which normally spermatozoa meet with the egg and fertilize it. The cause of the development of the disease can be frequent infectious and inflammatory processes in the uterine cavity, abdominal surgery ( after them, adhesions may form, which can compress the fallopian tubes from the outside), abdominal tumors ( can also compress the fallopian tubes) and so on.

With complete obstruction of both fallopian tubes, it is not advisable to perform artificial insemination, since the injected spermatozoa will not be able to reach the egg and fertilize it. In this case, it is recommended to treat the obstruction or perform the in vitro fertilization procedure.

At the same time, it should be noted that partial obstruction, as well as obstruction of only one tube, is not a contraindication for artificial insemination. With partial obstruction of both tubes, spermatozoa introduced into the uterine cavity or the tube itself can reach the egg and fertilize it. Also, the process of fertilization can occur with one passable tube, if at the time of the procedure it is in it that a mature egg is found.

Indications for insemination with husband's sperm

Before treatment infertile couple both sexual partners should be examined, since the cause of infertility can be not only diseases of a woman, but also diseases of a man.

Indications for artificial insemination by the husband are:

Inability to ejaculate ejaculation) in the vagina. The cause of this condition may be violations of the functions of the male genital organs. Also given state may be seen in damage spinal cord men, when the whole is paralyzed Bottom part body ( including genitals).
Retrograde ejaculation. With this pathology, the process of normal ejaculation is disrupted, as a result of which the sperm enters the urinary tract men. Insemination and fertilization do not occur, since the seminal fluid does not enter the female genital tract.
Deformities of the male genital organs. In the presence of anatomical anomalies in the development of the penis, sexual intercourse may not be possible, as a result of which the couple may also resort to artificial insemination. Similar conditions may also occur after traumatic lesions penis.
Oligospermia. Normally, during intercourse, a man releases at least 2 ml of seminal fluid. It is believed that with a smaller amount of sperm, it will not be enough for the spermatozoa to penetrate the cervical mucus and reach the egg.
Oligozoospermia. With this pathology, the number of spermatozoa in the sperm of a man is reduced. Most of them die on the way to the egg, as a result of which the probability of fertilization decreases.
Asthenozoospermia. With this pathology, sperm motility decreases, as a result of which they also cannot reach the egg. The problem will be solved by intrauterine or intratubal insemination.
Performing chemotherapy/radiotherapy. If the patient has been diagnosed neoplastic disease, before starting treatment, he can donate his sperm to a special storage. In the future, it can be used for artificial insemination.

Indications for insemination with donor sperm

If, during the examination of an infertile couple, the husband's sperm was found unsuitable for fertilization, donor sperm can be used for artificial insemination.

Artificial insemination with donor sperm is indicated:

With azoospermia in a husband. With this pathology, there are no spermatozoa in the seminal fluid of a man ( male sex cells), as a result of which the fertilization of the egg is impossible. It is worth noting that in the so-called obstructive form of azoospermia, the cause of the disease is a mechanical obstacle that forms in the way of semen excretion. In this case, the husband's sperm, obtained using special techniques, can be used.
With necrospermia in a husband. With this pathology, there are no live spermatozoa in the male seminal fluid that could fertilize the egg.
In the absence of a permanent sexual partner. If a single woman wishes to have a child, she can also resort to artificial insemination with donor sperm.
If the husband has genetic diseases. In this case, there is a high risk that these diseases can be transmitted to the unborn child.

How many times can you do insemination and what are the chances of getting pregnant while doing this?

You can perform artificial insemination an unlimited number of times, provided that the wife has no contraindications for this procedure. The number of inseminations performed does not affect the condition of the female genital organs or her health. The likelihood of pregnancy in this case depends on several factors that should be considered before performing the procedure.

The success of artificial insemination is determined by:

The quality of the preliminary examination. Before performing the procedure, it is extremely important to conduct a full examination of the couple and identify the cause of infertility. If you miss this moment and carry out the insemination of the husband’s sperm to a woman who, for example, has a complete tubal obstruction, there will be no effect. At the same time, when using low-quality male sperm the procedure will also be ineffective.
Cause of infertility. If the cause of infertility is partial obstruction of the fallopian tubes, pregnancy can occur only after 2-3 inseminations. At the same time, at poor quality sperm men the likelihood of pregnancy is also reduced.
The number of attempts. It has been scientifically proven that the probability of pregnancy at the first insemination is about 25%, while at the 3rd attempt - more than 50%.

It is worth noting that if pregnancy does not occur after the first insemination, there is nothing to worry about. It is necessary to perform the procedure at least 1 - 2 more times before talking about its inefficiency.

Contraindications to artificial insemination

Despite the relative simplicity and safety of the procedure, there are a number of contraindications, in the presence of which it is prohibited to perform it.

Artificial insemination is contraindicated:

In the presence of inflammatory diseases of the genital tract. Performing the procedure when there is an infection in the vagina, cervix, or uterus itself can make the procedure extremely painful. It also increases the risk of infection and development formidable complications. The likelihood of pregnancy in this case is reduced. That is why insemination should be performed only in the absence of these diseases.

In the presence of ovarian tumors. During pregnancy, the ovaries produce sex hormones that maintain the pregnancy. With ovarian tumors, their hormone-producing function can be disrupted, which can cause complications during gestation.
If there are contraindications to pregnancy or childbirth. IN this list includes many pathologies, from diseases of the uterus, cardiovascular, respiratory and other body systems to mental disorders women under which she will not be able to endure or give birth to a child.
With akinospermia in a husband. The essence of this pathology lies in the fact that the male sex cells are completely devoid of mobility. Such spermatozoa will not be able to reach the egg and fertilize it, as a result of which it makes no sense to perform artificial insemination with such seminal fluid. In this case, it is recommended to resort to in vitro fertilization, which is highly likely to lead to pregnancy.
In the presence of infectious diseases in the husband. In this case, the risk of infection of the woman during the procedure remains.

Is artificial insemination possible with endometriosis?

With this pathology, endometrial cells ( mucous membrane of the uterus) spread outside the organ, penetrating the cervix and other tissues. This can disrupt the process of sperm advancement, thereby leading to infertility.

Carrying out artificial insemination can contribute to the onset of pregnancy, but does not guarantee its successful development and outcome. The fact is that with endometriosis, the strength of the uterine wall can be violated. In this case, during the growth and development of the fetus, it can break, which will lead to the death of the fetus or even the mother. That is why, in the presence of endometriosis, you should first conduct a full diagnosis, evaluate all possible risks and execute necessary treatment, and only then proceed to artificial insemination.

Is insemination performed for polycystic ovaries?

This pathology is characterized by metabolic disorders, hormonal disorders and the defeat of many internal organs, including the ovaries. The process of maturation of the egg in polycystic ovaries is disturbed, as a result of which the woman experiences anovulation ( lack of ovulation, that is, during the menstrual cycle, the egg does not enter the uterus and cannot be fertilized). Perform artificial insemination husband's or donor's sperm) does not make sense.

Is artificial insemination performed for uterine fibroids?

uterine fibroids are benign tumor, which develops from the muscle layer of the organ. In some cases, it can reach a significant size, thereby blocking the entrance to the vagina or fallopian tubes and making the process of conception impossible ( sperm cannot reach the egg). Performing artificial insemination can help solve this problem, but it is worth remembering that the presence of fibroids is dangerous for a pregnant woman. The fact is that during the growth of the fetus there is a thickening and stretching of the normal muscle layer of the uterus. At the same time, the tumor can also increase, squeezing the growing fetus and leading to various violations its development. Moreover, if the tumor is located in the cervical region, it can become an obstacle to the fetus during childbirth, as a result of which doctors will have to perform a caesarean section ( removal of the baby from the uterus during surgery). That is why it is recommended to treat the fibroids first before planning the procedure ( if possible), and then perform artificial insemination.

Do they do artificial insemination after 40 years?

Artificial insemination can be performed at any age, if there are no contraindications for this. At the same time, it is important to note that during the procedure, women over 40 years of age significantly reduce the likelihood of success. So, for example, with artificial insemination of women under the age of 40, pregnancy can occur in 25-50% of cases, while after 40 years the probability of a successful outcome of the procedure does not exceed 5-15%. This is due to a violation of the functions of the female genital organs, as well as a violation of the hormonal background of a woman, as a result of which the processes of fertilization and development of the egg are disrupted.

Is it possible to perform insemination with teratozoospermia?

It is impossible to perform insemination with the sperm of a man suffering from teratozoospermia. The essence of this pathology lies in the fact that the structure of most male germ cells ( spermatozoa) is broken. Under normal conditions, each spermatozoon has a strictly defined structure. Its main components are the tail and head. The tail is a long and thin part that provides sperm motility. It is thanks to the tail that he can move in the genital tract of a woman and reach the egg, as well as merge with it. The head region contains genetic information that is delivered to the egg during fertilization. If the head or tail of the spermatozoa is damaged, they will not be able to reach the female germ cell and fertilize it, as a result of which it is impractical to inseminate with the seminal fluid of such a man.

Preparing women and men for artificial insemination

Preparation for the procedure includes a full examination of both sexual partners and treatment of diseases that could create difficulties during the procedure itself or in a subsequent pregnancy.

Before planning artificial insemination, consultation is necessary:

therapist- to detect diseases of internal organs.
Gynecologist ( for women) - in order to identify diseases of the female reproductive system.
Andrologist ( for men) - in order to identify diseases or disorders of the male reproductive system.

Urologist ( for women and for men) - to detect diseases genitourinary system, including infectious ones.
Mammologist ( for women) - a specialist who is engaged in the identification and treatment of diseases of the mammary glands.
Endocrinologist- doctor who treats endocrine glands (his consultation is needed in violation of the production of certain hormones).

If during the examination of the patient ( female patients) any disease is detected, an additional consultation of the relevant specialist may be required ( for example, a cardiologist for heart diseases, an oncologist for uterine fibroids or other tumors, and so on).

Tests before insemination

Before the procedure, you must submit whole line analyzes to evaluate general state female body and exclude the presence of a number of dangerous diseases.

For artificial insemination, you must pass:

General blood analysis. Allows you to determine the concentration of erythrocytes ( red blood cells) and hemoglobin. If a woman has anemia ( anemia, characterized by a decrease in the number of red blood cells and hemoglobin) should first identify and eliminate its cause, and only after that carry out insemination. Also, a general blood test allows you to identify possible active infectious and inflammatory processes in a woman's body ( this will be indicated by an increase in the concentration of leukocytes - cells of the immune system).
General urine analysis. This study allows you to detect the presence of infection of the genitourinary system. Also, the presence of blood in the urine may indicate more serious illnesses kidneys, which can adversely affect the course of pregnancy.
Blood chemistry. This analysis allows you to evaluate functional state liver, kidneys, pancreas, heart and many other organs. In case of a pronounced violation of their functions, the procedure is contraindicated, since terrible complications can develop during a subsequent pregnancy.
Analysis for STIs ( sexually transmitted infections). These infections include HIV AIDS virus), gonorrhea, syphilis, chlamydia, and so on. Their presence in the future mother jeopardizes the development of pregnancy and the health of the fetus, as a result of which they should be cured before insemination ( if possible).
Tests for sex hormones. The study of sex hormones in men and women is carried out to identify possible cause infertility. Moreover, an assessment of the functioning of the female reproductive system is necessary in order to determine whether a woman will be able to bear a child in the event of pregnancy. The fact is that the course of pregnancy, as well as the process of childbirth, is controlled by various hormones. If their excretion is impaired, this can lead to the development of complications during pregnancy or childbirth ( until the death of the fetus).
Rh factor analysis.

Doctors are trying to solve the problem of infertility by many by artificial means, including insemination of the woman's uterus with partner's sperm. The method has its advantages and disadvantages. Despite the fact that the effectiveness of the procedure is low and is about 15-20%, the method is used more and more often.

Intrauterine insemination is the artificial implantation of a partner's sperm into a woman's uterus. The method is carried out in order to ensure the reproductive functions of partners. The method has its own advantages.

It is closest to the act of natural fertilization, it has an affordable price, the method is easy to carry out and does not require expensive preparation and the use of a large number of medicines.

Among the shortcomings, one can note a slight pain during the procedure, invasiveness (introduction into the body of a woman), as a result of which the risk of infection increases. Also, the method has a low percentage of successful fertilization.

Who is shown the procedure

Insemination can be performed on any couple with infertility or single women who do not have a partner but want to have a baby. Artificial insemination can be indicated for both male and female infertility.

For successful fertilization, the hormonal background of a woman must be normal, there must also be a good patency of the woman's genital tract, there should be no inflammatory diseases of the mucous membranes of the uterus and vagina, as this can interfere with the attachment of a fertilized egg (zygote) to the endometrium.

In addition, healthy sperm must enter the uterine cavity with enough active sperm. In the absence or failure of one of the items necessary for fertilization, conception may not occur.

Artificial insemination for a reason is carried out in case of violation of the structure, number or mobility of spermatozoa, violation of ejaculatory functions or impotence.

The reasons for this condition may be the following factors:

genital trauma;
transferred infectious diseases (parotitis or, hepatitis, gonorrhea, syphilis, tuberculosis);
alcohol or smoking abuse;
emotional or physical stress.

Intrauterine insemination due to female infertility is performed with anatomical failure of the female genital organs, with diseases endocrine system, lack or excess of hormones.

These conditions may be caused by the following factors:

"The cervical factor on the part of the woman". This is a condition in which the cervical canal is covered with very thick and viscous mucus. The sperm that got into it cannot enter the uterine cavity, and the spermatozoa cannot reach their destination - the eggs.
Vaginismus is a condition in which there is a spasm (contraction) of the muscles of the vagina, which interferes with sexual intercourse and conception.
idiopathic (without clear reason) infertility.
Chronic inflammatory diseases uterus (for example, chronic endocervicitis).
Postponed operations on the uterus that impede the onset of pregnancy (amputation, cryotherapy).
Allergy to seminal fluid or the secretion of antibodies to the partner's sperm by the woman's body.
Ovulation disorders.

Who is contraindicated in artificial insemination with sperm?

patients with severe mental illness who cannot bear a child;
women with obstruction or absence of fallopian tubes;
in the absence of genital organs (uterus or ovaries);
with severe inflammatory diseases of the female genital organs (for example, endometriosis of 3-4 degrees);
neoplasms of the female genital organs;
malformations of the uterus, in which it is impossible to become pregnant (for example, a bicornuate uterus).

Preparation for the procedure

Proper intrauterine insemination should begin with the preparation of the material - the partner's sperm. Either untreated seminal fluid (native sperm) or processed, purified semen is used.

The second option is preferable, as some women may experience an allergic reaction in the form anaphylactic shock immediately after insemination. The reaction occurs on the protein contained in the man's sperm.

The processing of the material consists in separating the spermatozoa from the seminal fluid, which reduces the risk of developing anaphylaxis. In addition, the selection of the most active spermatozoa is carried out, which increases the likelihood of successful conception.

Frozen material with donor sperm can also be used. In this case, the seminal fluid is in a frozen state for at least six months, after which it is re-checked for the presence of infection.

Artificial insemination with donor sperm is used in the presence of genetic diseases in a man that can be passed on to a child, as well as for women who do not have a sexual partner, but want to become pregnant.

With a lack of sex hormones or a violation of ovulatory functions, hormonal stimulation is performed before the procedure. This leads to the maturation of the egg in the woman's ovary and its release into the lumen. fallopian tube(ovulation).

sperm insemination procedure

To happen successful insemination and conception, the introduction of sperm must be carried out at the time of ovulation. To do this, after hormonal stimulation of the ovaries, they are monitored using an ultrasound machine. The doctor monitors the growth of follicles.

Artificial insemination is carried out either a day before ovulation, or a few hours after it. Interestingly, several ovulations can occur in one menstrual cycle, then more than one sperm injection can be performed. So, a woman can endure from one to three inseminations per cycle.

Another important point necessary for successful conception is sufficient preparedness of the endometrium of the uterus (mucous membrane). This factor is monitored by ultrasound and, with a small thickness of the shell, the appropriate hormones are administered.

The direct introduction of sperm takes place on a gynecological chair, reminiscent of a regular examination by a gynecologist. The material is introduced using a special catheter directly into the uterine cavity.

As a rule, the procedure is painless. On the day of the procedure, the woman is advised to avoid physical and emotional stress. In addition, it is desirable to observe thorough hygiene of the genital organs, since the uterus after the procedure is very sensitive and can easily become infected.

The success of conception depends on several factors:

the age of the woman (it is recommended to carry out the procedure up to 40 years);
causes of infertility (male infertility reduces the chances of success);
transferred infectious or inflammatory diseases of the female genital organs, since after them cicatricial changes can form on the mucous membrane.

Possible consequences and complications after insemination:

Ovarian hyperstimulation syndrome. This condition occurs when the body is overly sensitive to hormonal drugs or with the wrong selection of doses of hormones. At the same time, the ovaries begin to actively increase in size, metabolism is disturbed. As a result, protein metabolism is disturbed, arterial pressure, a large amount of fluid is released into the abdominal cavity. Functions of many organs (liver, kidneys) are disturbed. This condition does not go away on its own, the woman needs to be hospitalized in a hospital, and insemination should be postponed.
Multiple pregnancy (increased risk of self-abortion).
Allergy to injected sperm.
If the rules of asepsis are violated, an acute infectious or inflammatory process may develop in the genitals of a woman.
Ectopic (ectopic) pregnancy. In this case, breeding is not possible.

Like any method, artificial insemination has its drawbacks. However, the procedure is often used as an alternative to in vitro fertilization, which helps many couples to have a baby.

artificial insemination method

I like!

Intrauterine insemination- is an auxiliary reproductive technology, in which the introduction of pre-obtained sperm into the cervical canal or uterine cavity occurs. This method is quite simple and as close to natural as possible.

Indications for carrying out

Given reproductive technique it is possible to use the sperm of the spouse or the sperm of a donor.

Indications for insemination with spouse's sperm:

Cervical factor of female infertility;
Congenital or acquired defects of the genital organs, making sexual intercourse impossible;
Erectile dysfunction in a spouse with normal or slightly changed indicators;
Severe vaginismus in the wife.

Indications for insemination with donor sperm:

Severe violations of the spermogram of the spouse, leading to absolute infertility (e.g. azoospermia) complete absence sperm);
Adverse(the spouse is a carrier of a serious genetic disease);
Absence of a spouse or sexual partner(with insemination in single women);
Severe forms of Rh-conflict, preventing the physiological course of pregnancy and the birth of a healthy child.

Contraindications

Somatic and mental illness, which are contraindications to childbearing and childbirth;
Oncological diseases;
Tumors of the uterus and ovaries;
Congenital and acquired malformations of the uterus;
Acute inflammatory diseases of any localization.

Methodology

This procedure is carried out in outpatient settings and does not require hospitalization of the woman. After a few hours, the patient can already go home. Until pregnancy is determined, it is not recommended to conduct sexual life should also exclude severe physical exercise.

Stages of the procedure

Stimulation of superovulation (not mandatory step, in some cases not carried out);
Semen collection and purification;
The introduction of sperm into the uterine cavity or cervical canal;
Confirmation of pregnancy.

superovulation induction

Ovarian stimulation is not performed in all women: insemination is possible with male factor infertility or infertility of unknown origin.

When ovarian stimulation occurs, the maturation of several eggs occurs, which increases the chances of a successful pregnancy. For these purposes, they are used, which are administered until the follicles reach a size of 18-22 mm.

After ultrasound confirmation of the readiness of the follicles, the patient is prescribed chorionic gonadotropin which speeds up the time of ovulation. great attention the doctor will also pay attention to the thickness of the endometrium, which by the time of ovulation should reach at least 9 mm. If the dimensions do not meet the standards, the woman will additionally be prescribed drugs to accelerate the growth of the inner layer of the uterus ( proginova, divigel).

information During stimulation, the insemination procedure can be repeated several times during one menstrual cycle, depending on the number of mature eggs.

Sperm collection and purification

For intrauterine insemination, it is possible to use the sperm of a donor or the sperm of the patient's spouse.

Donor sperm it is used only after long-term cryopreservation (at least 6 months), which completely eliminates the possibility of latent infections.

Sperm spouse should be entered into fresh without freezing. It is necessary to donate sperm for insemination only in medical institution through masturbation. Before surrender, a man must refrain from sexual intercourse for 3-5 days.

The resulting sperm is subjected to a thorough processing by centrifugation, which takes about two hours. A large amount of proteins are removed from the ejaculate, which can cause severe allergic reaction from a woman and select only morphologically complete motile spermatozoa. 2 ml of the culture medium is added to the precipitate obtained and centrifuged again. Immediately prior to insemination, the medium is re-added to the semen.

Introduction of sperm into the uterine cavity or cervical canal

Previously, insemination of sperm could be carried out in the cervix or even in the abdominal cavity. IN Lately such methods were abandoned: sperm is injected only into the uterine cavity.

During the procedure, the woman is on the gynecological chair. Intrauterine insemination does not require anesthesia, because. is a painless method and may cause only slight inconvenience. The doctor injects the resulting sperm concentrate using special catheters through the cervix into its cavity. The procedure takes several minutes, but after it the woman is recommended to lie down for half an hour.

important After insemination, it is important to maintain the full value of the second (luteal) phase of the menstrual cycle, which is carried out by taking progesterone preparations (duphaston or utrogestan).

Confirmation of pregnancy

The cost of intrauterine insemination in Russia

Intrauterine insemination is a fairly cheap technique, especially compared to other reproductive technologies.

The final price of insemination consists of several components:

The doctor's consultation;
Price medicines;
The cost of hormonal examination and ultrasound control;
sperm preparation;
The cost of sperm (when using donor);
The cost of the insemination procedure itself.

Taking into account the payment for all procedures and medications, the cost of intrauterine insemination is at least 25,000-30,000 Russian rubles.