Preparation for insemination for men and women. Indications and contraindications

Among the assisted reproductive techniques, a special place is given to insemination. It allows you to conceive a child in the case when fertilization in a natural way for some reason becomes impossible. About how insemination takes place, to whom it is carried out and what its effectiveness is, we will tell in this material.

Peculiarities

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

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

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

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

Insemination belongs to the category of artificial insemination techniques, but has nothing to do with IVF (in vitro fertilization). The main difference is that during in vitro fertilization, the fusion of the germ cells of a man and a woman occurs outside the female body. The eggs and sperm go through this stage in a laboratory Petri dish under the vigilant control of embryologists, and after a few days the embryos are transferred to the uterine cavity.

During insemination, human intervention in the natural process consists only in the fact that the sperm is “helped” to overcome especially difficult areas - the vagina and the cervical canal of the cervix. Thus, a greater number of male germ cells enter the uterine cavity and fallopian tube, and this increases the chances of pregnancy.

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

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

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

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

Kinds

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

homologous- insemination, for which the sperm of the husband or the woman's permanent sexual partner is used;
heterological- insemination, for which the sperm of an anonymous or other donor is used.

The procedure with donor sperm is carried out when the sperm of a spouse or a permanent partner is found unsuitable for fertilization due to a violation of the morphology of spermatozoa, a small number of live and active spermatozoa, and other severe violations of the spermogram. Also, insemination with donor biomaterial is recommended if a man has severe hereditary pathologies that can be inherited by a child. A woman who wants a child, but lives alone, without a husband, can also be inseminated at her request.

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

Indications

Unlike in vitro fertilization, which theoretically can help a large group of infertile couples with a variety of reasons for the decline or lack of fertility, intrauterine insemination is indicated for a rather narrow group of patients. These include:

women who do not have a partner;
couples in which there is a male factor of infertility according to the spermogram;
couples in which a woman has minor pathologies of the organs of the reproductive system.

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

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

Sperm donation followed by cryopreservation for insemination may be required for men who are undergoing cancer treatment, such as radiation therapy. Own germ cells can be severely damaged as a result of cancer treatment, and frozen sperm will remain unchanged and can be used for insemination if the couple wishes.

Among the female pathologies that prevent the onset of pregnancy in a natural way, but can be overcome through intrauterine insemination, include cervical or cervical infertility factors, in which the passage of the partner's sperm through the genital tract is difficult, with an immune factor of infertility, if a large amount of antisperm antibodies are produced, as well as with moderate endometriosis and mild forms of menstrual irregularity.

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

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

Contraindications

For most assisted reproductive technologies and techniques, the list of contraindications established by orders of the Ministry of Health is almost identical. As in the case of IVF, a woman who currently has acute inflammatory pathologies or exacerbated chronic diseases will not be allowed to inseminate. The ban applies to women with mental health problems who require regular or occasional use of psychostimulants.

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

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

Infectious diseases of the husband can also cause a refusal to perform the insemination procedure, since there is a possibility of infection of the woman at the time of the introduction of the spouse's biomaterial. That is why before insemination it is necessary to conduct a thorough examination and pass a rather impressive list of tests.

Preparation

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

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

A man should make a spermogram with a mandatory extended study for antisperm antibodies and various types of abnormalities in spermatogenesis. In addition, a man takes general blood tests, urine tests, chest x-rays, donates blood for HIV, syphilis, sexual infections, a smear from the urethra, donates blood for group and Rh factor.

Intrauterine insemination is included in the NRT (new reproductive technology) state support program, and therefore it can be done both at your own expense and free of charge, under the CHI policy. In the first case, with a doctor's opinion and tests, you can go to any clinic that provides such a service. In the second case, you will have to wait about a month until the documents submitted by the attending physician to the commission of the Ministry of Health of the region are considered.

If a couple is allowed to have insemination at the expense of state or regional funds, they will be offered a list of clinics and hospitals that can perform the procedure and are licensed to do so. It remains to choose one of them and go there with all the analyzes and documents to go through the quota procedure.

Order of conduct

For intrauterine insemination, a woman does not have to go to the hospital at all. This procedure is quite simple and fast. It can be performed in a natural cycle or with the use of hormonal drugs that should stimulate ovulation in a woman (if there are violations of the ovulatory cycle). Whether or not ovarian stimulation is needed, the reproductive specialist will decide, who will receive tests on the patient's hormonal background.

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

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

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

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

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

Sperm before the introduction is cleared of seminal fluid and other impurities by settling, washing, passing through a centrifuge. As a result, only concentrated ejaculate remains. Sperm is freed from immature, defective spermatozoa with poor morphology, from dead and inactive cells. The remaining strong sperm should not live, so they must be injected as soon as possible. The purified sperm of the husband or donor is not subject to freezing, therefore, the purification is carried out immediately before the introduction.

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

A woman who has undergone an artificial intrauterine insemination procedure is recommended to observe bed or semi-bed rest for the first two days, do not take hot baths, do not swim, do not go to the bathhouse and do not sunbathe. Get more rest, sleep well and eat a balanced diet. Diets won't work.

If the doctor prescribes progesterone preparations, they should be taken in a clearly marked dosage and in compliance with the multiplicity and scheme. It is unacceptable to skip the next pill or the introduction of a candle.

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

If unusual discharge appears after insemination - bloody, greenish, gray or profuse yellow, you should immediately inform your doctor.

Do not harass yourself looking for early signs and symptoms of pregnancy - they may not be. Therefore, doctors recommend going to the diagnosis of pregnancy as early as a couple of days before the delay of the next menstruation. During these periods, you can do a blood test from a vein for the plasma concentration of chorionic gonadotropic hormone - hCG. Pregnancy tests, which are dipped in a jar of urine at home, are best to start using only on the first day of delay and later.

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

Feelings after the procedure

Objectively, the sensations after intrauterine insemination are not much different from the sensations of a woman who had unprotected intercourse during the period of ovulation. In other words, there will be no special sensations on the days that women are waiting for and hoping for after artificial infusion of sperm.

On the first day, a slight pulling pain is possible, which is almost not noticeable. These are the consequences of inserting a catheter into the uterine cavity.

If at this stage the lower abdomen is strongly pulled, the temperature has risen, you need to call an ambulance, infection or air entering the uterine cavity is not excluded.

Approximately 7-9 days after the introduction of sperm, implantation can occur if fertilization has taken place. At the same time, some women note a slight increase in temperature, the appearance of aching pain in the lower back, and small, mild discharge from the genitals of a pink, cream, or brownish hue. They are caused by the ingress of blood into the vaginal secretion from the damaged endometrium. The functional layer of the uterus is damaged when a fetal egg is introduced into it. This phenomenon is called implantation bleeding.

It happens far from every woman, and therefore you should not rely heavily on such a sign of pregnancy. In addition, implantation is not always successful, and pregnancy, not having time to start, can be interrupted for a great variety of reasons, not all of which are known and understood by medicine in general and gynecology in particular.

If the pregnancy nevertheless began, from the moment of implantation, the level of the hCG hormone in the body will slowly begin to accumulate - it is produced by chorion cells, with which the fetal egg "clings" to the wall of the uterus. This does not mean that it will immediately begin to vomit, as some people think. Toxicosis also happens not to everyone and usually develops a little later.

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

There are women in whom all of these signs are absent even with the onset of pregnancy. And there are more sensitive women who intuitively feel that everything in the body now “works” in a new way. Before the objective data of blood tests and ultrasound, it is better to stop worrying and relax.

Efficiency

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

Women over 35 years of age are less likely to have a successful procedure, as their oocytes are already in a state of natural aging, which implies a decline in the quality of germ cells. Even if spermatozoa reach such eggs, they sometimes cannot fertilize them, and if intercourse does take place, then there is a high probability that implantation will not occur or the fetal egg will be rejected.

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

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

Price

The average cost of an intrauterine insemination procedure in Russia starts from 20 thousand rubles and can reach 60 thousand. The final cost depends on the region, on the protocol, on the need to use donor sperm. If ovulation stimulation is planned, the procedure can triple in price from the minimum value.

Is the procedure at home real?

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

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

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

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

Important questions

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

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

Unlike IVF, intrauterine insemination does not make it possible to make sure that the fetus has not inherited genetic diseases, that it does not have chromosomal disorders, because embryos are not selected, as is the case with in vitro fertilization at the stage of preimplantation diagnosis. The insemination procedure also does not allow you to find out the sex of the unborn child.

Pregnancy, if it occurs as a result of intrauterine injection of sperm, proceeds without features. It is no different from pregnancy, which occurred as a result of natural intercourse. A woman will not need to visit a antenatal clinic more often, as well as undergo additional examinations in excess of the generally accepted ones, as is the case with women after IVF.

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

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

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

takes longer than IVF itself. It is made in reproductive centers around the world. a lot of experience has been accumulated on the methodology, in connection with which it is widely used and brings the expected results.

The essence of AI is the introduction of purified spermatozoa into the genitals (internal) of a woman.

Historically, four variants of insemination were formed at the place of delivery of male germ cells:

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

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

into the uterine cavity. Today it is the most used and effective method of artificial insemination. About him and will be discussed further.

In the fallopian tubes.

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

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

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

Based on their sperm characteristics, it can be recommended.

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

Artificial insemination: indications

Conducting AI can be carried out with male and female factors.

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

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

Indications for artificial insemination by men:

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

Stages of AI

Despite its mechanical simplicity, AI is a delicate and responsible work of a team of specialists - a gynecologist-reproductologist, clinic laboratory staff, and doctors of related specialties. The method of implementation provides for a stepwise and sequential approach.

Stages of artificial insemination:

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

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

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

Directly carrying out artificial insemination.

Determining pregnancy by monitoring hCG. In the absence of pregnancy, the procedure, according to regulatory documents, is repeated up to 6-8 times. Although recently, experts have come to the conclusion that if 3 AI attempts were ineffective, then you need to change tactics and consider the possibility of artificial insemination in another way. For example, IVF, ICSI, PIKSI, IMSI.

Preparing for artificial insemination

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

The woman's preparation includes:

detailed medical examination by a gynecologist, internist, endocrinologist, cardiologist;
analyses;
ultrasonic monitoring;
treatment of detected chronic diseases, including infections and inflammation of the genital organs;
study of the menstrual cycle (it is necessary to determine the cyclicity and regularity of ovulation);
and the state of the inner lining of the uterus;
after treatment, control tests are given;
medical stimulation of the ovaries.

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

Man preparation:

urologist consultation;
tests for sexual infections;
analysis of prostate secretion;
in addition, a prostate massage can be prescribed;
treatment and correction of identified violations.

On what day of the cycle is artificial insemination performed?

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

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

One of the determining factors on which day of the cycle to carry out artificial insemination is the origin of the sperm. If used, then it can be administered, focusing only on ovulation. If fresh (native) sperm is used, then take into account the fact that the high quality of spermatozoa can only be achieved with abstinence for at least 3 days. Therefore, sperm can be administered immediately after ovulation. It does not harm, as it is proven to be viable up to 7 days.

How does artificial insemination take place?

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

How does artificial insemination work? Quickly, painlessly, under sterile conditions. You don't have to worry about this. Yes, and the sensations will be minimal - only at the moment the flexible thinnest catheter passes through the cervical canal of the uterus.

The woman moves to the gynecological chair. Mirrors provide access to the cervix. Prepared spermatozoa together with the medium are drawn into a syringe and connected to a catheter. With a slight movement of the catheter, they penetrate into the uterine cavity and carefully inject a prepared suspension of the “best” spermatozoa from the syringe. On the first day, everything. Manipulation completed. And the woman remains in a horizontal position for 15-25 minutes. Then he returns to everyday life.

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

Efficiency and chances of getting pregnant

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

Some fertility clinics claim to be as effective as 28%.

Seventy-eight percent of women manage to get pregnant in the first three cycles of insemination. The effectiveness of subsequent procedures is sharply reduced. That is why doctors rationally change the tactics of artificial insemination and recommend other IVF methods after a three-time insemination attempt.

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

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

How to prepare for artificial insemination: basic steps

Choice of clinic

Here, each couple is guided by criteria that are important to it. Someone chooses by price (lower / higher), someone by the reputation of the clinic, someone by the recommendations of friends, someone goes to this particular doctor and it doesn’t matter where he works.

Procedures for making a decision

In the clinic, the decision to carry out artificial insemination is made after the woman and man undergo some procedures:

examination by a therapist to assess the health status of a woman and a man, to identify the presence or absence of any diseases;
laboratory tests, namely blood donation for HIV, for the Wasserman reaction, to determine the group and Rh factor, as well as taking a vaginal smear from a woman and a smear from the urethra from a man;
testing of functional diagnostics: in a woman - to characterize the menstrual cycle and the estimated time of ovulation (rectal temperature is measured for at least three menstrual cycles, additional studies are carried out: colpocytological, fallopian tube patency, dynamic determination of the cervical number, postcoital test); in a man - to characterize sperm (a spermogram is made).

Preparing for artificial insemination

A woman's preparation goes according to a certain scheme.

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

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

On the second day after the injection that causes ovulation, insemination is performed. In the same place, the delivery of sperm by a man takes place. This process also has its own rules. Before donating sperm, a man needs to sexually abstain from two to six days, but no more. It is also necessary to urinate to clean the urethra, wash your hands, and then pass the sperm into a special test tube. When the sperm is liquefied, it is specially prepared: the spermatozoa are cleaned of seminal fluid, cellular waste is removed, and the spermatozoa most suitable for fertilization are selected.

Insemination procedure

Insemination is carried out on an ordinary gynecological chair. A woman should relax in order not to feel any pain, except for the cold from the catheter, with the help of which spermatozoa are introduced into the uterine cavity. Then you need to lie down for 30-40 minutes and that’s it, you can return to your usual way of life (unless you can’t carry weights and make love violently). Your doctor may also prescribe the pregnancy hormone progesterone.

Don't be discouraged

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

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

Benefits of the procedure

In general, artificial insemination at home is a procedure in which artificial insemination is carried out using a syringe or similar device. Unlike other options for artificial insemination, the fusion of sperm and egg takes place inside the female body. When applied, fertilization is carried out in the laboratory, while the oocytes are preliminarily collected.

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

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

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

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

Preparation for the procedure

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

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

The main ones among them are:

Ultrasound of the pelvic organs
tests for genital infections
spermogram
hepatitis test
general urine and blood tests

In addition, during the diagnostic period, the most appropriate estimated date of conception is determined. For this, the woman's menstrual cycle is studied in detail, which is necessary in order to find out - the most optimal moment for fertilization. If a woman has certain menstrual irregularities, she is prescribed hormone therapy aimed at restoring the normal function of the reproductive organs.

After diagnosing and setting a specific time period for fertilization, it is important to ensure that the necessary tools for the operation are available. You can purchase the necessary items separately, but at the moment there are special kits designed specifically for insemination at home.

They include the following tools:

FSH test
syringe
catheter
gynecological speculum
pipette
hygiene products

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

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

Using ovulation tests

As already noted, it is extremely important for insemination to choose the right time period. The greatest chance of success occurs at the time of ovulation - the process in which the egg is released from the ovaries and its movement to the uterus.

Insemination kits usually include test analyzes for the content of hormones that stimulate the work of the follicles, as well as tests to determine the optimal date for the procedure. To get pregnant, you need to inseminate a few days before the expected date of ovulation. The procedure must be repeated after 2 days. You can repeat the operation every 48 hours.

You need to conduct an ovulation test 2 times, while 1 week should pass between the tests. On which day of the menstrual cycle the analysis is performed is not a fundamentally important indicator.

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

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

Fertilization stages

After the implementation of the preparatory measures described above, you can proceed directly to the procedure. Artificial insemination is carried out in several stages, each of which requires maximum care and attention.

The main stages of insemination:

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

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

Historical reference

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

Since the second half of the 19th century, artificial insemination has been widely used for the treatment of infertility in many European countries. Initially, native sperm was injected into the woman's posterior vaginal fornix. Subsequently, techniques were developed with irrigation of the cervix, intracervical administration and the use of a special cervical cap.

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

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

Indications for intrauterine insemination

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

In the Russian Federation, when deciding on the advisability of insemination with the husband's or donor's sperm, they rely on the Order of the Ministry of Health of the Russian Federation No. 67 dated February 26, 2003. Allocate testimony from the woman and from her sexual partner (husband).

Intrauterine insemination with frozen donor sperm is used when the husband has hereditary diseases with an unfavorable medical and genetic prognosis and for sexual and ejaculatory disorders, if they are not amenable to therapy. The indication is also the absence of a permanent sexual partner in a woman.

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

Like other auxiliary methods, insemination is not carried out in the presence of an active inflammatory process, an infectious disease or a malignant tumor of any localization. The reason for refusal may also be some mental and somatic diseases, if they are a contraindication to pregnancy. You can not use insemination and in the presence of pronounced malformations and pathology of the uterus, preventing the bearing of a child.

Methodology

For the implementation of intrauterine insemination, the woman does not need to be hospitalized. Depending on the type of infertility, the procedure is carried out in a woman's natural or stimulated cycle. The protocol for hormonal stimulation of hyperovulation is determined by the doctor and is most often similar to that in preparation for.

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

There are several stages of the procedure:

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

The intrauterine insemination procedure itself is short and painless. To facilitate access and provide visual control, the doctor usually uses vaginal mirrors. The cervix usually does not require additional expansion, the small diameter of the catheter allows you to easily pass it through the cervical canal, which is ajar during ovulation. However, small diameter cervical dilators are sometimes required. Semi-rigid or flexible memory catheters are currently used for insemination.

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

Semen preparation

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

When carrying out intrauterine insemination, the sperm of a woman's sexual partner or frozen donor biological material is used. The choice depends on the quality of the ejaculate, the presence of contraindications to the use of the husband's biomaterial (for example, in the presence of severe genetic abnormalities) and other criteria. There are no special requirements for the collection of native sperm. But it is desirable to receive the ejaculate in a medical institution for the fastest and most gentle transportation to the laboratory.

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

One of the following methods can be used to prepare sperm:

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

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

It is also important to free the ejaculate from dead, immature and immobile spermatozoa, leukocytes, bacteria and admixture epithelial cells. Competent pre-treatment provides sperm with protection from the resulting oxygen free radicals and maintains the stability of the genetic material of the cells. As a result of processing, the specialist receives a sample with the maximum concentration of spermatozoa suitable for fertilization. It is non-storable and must be used the same day.

artificial insemination at home

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

After the procedure, the woman must remain in a horizontal position with a raised pelvis for at least 30 minutes to avoid semen leakage. Orgasm increases the likelihood of pregnancy, because it helps to reduce the walls of the vagina and changes the patency of the cervical canal.

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

Method efficiency

According to the European Society for Human Reproduction and Embryology, the prognosis of pregnancy after a single intrauterine insemination is up to 12%. At the same time, a repeated procedure in the same cycle only slightly increases the likelihood of conception. Most of all, the effectiveness of insemination is affected by the time of its implementation, it is desirable to carry out the procedure as close to the time of ovulation as possible. Depending on individual characteristics, the periovulatory period begins already on the 12th day of the ovarian-menstrual cycle, or it falls on the 14th - 16th days. Therefore, it is very important to determine the time of expected ovulation as accurately as possible.

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

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

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

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

Risks and possible complications

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

Possible complications of this procedure include:

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

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

Intrauterine insemination may not give a positive result in the first reproductive cycle. The procedure can be repeated up to 4 times, this will not have a negative impact on the woman's body and will not cause serious complications. If the method is ineffective, the issue of IVF is decided.