We want to support married couples and single women who decided to undergo a procedure of intrauterine insemination (further, IUI or AI).
Unfortunately, not everything in life goes easy and smoothly: some people are lonely when they already want to have a family, and some people have diseases, losses of loved ones, and other misfortunes. Do not think that you're just out of luck - everybody has some kinds of troubles.
And do not be ashamed that you have to apply to physicians -for example, we do not hesitate to go to the doctor with a broken leg in order to get rid of pain and be able to walk in the future.
Human artificial fertilization, intrauterine insemination, and appeal to the doctors in order to have a child are just less habitual for us. This is also less usual for the people surrounding us. Methods of artificial fertilization (including intrauterine artificial insemination) in Moscow and regions year by year help an increasing number of couples. Artificial insemination, with donated or husband’s sperm, will give you the desired result - your child. However, if you are not ready or do not want to meet suspicion, skepticism and even jeering of surrounding people (natural human reactions to something new and unusual), and you do not feel the confidence to convince people and seek their understanding of the situation, it is probably not worth to tell your relatives that you have gone in for such procedure as intrauterine artificial insemination.
The result of insemination - a successful pregnancy - will please both you and your loved ones. Conceiving a child is an intimate and private thing, and it appeals only to you. You can answer that to the questions of your relatives, or you can just smile enigmatically. Methods of artificial fertilization used for this purpose appeal only to you, your spouse and your doctor.
Sometimes misfortune is so disappointing that it results in a complete despondency. But over time you realize that the problem will not be solved by itself, and the life will not become better on its own. Human artificial insemination is a medical method of treatment, and there is nothing obscene about it. The problem of artificial fertilization is largely sophisticated by the people uninformed in this issue. If this procedure (artificial insemination with donated or husband’s sperm) is indicated for you, it is necessary to think things through and start acting. You have to fight off the misfortune, but not surrender to it. There are always ways to solve the problem. Perhaps, they are not always easy, it is not always easy to accept something psychologically, and there is not always enough patience and will. Sometimes you just do not know how to solve a problem, or which way is better.
Artificial Insemination. Indications:
* for couples where not everything is all right on the part of man (sexual disorders or poor sperm quality).
* for single women (if there are no "female" problems)
Many single women are eager to have a baby. But what should they do if there is no suitable partner? Women learn what does artificial insemination mean, who became pregnant after artificial insemination, where the in vitro fertilization is performed, and how much the artificial insemination costs in Moscow and in the regions. After ascertaining all the issues, women apply to the selected clinic, where they perform artificial fertilization. If intrauterine insemination was successful, it results in the long-awaited pregnancy. And it does not matter how much does the artificial insemination cost; the result is a new life and your own baby in your arms. We would like to wish single women good luck, as well as prompt understanding and help of the loved ones with raising the child.
Let’s consider man's problems in more detail. Nowadays certain problems in the reproductive sphere in men, including young ones, are rather often, and, unfortunately, not always treatable. The problem of artificial fertilization for men is quite acute. This is a heavy blow to the male ego and simply a human disaster. Often it causes disturbance of harmony in the pair.
It is absolutely pointless to do nothing in this situation, and to move away from it. Sooner or later the problem will have to be solved in order to determine the future destiny, and delaying usually results in an expansion of the problems.
In this situation it is important to collect comprehensive information on how the modern medicine can help you, where exactly and how successfully. It is also important to visit clinics and doctors in person to get answers to your questions and concerns. If artificial insemination is indicated for you, the analyses will help to choose the right tactics of treatment.
We would like to mention separately that poor quality of sperm is not a diagnosis, it is an analysis. If the man have not been examined, and there is no conclusion about the diagnoses, causes of poor sperm quality and the possibility of treatment, it is early to make predictions, whether the pregnancy through natural way is possible, or the artificial intrauterine insemination or other ART method is needed.
In case of severe sperm pathologies, when it is not possible to fix them, inseminations with husband's sperm will not help to solve the problem. In these cases, the medicine can only help through donor sperm insemination or IVF/ICSI with the husband's sperm.
In case of artificial methods usage, the role and importance of man in the conception does not become lower, but it is much higher and responsible. Even if you are using donor sperm, it's your child, brand new life arises thanks to you, and this child will be the way you will raise him.
Artificial insemination (AI) is a method of assisted reproduction (along with IVF, IVF/ICSI), in which, as well as in other methods, certain point of conception is artificial.
1. General Information.
Insemination means introduction of sperm into the female genital tract by artificial means. The whole further process occurs naturally: sperm cells are running from the uterus to the fallopian tubes, where they meet a matured egg cell emerged from the ovaries and also caught in a fallopian tubes, fertilize it, and then the fertilized egg enters the uterus, attaches to the uterine wall and gives rise to the pregnancy.
Inseminations are carried out close to the time of ovulation (release of mature egg from the ovary), approximately in the middle of menstrual cycle.
Previously there was used the introduction of sperm into the vagina, but recently used sperm introduction directly into the uterus, so-called intrauterine insemination (IUI), is more successful.
Before the intrauterine insemination sperm is preprocessed, resulting in a change of a sperm structure, similar to one the sperm gets after entering the vagina on the way to the uterus during natural intercourse, and selecting a "fin" of the sperm cells, which are most capable of fertilization. The introduction of unprocessed sperm directly into the uterus is unacceptable.
2. Artificial Insemination. Indications.
Inseminations are carried out for single women, and are used to achieve pregnancy in infertile couples, if treatment in order to achieve a natural pregnancy was nor successful.
Artificial insemination. Results: pregnancy as a result of insemination may occur in a woman only when there are no diseases that prevent pregnancy. Inseminations are not carried out in case of obstruction/absence of the fallopian tubes, endometriosis of high degree, lack of ovaries or uterus.
The following methods of assisted reproduction are distinguished
* artificial insemination with husband's sperm (HSAI)
* artificial insemination with donor sperm (DSAI).
2.1 Artificial insemination with husband's sperm (HSAI)
AIHS is indicated and can overcome infertility only in those cases when artificial introduction of sperm bypasses that/those obstacle(-s), which caused pregnancy failure, namely:
* in case of sexual disorders, vaginismus, irregular sexual life,
* in case of the cervical factor of infertility, when husband's sperm cells perish in the wife's vagina,
* with minor deteriorations of sperm quality in comparison with normal,
* in case of unexplained infertility, when the couple underwent a full list of examinations, and the cause has not been found, however, the use of IVF seems to be premature, insufficiently substantiated or too expensive.
In all cases, except the first one, it is assumed that the couple underwent a full examination for infertility according to the complete list of examinations, and there is a conclusion about the causes of infertility. If the couple has indications for the artificial insemination, analyses will help to choose the right treatment.
All of the above cases are relatively rare and represent only a small percentage of infertility cases.
In case of insemination with husband's sperm there is used a fresh (native) sperm, donated in clinic immediately before insemination on the same day before a few hours. To carry out insemination, husband has to be examined at least for all sexually transmitted infections.
A child born as a result of such insemination is genetically native to the woman and her husband.
2.2. Artificial insemination with donor sperm (DSAI)
I believe that before resorting to IVF it is worth to take the chance of AI with donor sperm (DSAI). Why??
It is important to understand that if the pregnancy will not occur after inseminations with donor sperm, nothing can prevent the usage of IVF. If IVF is performed in the first instance, and pregnancy does not occur after a few attempts, there is a risk that reproductive health and mental state of a woman will deteriorate as a result of IVF, and application of donor sperm inseminations will then be inappropriate, meaning that there will be no other way.
There are advantages of donor sperm inseminations regarding IVF/ICSI:
* no strong hormonal stimulations, which may adversely affect the health of the future child,
* transmission of male infertility to the following generations is excluded (possible transmission during IVF/ICSI has not been investigated by medicine),
* no risk to the health of the mother in contrast to IVF procedure.
DSAI is used:
* with poor quality of husband's sperm (as an alternative to IVF, IVF/ICSI) or in case if woman doesn't have a sexual partner/husband.
There may be used sperm of an anonymous donor from a donor sperm bank of the clinic or sperm of a donor, which you bring yourself - it may be a close relative of your husband (brother, father), someone you are familiar with or a little-known person, who is willing to make a donation.
The child born as a result of such insemination will be genetically native to the woman and the donor, but woman's husband (if there is one) officially and practically becomes the real father of the child. Doctors maintain patient confidentiality, and pregnancy after inseminations is carried out as a normal pregnancy. Donor has no rights to paternity and no obligations.
2.2.1. More information about donors.
According to the order of the Russian Federation Ministry of Health, in order to prevent the transmission of infections, medical institutions are permitted to use only cryopreserved donor sperm, that has been frozen and kept in quarantine for at least six months, so latent infections can be detected.
As not every man's sperms withstands freezing/defrosting without serious deterioration of its quality, only those men are accepted to be anonymous donors, whose sperm has this property (cryotolerant).
Anonymous donors are examined for all genital infections, it is also obligatory that they do not have any mental disorders and congenital malformations.
Other requirements for the anonymous donors depend on the clinic: the most stringent requirements are genetic tests for potential inheritance and presence of his two healthy children.
Carefully choose the clinic for the performance of artificial insemination! Clinics are looking for and attract anonymous donors themselves. The number of donors whose sperm is composing the donor sperm bank may include only 2-3 people, or there may be dozens of them. The information provided about the donor includes general information about the appearance, nationality, blood type, presence of his own children, education and occupation.
In case of insemination with sperm of the donor that you bring yourself, as an exception, there can also be used a fresh sperm, which was not cryopreserved for six months. If the artificial insemination is carried out in this mode, the cost of the procedure will be lower, waiting time will be reduced, and the chance of pregnancy after the artificial insemination will increase.
To carry out the insemination, the donor, who you bring yourself, has to be examined at least for all sexually transmitted infections.
3. Where the artificial insemination can be performed. Formalization.
Inseminations are carried out in clinics dealing with problems of reproduction, same places where IVF is performed (see the list online >>>).
Insemination is carried out by a fertility specialist (separate specialization in gynecology) with participation of embryologist, who is dealing with the sperm preparation.
In order to perform an artificial insemination there has to be signed an official agreement with the clinic - consent to insemination, with passport data.
If a woman is officially married, official consent to insemination has to be signed by the wife and husband in both cases, when insemination is carried out using husband's sperm and donor sperm.
When performing insemination with sperm of donor that you bring yourself, his official consent also has to be signed. In this case there have to be specifies his passport information and passport details of the spouses or a single woman, for whom he is willing to become a donor.
4. Insemination procedure.
Before carrying out the insemination the woman should be examined for sexually transmitted infections and should undergo an ultrasound examination in order to exclude possible gynecological diseases, which can prevent the onset or carrying of the pregnancy.
Insemination is carried out close to the time of ovulation - release of the mature egg from the ovary, approximately in the middle of menstrual cycle. It is ideal if the procedure is carried out in the interval of time "day before the ovulation - few hours after", because it is the most favorable time for conception. Although insemination carried out one, two or three days before ovulation can also lead to pregnancy.
In order to determine the time of ovulation with accuracy to at least a day, and to make sure that the egg has matured, there is performed an ultrasound monitoring: at first of the menstrual cycle, during which the AI is supposed to be performed; ultrasound examination is performed for a several times in order to track the ovaries functioning and growth of one or more follicles (oocytes). Growth rate of the follicle is usually 2mm/day, and ovulation occurs when the follicle reaches the size of 18-22mm.
In addition to the ultrasound examination, in order to determine the exact time of ovulation, there are used ovulation tests (similar to pregnancy tests for urine) that are sold in pharmacies.
AI can be carried out with the use of the ovary function hormonal stimulation. Hormonal stimulation is carried out with the same medications as for IVF (see page "Pharmacology in IVF" >>>), but usually in much smaller doses.
Stimulation might result in formation of a few follicles/eggs, and improve their quality, which increases the chance of pregnancy. It should be mentioned that drugs with active ingredient "clomiphene" (Clostil, Clostilbegyt) are outdated medications with many side effects and lower efficiency.
At the pre-ovulatory size of follicle(s) an ovulation provoker, human chorionic gonadotropin (HCG) can be prescribed.
Two days after ovulation there can be assigned a hormonal support of the cycle second phase with drugs Dufaston and Utrogestan, which promotes onset and maintenance of pregnancy.
In addition to matured follicles/eggs, an important factor for pregnancy is thickness of the endometrium in the uterus by the time of ovulation. Development of the endometrium is also tracked during the ultrasound monitoring, and if the development is insufficient (by the time ovulation it should not be less than 9mm) an extra hormonal drugs for endometrium development are assigned (Estrofem, Proginova, Divigel).
Inseminations can also be performed without prescription of any drugs.
One menstrual cycle may include 1 or 2-3 inseminations. This depends on whether there is maturation of one or more follicles/eggs, and when ovulation of each of them occurs (follicles may ovulate at intervals of 1-2 days); and it is also determined by how accurately the time of ovulation can be predicted.
In case of cryopreserved donor sperm usage, there may be performed 2-3 inseminations with an interval of one day.
When a fresh (native) sperm is being used, it must be assumed that in order to get a good quality of sperm sexual abstinence (ideally for 3-5 days) is required. Therefore insemination is performed either once - on the day of the expected ovulation, or twice with an interval of 2-3 days - for example, 2 days prior to ovulation, and few hours before or after ovulation. Ultrasound monitoring is carried out until it will be determined that ovulation has occurred (!).
Preparation of sperm for AI takes about 2 hours: about one hour is spent on the so-called liquefaction, after which the sperm has to be processed without any delay (otherwise its quality will deteriorate). Processed sperm can be stored for several hours without losing its quality. In case of cryopreserved sperm usage, more time is needed for sperm defrosting.
The actual procedure of insemination (sperm injection) takes a couple of minutes, and is carried out on a gynecological chair.
Sperm is injected via a delivery catheter directly into the uterus. The procedure is painless; you may feel just a slight stretching. You may feel some tension of the uterus (tonus) during a few hours after the procedure. After the sperm injection it is necessary to remain on the chair at the same position for 15 minutes, then it is allowed to stand up. A slight leakage of fluid is normal.
On the day of insemination you should limit physical activities and maintain the same regime as during critical days (menstruation). Since during insemination there is a direct intervention into the uterus, increasing the risk of infections, proper hygiene and caution have to be followed more carefully. No restrictions of the life regime are required in the following days.
Consulting, ultrasound monitoring, prescribing and insemination itself are carried out by the same doctor - reproductologist. Storage and preparation of sperm for insemination is being performed by the embryologist.
Hormonal support of the cycle second phase with Utrogestan or Duphaston prevents menstruation, even if pregnancy has not occurred. Therefore, if hormonal support is being used, it is necessary to take a blood test for pregnancy (blood for HCG) 2 weeks after ovulation.
In the case of a negative analysis support is canceled, if the result is positive the support is continued up to the consultation with a physician.
It is recommended to perform inseminations for a several cycles in a row, as there is a possibility of some processes, during which the created conditions for conception in a certain cycle are better than in previous ones.
5. Cost of insemination.
Artificial insemination. Price. Cost of the AI consists of several components:
initial consultation with the physician, cost of ultrasound monitoring, procedure of insemination itself, sperm preparation for insemination, cost of donor sperm (if sperm from the clinic's donor sperm bank is used), cost of the medications used.
Thus, the cost of insemination depends on the selected clinic, on whether drugs for the ovaries stimulation and other medications are applied, and whether the donor sperm bank is used.
In some clinics, where artificial insemination is carried out, the price is established as a total for everything that is carried out during the cycle
- for ultrasound monitoring and inseminations regardless of whether 1 or 2-3 procedures will be required. There are clinics where payment is made for each type of services - separately for ultrasound monitoring, or even for each ultrasound examination.
- for each procedure of insemination.
So when asking for the cost of insemination at the particular clinic we recommend to ask separately, how much does the entire required set of services cost.
Cost of donor sperm from the donor sperm bank is paid separately. Medications are purchased independently in the clinic or pharmacy. The cost of modern drugs for stimulation is comparable to the cost of medical services for the insemination procedure.
Higher price for the "set" or for the insemination procedure itself, in comparison with other clinics, does not necessarily mean that this clinic has a higher result. Insemination procedure in the clinics of Moscow and St. Petersburg in the average costs a few hundred dollars for one menstrual cycle.
6. Artificial insemination. Who has become pregnant? Probability of success and possible causes of failure.
Pregnancy as a result of inseminations occurs less frequently than with natural sexual life in healthy couples, and after the IVF procedure. That is, the probability of pregnancy in one cycle during performance of inseminations is less than 30%. Therefore we recommend to be prepared for performance of at least 3-4 cycles of insemination.
If pregnancy does not occur after 3-4 cycles of inseminations, it is recommended to change the method of treatment or donor.
This restriction is partly due to the fact that it is undesirable to carry out ovarian stimulation for more than 3-4 cycles; and partly because there is a more efficient method - IVF (but more expensive and less harmless to health). However, it may be quite reasonable to perform more than 3-4 insemination cycles without ovarian stimulation, while imitating a natural sex life.
6.1. Possible reasons of failure:
a) insemination is carried out with no indications, there are obstacles for pregnancy,
b) insemination was carried out with insufficient qualification or negligently
c) bad luck.
More details about each of the reasons:
a) Indications.
Unless the woman was examined for fertility, presence of diseases, preventing her pregnancy cannot be excluded. It is also important to realize that mature and ovulated follicle does not necessarily mean that the matured egg is fully functional and has a good quality. If the woman has hormonal disorders, ovarian failure or her age is over 35 years - a possible cause of the failure may consist in poor quality of the egg cells.
HSAI in case of sperm counts reduction should be mentioned separately. To make a decision about whether the performance of insemination is reasonable, there are required 2-3 spermograms, as sperm counts can vary greatly. During preparation of sperm for insemination embryologist provides an independent opinion on the quality of sperm and prognosis about the possibility of pregnancy - it is important to know that conclusion in order to make a decision on further treatment, if pregnancy does not occur.
b) Doctors’ professionalism.
The whole scheme of operations per cycle of inseminations is described above. Thus, the failure may be caused by the following reasons:
* delay in the preparation of sperm,
* poor quality of biological media used in the processing of sperm in the clinic,
* not accurately established time of ovulation, and carrying out of inseminations not at the optimal time, lack of verification of whether the ovulation has occurred, prescription of ovulation provocateur when follicle(s) is/are not completely matured or overgrown,
* thin (underdeveloped) endometrium in the uterus.
If you feel the negligence or contradictions in the actions of the doctor, you should think about changing the clinic or the doctor.
c) Bad luck.
If you do not find causes of failures in the reasons a) and b), and you have performed only 1-2 cycles of inseminations, it is most likely that you just have no luck.
It is possible to use ovarian stimulation if it was not applied before, to change the stimulation drugs, to perform 2-3 inseminations in the cycle if only 1 was carried out previously, to increase time of man's sexual abstinence before sperm donation (up to 5 days). Absence of pregnancy for even a few cycles of inseminations does not mean that the woman cannot become pregnant while having a natural sexual life with a healthy man.
Based on the collected information and experience of those, who have passed through insemination, and consultation with numerous reproductologists, you should try to understand whether it is worth in your case to resort to the AI, and how to accomplish all of this. It is possible that AI is your chance!
Send us stories about your success! They will bring a real hope to those who are thinking and have doubts, or are afraid of failing!
