Our main wish is to help those patients (both married couples and single women) who are on the edge of performing intrauterine insemination procedure (IUI). Everyone has different reasons to go for artificial insemination of a woman - a desire to destroy loneliness, diseases that do not allow spouses to have a desired child. Do not think that you are the one who has such miseries. IVF clinic will help you.
Artificial insemination (or artificial fertilization) - what is it? After reading this article, you can find out what the IUI procedure is, how does cell fertilization occur, what is the difference between external fertilization and internal fertilization, how time of fertilization is chosen, how fertilization of a woman using different methods of ART is performed, and how much the fertilization costs. Prices of ART procedures depend on the method chosen; and the clinic of artificial fertilization that you have chosen will necessarily give you the information about the cost of fertilization and will determine what is included in it. In addition, in the pages of the corresponding topic in the Internet you will be able to read reviews about how the artificial fertilization is performed in the clinic that you have chosen.
It should be understood that the visit to the doctor who performs infertility treatment is not something shameful. We certainly visit a physician or a dentist more often, and therefore we take it as a given. However, reproductive clinic does not differ from other medical institutions. Your goal is pregnancy and birth of a healthy baby. And you should not deviate from the desired goal!
Infertility treatment is something to what we still refer with suspicion, as to something new. This is not only about the patients themselves, who have indications for external or internal fertilization with application of ART, but also about people surrounding them. If you are concerned about a possible skepticism, misunderstanding, jeering and negative reviews (responses that are perfectly natural when people are faced with something unknown or unfamiliar to them), do not tell outside people about your problems. Process of fertilization, birth of a new life has always been a mystery not intended for prying eyes. Let only the closest people know about the fact that you applied to the clinic, and that you need such method of infertility treatment as insemination with donor sperm.
"How to get pregnant?" - this question is discussed only by to people - husband and wife.Therefore, it is not necessary to answer all the questions of the acquaintances. You should not lose heart, because it can only make the problem worse, while you do want to get something quite different, right? Your goal is a successful fertilization, pregnancy and a healthy baby. Therefore you need to fight to the last, giving all your strength to this fight. It is extremely important to make the right decision, and this is very hard to do.
Insemination is recommended in the following cases:
- male factor of infertility (bad sperm analysis, sexual disorders);
- absence of a male partner (if woman doesn't have diseases herself).
Single women make such decision independently, and many of them (due to age-related causes and absence of partner) are afraid that favorable time will be missed. That is why they decide to resort to artificial insemination. The cost of fertilization, whatever it is, no longer seems to them too big (it should be mentioned that artificial insemination at home is one of the least expensive ART procedures). We wish them understanding of their family, as well as strength and patience, because raising a child alone is very difficult.
Male infertility is a factor that requires more detailed consideration. Infertility in men is not always possible, regardless of the patient's age. Men often accept such stroke of fate very difficultly; conception by artificial means may result in a huge crack in the relationship of the spouses.
Walking away from the problem and ignoring it is a meaningless decision, which can only exacerbate the situation. Sexual cell fertilization, as well as conception and birth of a child through assisted reproductive technologies is a real chance to find harmony of marriage, and become the proud parents of a long-awaited baby.
It is important to get previously acquainted with the list of services provided by infertility treatment centers, find out how much fertilization costs (prices may vary between clinics), and figure out how they will be able to help exactly you. Talk to reproductologists, trying to dispel any unclear questions and doubts, read patients' reviews about this clinic.
If the doctor says that you have a poor sperm analysis, be aware that this is not a diagnosis. It is not possible to evaluate the state of health according to just one spermogram. It is necessary to find out reasons of such sperm analysis; only after that any predictions can be made.
If spermogram shows presence of severe not treatable pathologies, intrauterine insemination with husband's sperm will not lead to pregnancy. The process requires presence of at least one healthy sperm cell. In order to conceive a child, there will be required to use donor sperm, in vitro (external) fertilization or ICSI with husband's sperm.
One should not think that artificial fertilization with donor sperm diminishes importance of the husband. On the contrary, he bears a very important and serious responsibility - raising of a common child, and what will he be like when he grows up depends only on you.
Artificial insemination (AI) belongs to the category of assisted reproductive technologies, which are used for artificial fertilization.
1. General information
Insemination is a method during performance of which sperm is injected into the uterine cavity by artificial means. Then everything occurs naturally: sperm cells aspire to reach the egg cell through fallopian tubes, resulting in fertilization of the egg, which is then attached to the uterine wall. This means that the long-awaited pregnancy occurred.
The procedure is performed within the period close to the natural ovulation (when successful fertilization of the organisms is the most probable), usually this moment falls in the middle of menstrual cycle. Some time ago sperm was injected into the vagina. However, practice has shown that introduction of sperm into the uterus is more effective.
Before IUI sperm is subjected to pre-processing. In the natural process, its composition is changing, while moving from the vagina into the uterus. That is why sperm has to be modified. Injection of unprocessed sperm into the uterine cavity is strictly prohibited.
2. Who are candidates for AI?
The procedure is usually assigned in two cases: when there is a factor of male infertility, and for women who do not have a partner, but at the same time there is a desire to have a baby. Main condition is that the woman doesn't have any diseases, which can prevent pregnancy.
The procedure is not assigned to patients with the following pathologies:
- obstruction of the fallopian tubes, treatment of which was not successful;
- absence of the fallopian tubes;
- absence of the uterus or ovaries;
- endometriosis of 3-4 degree.
This method belongs to assisted reproductive technologies, and can be of two types:
- AI with husband's sperm (HSAI);
- AI with donor sperm.
2.1 AI with husband's sperm
HSAI as a method of infertility treatment is assigned in case of the following pathologies:
- sexual disorders, irregular sexual life, vaginismus;
- slight deterioration of sperm analysis;
- cervical factor of infertility, at which sperm cells are not able to reach the uterine cavity;
- unexplained infertility;
- there are no obvious reasons why the pregnancy does not occur, but there are also no clear indications for IVF.
It is understood that by this time both spouses have passed complete examination, and have in their hands the medical report, in which the causes of infertility are indicated. Typically, these pathologies are very rare, most often causes of infertility are completely different. HSAI requires usage of a fresh sperm. The husband has to hand over his sperm directly into the infertility treatment clinic, a few hours before the procedure. Preliminarily husband has to undergo a complete examination for sexually transmitted infections. The child born as a result of HSAI will be genetically native to both spouses.
2.2 Artificial insemination with donor sperm
Before you decide to go for such method of infertility treatment as in vitro fertilization, it makes sense to try application of donor sperm (DSAI). Even if the procedure does not give a positive result, you can always agree to IVF. If you do it vice versa (perform the IVF first), it is quite possible that after few unsuccessful attempts reproductive health of women will simply not withstand such a heavy effect on the organism. This means that donor sperm will no longer help in this case. Infertility treatment will fail.
There are several advantages of DSAI in comparison with IVF or ICSI:
- no risk for the patient's reproductive health;
- no possibility of transmission to the posterity of such pathology as male sterility (there is no data about possibility of transmission during carrying out of IVF or ICSI procedure);
- no need to use a strong hormonal stimulation, which can harm the health of the future child.
Indications for use of DSAI usually include poor sperm analysis of the husband's sperm or desire of woman to have a child while there is no partner. Donor sperm can be taken at the sperm bank, in which case the donor of sperm will remain anonymous, or a woman can bring her own sperm donor, who may be a relative, friend or anyone who has agreed to this procedure.
The child that was born as a result of the procedure will be genetically native only to the woman, and also to the donor, whose sperm was used. Woman's spouse accepts a formal paternity, practically becoming a real father of the baby. Infertility treatment clinics strictly keep medical confidentiality. Pregnancy management is carried out in the usual way. Sperm donor has no right to claim paternity and any obligations associated with it.
2.2.1. Sperm donors
According to the order of the Ministry of Health of the Russian Federation, only cryopreserved donor sperm can be used in any medical institution. This decision was made in order to prevent transmission of potential infections through the sperm. Initially donor sperm is being frozen and stored in that condition for up to 6 months, during which latent infections can be detected.
Not always sperm can withstand cryopreservation and subsequent unfreezing without loss of quality. That is why only that man whose sperm preserves high quality after unfreezing can become an anonymous sperm donor. Each sperm donor is required to undergo multiple examinations, such as analysis for sexually transmitted infections. One of the mandatory requirements is the lack of congenital abnormalities and mental illnesses.
Infertility treatment centers have different requirements for donor sperm. But all of them have very strict requirements for such indices as genetic analysis, as well as presence of healthy children - two or more.
A lot of infertility treatment clinics are looking for sperm donors independently. Sperm bank may consist of two or three samples of sperm, or of several dozens. Women who are willing to use donor sperm for the artificial fertilization are not provided with donor's photo. A woman that has indications for AI with donor sperm can get acquainted only with general information about the sperm donor: height, weight, approximate appearance, nationality, occupation, presence of his own children..
If the patient brings a sperm donor herself, she may be injected a fresh sperm instead of cryopreserved. This allows to save expenses, shorten the result waiting time, and in addition, chances of pregnancy occurrence when a fresh sperm is used are a lot higher.
In this case the patient is recommended to examine her donor at least for the presence of any sexually transmitted infections.
3. Clinics where AI can be performed. Procedural formalities
Any infertility treatment center usually performs insemination, along with other assisted reproductive technologies (list of clinics can be found on the сайте).This procedure can only be performed by a reproductologist together with an embryologist, who prepares the semen.
Before performing the procedure, the patient must sign an official agreement with the infertility treatment center, in which the woman indicates her passport data and confirms her consent to the AI performance. In the presence of an official spouse, he also has to confirm his consent to this procedure, regardless of whether there will be used husband's or donor sperm. If a woman brings her own sperm donor, he is also required to sign a contract, indicating his passport details.
4. Implementation of the procedure
The patient should be preliminary examined for sexually transmitted diseases, and should undergo an ultrasound examination in order to exclude presence of serious gynecological diseases.
Date of the procedure performance is settled individually for each patient - according to the calculation of the estimated ovulation period. AI is carried out just before this moment, which typically corresponds to the middle of the menstrual cycle. Ideal interval is one day prior to ovulation or maximum a few hours thereafter. Sometimes AI carried out a few days before ovulation, also ended with a normal pregnancy.
More accurate time of ovulation can be determined by means of ultrasound monitoring. For this purpose, starting from the first day of the menstrual cycle, ultrasound examination is performed several times, in order to determine functioning of the ovaries, and development rate of the egg cell. Normal rate is 2 mm per day; ovulation occurs when the egg grows up to 18-22 mm. Besides that, time of ovulation can be determined using special tests for ovulation; they can be easily purchased at any pharmacy.
AI with donor sperm is often performed using ovulation stimulation. Ovarian functioning is stimulated with the same drugs that are used for in vitro fertilization. The only difference is the smaller doses. In the process of ovarian stimulation there can be developed several eggs of high quality, increasing the chances of a successful outcome. It is appropriate to remind that some drugs, such as clomiphene (Clostilbegyt, Clostil), has long been considered obsolete. Their application is fraught with numerous side effects, while the effectiveness is very low.
If the egg has reached pre-ovulatory size, the woman may be prescribed ovulation stimulation with the use of human chorionic gonadotropin (hCG). In a couple of days after ovulation the patient is sometimes prescribed hormonal support, which increases the probability of pregnancy, contributing to its maintenance. For these purposes, there are used drugs such as Utrogestan or Duphaston.
However, presence of mature eggs is not enough for getting pregnant. Thickness of endometrium, which is reached by the time of ovulation, is also very important. Performing ultrasound monitoring the doctor observes endometrium development, and if by the right moment the thickness is insufficient (less than 9 mm), the patient is prescribed hormonal drugs (Proginova, Estrofem, Divigel), which contributes to the endometrium layer development. However, there are cases when no drugs are used during the procedure.
During one menstrual cycle the patient can undergo from one to three inseminations. Everything depends on the number of mature eggs and ovulation date of each of them. If follicles ovulate at different times, it is possible to carry out more than one AI, but only if the time of ovulation is guessed as accurately as possible.
If the procedure is performed using cryopreserved semen of a donor, it can be carried out with daily intervals. If it is planned to use a fresh sperm, patent's husband or donor are recommended to refrain from sexual intercourse for 3-5 days. AI is performed either 1 time at the moment of ovulation, or twice, but with certain intervals - about 2-3 days. The first one may be carried out a couple of days before the ovulation, and the second - closer to the time of ovulation, before or after it. Ultrasound monitoring has to be carried out until the exact moment of ovulation is determined.
Semen processing and its preparation start a few hours before the AI procedure, because the material cannot be stored for a long time. Initially sperm is liquefied up to desired state (this takes about an hour); approximately same amount of time is spent for the further processing. In case of cryopreserved sperm application, much more time is spent for its processing, as sperm has to be previously unfreezed.
Then the patient, who is in a gynecological chair, undergoes injection of the prepared sperm - it takes just a few minutes. Injection is performed through a catheter; semen gets directly into the uterine cavity. Usually patient is not experiencing any painful sensations during the procedure. Some patients feel barely noticeable stretching. It is allowed to get up from the chair in 15 minutes. At this point a little amount of fluid may leak from the vagina. Slight tension of the uterus after AI is normal; it passes in a few hours.
It is necessary to minimize physical activities on the day of the procedure, just as it is done during menstruations. In addition, it is important to carefully follow the body hygiene, because after any manipulations uterus becomes very susceptible to infections. The next day, all restrictions are canceled.
Two specialists are involved in the procedure: reproductologist performs ultrasound monitoring, makes all medical prescriptions, and carries out AI, while embryologist's task consists in storage and preparation of the sperm.
When hormonal support with Duphaston or Utrogestan is used during the second phase of the cycle, menstrual cycle does not start despite the absence of pregnancy. In this case pregnancy diagnostics is carried out in 2 weeks, after blood analysis for hCG. If the analysis is positive, the hormonal support is being continued until it is canceled by the doctor. If the result is negative, the support is no longer needed, and therefore it is canceled immediately.
If the first procedure was not a success, it is recommended to make a few more attempts in a row. Certain processes contribute to the creation of favorable conditions that increase the chances of conception success in the subsequent cycle.
5. Artificial insemination. Cost of insemination
Cost of AI includes the cost of the initial visit of the reproductologist, preparation and processing of sperm, the cost of ultrasound examinations and used medications, the cost of the donor sperm (if the patient is administered sperm from a sperm bank at the fertility treatment clinic), and the cost of the insemination procedure itself. A woman may wish to perform the procedure using the sperm of a donor that she has invited. Price of the service will be corresponding.
Different infertility treatment centers set their own prices for the procedure, which involves participation of a sperm donor. The cost depends on whether there is used a material from the sperm bank, and on the drugs, which are used for the ovarian stimulation. Some infertility treatment clinics establish a comprehensive price for the entire procedure, regardless of how many insemination attempts will be needed. There are centers where the cost of each provided service is calculated separately.
When choosing a clinic, specify what is included into the named price. Usually patients pay separately for the material from the sperm bank. Woman will have to buy medications on her own; meanwhile, their cost is comparable with the rates for the procedure itself.
If price named in the clinic exceeds prices of other centers, there is no guarantee that the result obtained in it will be higher. Average prices for insemination at infertility treatment clinics in Moscow and St. Petersburg range from 250 to 400 USD per one trial.
6. Chances of success and probable causes of failure
AI does not give an absolute guarantee of pregnancy occurrence; a positive result of this procedure is less frequent than in case of in vitro fertilization performance or a natural process (this is related to healthy spouses). Positive diagnosis of pregnancy is noted only in every fourth or five cases. Women are recommended to set themselves up for a few tries. If after 3-4 insemination procedures pregnancy does not occur, it is recommended to change the donor or to choose a different method of infertility treatment.
This limitation is due to the fact that ovarian stimulation is permitted to carry out only within 3-4 cycles. If the procedure is carried out without the use of stimulant medications, it is allowed to increase the number of attempts without any harm to health. On failure, women are advised to use other assisted reproductive technologies such as in vitro fertilization.
1. There are reasons preventing pregnancy occurrence. Typically, this means that AI is performed in spite of indications.
2. Procedure is performed by an unskilled doctor, or there is an obvious negligent attitude to work.
3. Banal bad luck.
Here are more details about each reason:
1) Indications.
The patient who is going to perform AI is recommended to undergo a fertility test. Otherwise it is impossible to determine whether she has gynecological problems that may prevent pregnancy occurrence. In addition, even if the egg has matured, and ovulation has occurred, it does not guarantee high quality of follicles. Egg cells of a low quality are mostly formed in women with different hormonal disorders, ovarian abnormalities, as well as in patients older than 35 years.
Insemination, indication for which was low quality of sperm, may also fail. Everything depends on spermogram; it is better to make 2-3 studies, as indicators of sperm quality may vary. During preparation of sperm embryologist has to give an independent opinion, which includes a conclusion about the sperm quality, as well as an approximate prognosis of the procedure outcome. This information will be useful, if pregnancy does not occur, and you choose to continue treatment of infertility with other methods.
2) Qualification of doctors.
We have tried to provide a detailed description of the whole procedure and sequence of actions. On this basis, it can be assumed that the failure may be determined by the following reasons:
- poor quality of biological media, which are used in the processing of semen;
- usage of not very fresh sperm (delay of its preparation);
- error in the determination of ovulation time, performance of insemination without prior confirmation of the ovulation process, prescription of drugs that stimulate ovulation when size of follicles is not appropriate
– overgrown or undergrown;
- insufficient thickness of endometrium layer (less than 9 mm).
If you have any doubts concerning the doctor's competence, think whether you should change specialist or infertility treatment clinic.
3) Banal bad luck.
Often it is very difficult to understand why you are not accompanied by a good luck. If you are sure that the reasons listed above are not applicable in your case, then banal bad luck should be blamed in everything. But it also may end.
Talk to your doctor; may be it is worth to use ovarian stimulation, if previous attempts were carried out without it. Sometimes it is enough to change the drugs contributing to the stimulation or to perform two or three inseminations during one cycle. Sometimes it is recommended to increase the period of sexual abstinence of a spouse or a sperm donor for a day or two. If pregnancy does not occur after several attempts of insemination, the woman may well conceive a child naturally, but her partner has to be a healthy man.
Analyze different information about the insemination, as well as the experience of those who have already been through this procedure, consult with doctors, and make your own conclusion. Anyway, you are the only person who can make the decision.
If the AI succeeds, share your good fortune with others! After all, such stories can give hope to those who have not yet made a final decision.
