The sperm is
usually placed in the cervix (intracervical insemination)
or in the uterus (intrauterine insemination). In intrauterine
insemination, sperm is injected directly into a woman’s
uterus thus allowing the sperm to bypass the cervix enabling
more sperm to successfully reach the uterine cavity and
fallopian tubes where fertilization usually takes place.
Both procedures are best performed at the time of ovulation,
which may be determined by basal body temperature, ovulation
test chart, cervical mucus examination, hormonal profile
and ultrasound scan.For women with irregular ovulation
patterns, medication may be used to induce ovulation prior
to artificial insemination. Timing of the insemination
procedure with ovulation is essential.
The male’s sperm is analyzed via seminal fluid analysis
to determine if it is suitable for insemination.
For academic purpose it is important to note that other
modes of AI note also utilized include intrafallopian insemination
and intraperitoneal insemination, procedures in which sperm
is introduced near the mouth of the fallopian tubes and
ovaries. However these are not as popular as intracervical
or intrauterine.
In most cases, abnormalities with the male factor is the
indication for AI with less indications from the female
via cervical factors that prevent the sperm from entering
the uterus from the vagina. It is not recommended for women
whose infertility can be linked to tubal factors, uterine
abnormalities, active pelvic infection or anovulation.
AI is thus indicated if the couple’s problems are
related to conditions that make it difficult for the man’s
sperm to reach the woman’s uterus.
Artificial insemination may be recommended thus increasing
the chances of fertilization when either partner is diagnosed
with:
Male Factors
-Unexplained infertility
-Erectile dysfunction -drugs, alcohol.
-Premature ejaculation
-Sperm abnormalities: Oligospermia-Low sperm count
Asthenospermia (decreased ability to move)
Abnormal sperm morphology (abnormal shape and structure)
Sperm antibodies (antibodies produced by the body to destroy
the sperm)
Retrograde ejaculation (a condition that causes semen
to be released backward into the bladder at male climax)
-Hypospadias (a congenital condition in which the urethra
opens on the underside of the penis)
Female Factors
-Unexplained infertility
-Poor interaction between sperm and cervical mucus
-Cervix disorders
-Endometriosis
AI may involve a donor which maybe may be a known or unknown
individual. A donor may be recommended for a number of
reasons, such as:
-Severe semen abnormality.
-Male partner has a sexually transmissible disease e.g.
HIV, HBV
-One or both partners carry a heritable disorder. A couple
may choose donor insemination when there is potential for
hereditary disease in their offspring.
Artificial Insemination: Preconditions
Before a woman undergoes artificial insemination, the cause of the infertility
must be diagnosed. The woman must also have the regularity of her ovulation
asserted.
The male partner’s sperm must be analyzed to determine
if it is suitable for insemination. The required sperm
can be collected in a number of ways including:
· Cup collection. This method requires a man to
masturbate and ejaculate into a sterile cup.
· Condom collection. During this process, semen
is collected during intercourse using a special condom.
· Split ejaculate. This method uses a two–part
container to collect sperm. The initial spurt should be
collected in one part of the container, and the rest is
collected in the second part.
· Urine collection. During this process, semen
is collected from urine sample of the male partner in a
laboratory. This is an option for men who have retrograde
ejaculation.
The sample must be collected no more than two hours before
the scheduled insemination time.
In some cases, men having treatments that cause or may
cause sterility, including testicular surgery, vasectomy,
prostate surgery, radiation and/or chemotherapy for cancer
treatment, may choose to store their sperm for future use
in an artificial insemination. Single women may require
donated sperm. In either case, sperm, which can be frozen
indefinitely, is stored in containers of liquid nitrogen
until it is required.
Sperm being used for an intrauterine insemination (IUI)
must first be washed. This procedure removes substances
that may cause complications. It also concentrates the
semen into a small sample of the most active sperm, thus
increasing the chance of fertilization.
Artificial Insemination: procedure
Artificial insemination is performed when a woman is ovulating. Ovulation occurs
when a follicle from the ovary releases a mature egg. If a woman's cycle
is regular, it usually occurs 14 days before the start of their next menstrual
period. Ovulation is often estimated with the aid of basal body temperature
charts, ovulation test kits and a cervical mucus examination. Blood tests
measuring levels of the hormone LH (luteinizing hormone) and ultrasound pelvic
scans may also be used. The procedure is performed 30-34 hours after the
spontaneous LH surge or 40-44 hours after the administration of medication.
Prophylactic antibiotics are not necessary unless a medical indication exists
(eg, history of mitral valve prolapse). For women undergoing ovulation induction,
the chances are greatly increased and timing the insemination procedure with
ovulation is essential.
The procedure is quite simple taking only a few minutes
to perform. It is performed on an out-patient basis and
may be done once or twice a month, depending on the regularity
of the woman’s menstrual cycle.
With the patient lying supine, the legs are hung on a
stir-up, the vulva clean and a speculum is inserted into
the vagina. This is a plastic or metal instrument that
helps to hold open the vagina and expose the cervix. A
catheter, a thin plastic tube is inserted into the vagina
until it reaches the cervix. A special syringe filled with
washed donor sperm is attached to the end of the catheter.
The sperm sample is pushed out of the syringe and travels
through the catheter, where it is deposited around the
cervix. In intrauterine insemination, the sperm is deposited
in the uterus. It has a higher success rate. A soft sponge
cap may be placed over the cervix in order to prevent leakage
of any sperm. This sponge can be removed between six and
eight hours after the procedure. You will be asked to rest
for a short time after the procedure has been performed – usually
30 minutes.
Artificial Insemination: After the procedure
Following the procedure, the woman should be able to resume normal activities.
Ovulation may be monitored via ultrasound for the next three days to confirm
its occurrence.
Chances of success are higher where the woman is less
than 35yrs of age, has been pregnant before and insemination
is done on the expected day of ovulation. Use of drugs
to induce ovulation also increases the chances as well.
Success when achieved occurs usually within the first
six cycles of therapy, however if the reverse is the case,
other forms of treatment, such as In Vitro Fertilization
(IVF) Intracytoplasmic Sperm Injection (ICSI) and Gamete
Intrafallopian Transfer (GIFT), may be employed.
Success Rates
Intracervical insemination success rates are about comparable to those associated
with intravaginal insemination. Typical success rates range from about 5%
to 30% per cycle, depending upon the quality of the sperm sample used and
the female's reproductive health status. Insemination is typically performed
twice each cycle, to increase the chances of pregnancy.
Sperm washing can help to boost your the of success with
intracervical insemination. Sperm washing is a preparation
method used to weed out slower and less healthy sperm cells.
Summary
Artificial insemination, it is a quite simple procedure with few side effects.
The success rates for artificial insemination are not colossal being in the
area of 15 percent, each cycle. However, it is less expensive and invasive
than other forms of Assisted Reproductive Technology (ART). Artificial insemination
also allows for fertilization to occur naturally in the body.
The demerits of the procedure are few and include the
uncommon introduction of infection into the female reproductive
tract and for those the that require induction, the ever
popular risk of multiple pregnancy and its attendant risk.
For IUI, IVF, and ICSI procedures, the removal of certain
components of the ejaculate (ie, seminal fluid, excess
cellular debris, leukocytes, morphologically abnormal sperm)
with the retention of the motile fraction of sperm is desirable.
After sperm preparation, the spermatozoa are enhanced
in motility and become activated and ready to fertilize
an oocyte. Currently, no reliable technique allows the
separation of the X- and Y-bearing spermatozoa. IUI is
performed during a natural cycle or after ovulation induction
with medication.
The average pregnancy rate achieved after a natural-cycle
IUI is 8%. The rate increases to 10-12% after clomiphene
citrate ovulation induction and to 12-15% per cycle after
hMG/hCG ovulation induction. Of the successful pregnancies,
85% are achieved within the first 4 cycles of IUIs.
Homologous insemination refers to the use of sperm from
the patient's partner. Heterologous or therapeutic insemination
(TI), refers to the use of frozen sperm that has been quarantined
for at least 6 months. Thereafter, the specimen is ready
to use once the donor has undergone the necessary screening
tests The source of the sperm can be either anonymous or
from a designated donor previously accepted by the infertile
couple. A cumulative pregnancy rate of 80% is achieved
during the first 6 cycles of TI.
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