Recommendations before insemination. Intrauterine insemination - what is this method and when is it used. How to find a donor for insemination

Intrauterine insemination is carried out in the supine position on the gynecological chair. A woman is injected with capacitated (cleaned) spermatozoa using a catheter. During this procedure, there are no pain however, a feeling of slight coolness from the catheter is possible. After the IUI is performed, the patient is in this position for about 30-40 minutes, in the future, weight lifting and sexual abstinence are prohibited.

This technique is performed in one menstrual cycle: one day before the onset of ovulation, immediately during and a day later (after ovulation). When using donor material, the ovulatory period is monitored by an ultrasound machine, and only one donor's sperm is used.

After undergoing this procedure, the doctor may consider it necessary to use progesterone, which will be administered vaginally. If unsuccessful, menstruation begins twelve days after IUI. In the absence of menstruation, a pregnancy test is performed after eighteen days, the attempt is considered successful with a positive result.

If during insemination within two menstrual cycles pregnancy did not occur, without fail a woman is stimulated to ovulate by various methods.

Indications for intrauterine insemination with husband's sperm

For a woman (wife):

Unexplained infertility;
Production of antisperm antibodies (ASAT);
Absence or violation of ovulation, treatable;
Allergic reaction to injected sperm;
Infertility of the cervical (cervical) factor;
The presence of vaginismus.

For a man (husband):

Reduced ability of sperm to fertilize;
ejaculatory dysfunction;
Violation of ejaculation, in which sperm is sent to the bladder;
Anomaly in the development of the penis - hypospadias;
Insufficient amount of sperm;
Increased plasma viscosity in semen;
The presence of ASAT;
The use of sperm that has undergone cryopreservation.

Under what indications is insemination carried out with donor material (from the husband)

A clear violation of the mobility and concentration of spermatozoa;
ejaculation disorder;
Unfavorable prognosis from medicine and genetics.

Violations of a mental and somatic nature, in which pregnancy and bearing are prohibited;
The size of the uterus is up to 35 mm;
The presence of a disease with an acute inflammatory process at the beginning of the procedure;
Acquired or congenital pathologies development of the structure of the uterus, in which implantation and gestation is impossible;
Oncology ( benign neoplasm) requiring surgical intervention or the presence of a malignant neoplasm.

Under what conditions is intrauterine insemination performed?

At the wife:

the presence of ovulation;
patency fallopian tubes.

Husband:

the presence in the ejaculate of 10 million or more spermatozoa with good mobility. It is checked by carrying out 2 spermograms.

The specialist individually for each patient determines the number, frequency and interval of insemination.

According to WHO regulations, only pretreated material is allowed for this method. Are removed proteins capable of causing an allergic reaction female body foreign body, or an inflammatory process in the presence of various kinds pathogens.

To donate sperm for the intrauterine insemination procedure, you must follow these rules: immediately before donating, you must have sexual abstinence for about three days, but not more than six days. Next, the urethra must be washed, for this it is necessary to urinate, be sure to wash the penis.

Sperm is obtained by masturbation into a container that is prepared in advance, and then it is liquefied. After the delivery of the material, about an hour through the floor, it can be cleaned according to this principle: it is necessary to remove seminal fluid, cellular waste and to isolate pure spermatozoa, among which the most active and ready for fertilization for the intrauterine insemination procedure will be selected.

Ejaculate preparation

What is the effectiveness of the IUI method

In this method of fertilization the most important role the age of the patient plays, because the probability of a successful outcome is higher in a young woman who does not have pathologies and diseases than in older women age group, in which the quality of the produced eggs is lower. In addition, an important parameter is the condition of the fallopian tubes, or rather, their patency, at least one must be healthy for fertilization. The spermogram is also significant, because with a sperm count per 1 ml less than 10 million and poor activity (less than 25%), the procedure does not make sense.

The onset of pregnancy during the IUI method occurs in approximately 17-18%, pregnancy with twins (15%) and triplets (3%) is also likely.

In the event of an unsuccessful attempt, it is possible to repeat intrauterine insemination, it is only necessary to withstand a period of a couple of menstrual cycles. Approximately 87% of patients suffered after three IUI procedures. It is worth noting that the percentage of women who continue to make attempts to get pregnant decreases by 6% with each attempt.

The procedure can be carried out no more than six times, after prolonged failures, it is worth deciding on fertilization with other modern technologies.

How much does the procedure cost

The price of intrauterine insemination is the main advantage over other technologies, for example, IVF will cost from UAH 25,000 to UAH 40,000 in Ukraine.

Video: Intrauterine insemination

The problem of infertility in married couples is not necessarily associated with improper work reproductive system one of the partners. There are many cases in which a woman does not have significant health problems, and the analysis of the male spermogram is far from ideal. Or, on the contrary, a man is able to conceive a child naturally, and the body of his partner produces anti-sperm antibodies that do not allow to conceive and bear a child in a natural way.

The problems of such a plan practically do not affect the general state of health, but at the same time do not allow the couple to become happy parents. And far from always this or that deviation lends itself successful treatment. In such cases, people are forced to resort to the procedure artificial insemination, which has been successfully carried out in our clinic for several years now.

In the overwhelming majority of cases, it is possible to solve the problem of infertility using a simple and relatively inexpensive procedure of artificial insemination, or, in other words, artificial insemination. This type artificial insemination should be carried out exclusively an experienced doctor who you trust. Dr. Lazarev Alexander Pavlovich, author of thirty scientific works in the field of treatment various forms infertility, has helped more than 1500 couples to experience the joy of birth long-awaited baby. Our clients will be offered an individual treatment plan depending on the form of infertility, and multidisciplinary consultations and medical manipulations are held in classrooms and laboratories equipped according to the rules of world standards.

Types of artificial insemination

To date, several types of artificial insemination are practiced, which differ in the method and location of the introduction of sperm into the patient's body:

vaginal;
uterine;
intracervical;
intrauterine;
intrafollicular;
intracavitary.

In some cases, the ejaculate can be delivered to the fallopian tubes (perfusion). However, the most famous and frequently used method of artificial insemination is intrauterine.

What is Artificial Insemination?

Artificial insemination is one of the most common and available ways conception of a child, which consists in the delivery of pre-prepared male sperm directly into the uterine cavity of the expectant mother. This procedure differs from IVF and ICSI methods in that in this case fertilization does not take place laboratory conditions but in the body of a woman.

The chances of getting the desired pregnancy during artificial insemination are much higher than when trying to conceive a baby naturally. This is due to the fact that during the procedure, the male ejaculate undergoes special processing and, with the help of special tools, is placed directly into the uterine cavity. Thus, the task of spermatozoa is greatly simplified - they reach the goal much faster and meet with the egg. In this case, it does not matter if sperm motility is somewhat underestimated, and their number is not normal.

Indications for artificial insemination: men

Artificial insemination is indicated for men who have the following reproductive problems:

insufficient volume of semen;
decreased ability of sperm to fertilize an egg;
premature or late ejaculation;
sexual disorders different nature, including impotence;
the consequences of chemotherapy in the treatment of neoplasms;
increased viscosity of the ejaculate;
the need to freeze the male biomaterial.

Indications for artificial insemination: women

If problems are diagnosed by a woman, then this is usually:

involuntary spasms of the vagina and uterus during intercourse;
lack of ovulation;
production of antisperm antibodies by the cervix;
infections and inflammation of the internal genital organs;
increased acidity in the vagina;
abnormal structure of the reproductive organs;
allergic reactions to ejaculate;
surgical interventions in the uterus in history;
unidentified causes of infertility in a couple.

Important! In order to be able to carry out the procedure of artificial insemination, the woman's fallopian tubes must be passable, and the quality of the processed ejaculate must be high.

The probability of fertilization in a woman under 30 years of age is slightly higher than in older women. late age. If the partner's spermogram has an unsatisfactory result, it is recommended to use donor material for conception.

Who is contraindicated in artificial insmenation?

Unfortunately, not all patients are shown artificial insemination. These contraindications include:

Various psychical deviations in a patient in which it is not possible to conceive and bear a healthy child.
Diseases and abnormalities in the development of the uterus, as the bearing of the fetus becomes impossible.
Neoplasms in the region of the ovaries.
Malignant formations in the body of a woman.
inflammatory processes.

Benefits of artificial insemination

Despite the simplicity and relative accessibility of this manipulation, this way artificial insemination has quite a high percentage efficiency. Because the male sperm placed directly into the uterine cavity, thereby avoiding many of the problems that Everyday life impede the process of fertilization:

There is no effect of the secret that is produced by the cervix of a woman and contributes to the retention and passage of spermatozoa through the genital tract.
It becomes possible to control the process of ovulation, and also ensures the fusion of female and male germ cells in the required period of time.
cum exposed pretreatment in laboratory conditions, which improves its quality several times and increases the likelihood of pregnancy in a woman compared to ordinary sexual intercourse.
low cost - this method artificial conception is considered one of the most affordable today.
The consequences for the body of the patient herself after the procedure are minimized.
The manipulation itself is a simple process and does not require long preparation.
Pretty high performance.

Conditions for artificial insemination

In order for this method to give the desired result, the following requirements must be met:

a woman should not have problems with the patency of the fallopian tubes;
there should be no pathology in the uterine cavity;
the partner's sperm quality is satisfactory;
the supply of follicles in a woman's body should be sufficient;
the couple has no contraindications to the IVF procedure.

Before proceeding with the procedure of artificial insemination, the couple must be fully examined for general condition organism. Then the preparation of the male biomaterial is carried out, its purification, and the presence of ovulation in the current cycle is monitored and monitored in the woman. After that, the AI procedure itself is performed - intrauterine insemination eggs from the sperm of a donor or partner of the patient.

The process of preparing partners for the procedure can take up to several months. A man needs to take a spermogram for analysis, and a woman needs to do an ultrasound of the pelvic organs, check the fallopian tubes for patency, be tested for various sexual infections, HIV, hepatitis and syphilis. As a rule, both spouses are advised to drink alcohol three months before the intended conception. multivitamin complex, adjust weight if necessary and stop smoking cigarettes and drinking alcoholic beverages.

Many childless couples are wondering: "What is insemination and how is the procedure?". In some cases, a woman is additionally stimulated in order to mature more eggs. In the process of semen purification, the highest quality and active spermatozoa are cultivated from it, and the sperm itself is purified from seminal plasma. The artificial insemination procedure itself is carried out within the walls of the clinic, in an office equipped with everything necessary, in conditions of complete sterility.

The process of artificial insemination

How does fertilization occur during insemination? Artificial insemination is prescribed for the period when a woman should ovulate. Artificial insemination is carried out by a reproductive doctor and embryologist, who takes care of the cleaning and preparation of the male ejaculate. Before starting the manipulation, it is necessary to conclude an agreement with medical institution. If a married woman wishes to use donor material, then the written consent of her husband will be additionally required. In order to conduct AI, the specialist will need the following medical tools: tweezers, a syringe, a speculum, a catheter with processed sperm, and sterile cotton wool.

A woman is invited to an office equipped with a gynecological chair, arranged in horizontal position- the patient's pelvis should be slightly raised. In this position, the doctor, using a special tool, places under pressure the partner's or donor's sperm directly into the uterus. Manipulation lasts about two to three minutes. After the procedure, it is best for a woman to remain calm for some time, 30-40 minutes, and then she can leave the walls of the medical institution.

Typically, the AI procedure is performed three times during the current cycle in order to increase its effectiveness. If the cycle does not end with menstruation, then on about the 18th day, the woman is invited to take a pregnancy test.

Important! Before a visit to the doctor, it is forbidden to carry out any douching of the vagina, as well as various manual studies.

Chances of success

According to statistics, it takes several attempts to achieve the desired result when using the artificial insemination method. As for the financial side of the issue, such manipulation costs are approximately equal to one IVF procedure. That is why, if your partner's sperm quality is not very high, and your own ability to conceive does not cause firm confidence, it is recommended to immediately perform the most effective in vitro fertilization procedure.

In general, the probability of a successful outcome is determined by several factors at once:

the true cause of infertility;
age of future parents;
period of infertility;
the number of treatment cycles;
the quality of the male ejaculate.

In order to increase the likelihood of long-awaited pregnancy, should be carried out this procedure according to strict indications, pass an additional sperm test for DNA and an HBA test.

Intrauterine artificial insemination (IUI) is one of the most popular methods of fertilization. The procedure consists in the fact that the sperm is injected directly into the uterine cavity for development natural pregnancy. Artificial insemination is also carried out with donor sperm.

Previously, the procedure was ineffective. The introduction of semen caused unpleasant, even pain. The risk of infection increased. Under such conditions, the success of manipulation was only 7-10%. However, many years of research have identified a number of laboratory methods, which significantly increase the chances of conception after artificial insemination.

Processing sperm in a centrifuge allows you to clean it of impurities and enrich the cells with protein and minerals. After special treatment active sperm more remains, as the defective are eliminated. By increasing the concentration of healthy cells, it is possible to increase the chances of success: a little sperm is injected into the uterus, but most of the cells are viable.

Unfortunately, there are many applicants for artificial insemination. It is not enough to feel healthy and not have problems with sex life. The ability to fertilize depends on internal factors.

If there were injuries to the genital organs (actual and exposure to instruments during the operation), the reproductive function could be impaired. The same applies infectious diseases, because mumps, syphilis, gonorrhea, hepatitis and tuberculosis negatively affect reproduction.

The most common cause of infertility in men is the expansion of the veins of the seminal canal, which leads to overheating of the testicles. Under the influence of abnormal high temperatures germ cells die, and with insufficient concentration of active spermatozoa, fertilization does not occur. This is due to the fact that it takes not one, but thousands of spermatozoa to go all the way to the uterus. Most simply help one to overcome obstacles, but without enough no sperm will reach the target.

Habits (overeating, smoking, sedentary image life). They help reduce the number of healthy cells, change their structure and degree of mobility.

At female infertility, artificial insemination with the husband's sperm is relevant if a woman is diagnosed with an unfavorable environment. It often happens that slow spermatozoa hardly make their way into the cervix, where they are “finished off” by antibodies. This happens with long married life when the uterus learns to perceive the sex cells of the partner as something foreign.

Artificial insemination with sperm is also suitable for some patients with an abnormal structure of the genital organs. Important role plays the time and method of introducing sperm, because through insemination imitates natural process conception.

The method allows you to carry out those stages of fertilization that do not occur due to deviations. The procedure is divided into 3-5 cycles. If insemination is ineffective after four attempts, they resort to or (depending on the causes of infertility).

Indications and contraindications

Insemination allows you to solve the issue of infertility in men with such deviations:

sperm subfertility;
retrograde ejaculation;
ejaculatory-sexual disorders;
insufficient amount of seminal fluid;
displacement of the urethra;
thickening of sperm;
low sperm motility;
complications after vasectomy;
consequences of radiation or chemotherapy.

Also, artificial insemination is in a good way use cryopreserved sperm. The procedure allows a woman with such deviations to become pregnant:

cervical infertility (problems with the cervix);
difficulty in the penetration of male germ cells into the uterus;
chronic inflammation of the cervix;
manipulations resulting in damage to the cervix;
anatomical or physiological disorders of the uterus;
ovulation dysfunction;
vaginismus (reflex muscle spasms that prevent sexual contact);
sperm allergy.

IUI is recommended in the presence of an excessive amount of antisperm bodies, which are characterized as immunological incompatibility partners. The procedure is also used for unexplained infertility. Contraindications for artificial insemination:

the age of patients is more than 40 years (the chance of the effectiveness of the procedure is reduced to 3%, which is almost impossible, therefore more promising methods of artificial insemination are recommended);
having more than four failed attempts VMI;
psychological and somatic disorders which exclude any possibility of pregnancy;
Availability genetic diseases that can be passed on to the child;
there are foci of infections of the genital tract;
acute inflammation;
congenital or acquired uterine malformations that make it impossible to fully and healthy development fetus;
pathology of the fallopian tubes;
ovarian tumors;
syndrome;
malignant tumors in any part of the body;
unexplained bleeding in the genital tract;
pelvic surgery;
syndrome of luteinization of the unovulated follicle (lack of ovulation in the presence of manifestations).

Training

The procedure is performed during the ovulation period of the menstrual cycle. Insemination is carried out against the background of the natural maturation of the egg or by stimulating the ovaries (ovulation induction). Use fresh sperm or cryopreserved.

The preparation plan includes a consultation with a doctor who will study the anamnesis and draw up an individual examination scheme. First of all, you should confirm the absence of STIs (sexually transmitted infections).

It is unacceptable to perform IUI with hepatitis, syphilis,. A test for TORCH infection is ordered. A man undergoes a spermogram for analysis of qualitative and quantitative characteristics. To assess the microflora of the genital organs, a smear is taken. At risk are people with ureaplasmas, papillomavirus, group B streptococcus.

Diagnosis is important because these infections do not have symptoms. In the presence of pregnancies that were interrupted by themselves, you need to donate blood for analysis of the immunological side (ELIP-TEST 12).

A woman should keep a journal of her menstrual cycle, measure basal body temperature and do ovulation tests. Folliculometry is done to confirm ovulation.

Stages of artificial insemination

Stage 1 - ovarian stimulation

Hormones (FSH, LH) are used for this. Through ultrasound, the development of the cycle and the formation of the follicle are monitored. An analysis of its size and structure is also carried out. After the maturation of the follicle, a hormone that mimics luteal is injected to stimulate natural ovulation. Thus, the egg cell is activated.

Stage 2 - sperm preparation

A man gives a sample on the day of the procedure. If cryopreserved sperm is used, it is thawed in advance. I process the sample in a centrifuge, add nutrients(the procedure takes an average of 45 minutes). After the separation of active germ cells from abnormal ones, the concentration of spermatozoa becomes acceptable for implantation.

Stage 3 - insemination

It takes place on the day of ovulation. It is undesirable to do IUI with respiratory disease, stress, fatigue, feeling unwell. Cells should be injected within 1-2 hours after their treatment. The fact of ovulation is confirmed by folliculometry.

In the absence of ovulation, stimulation is repeated. In the presence of ovulation, sperm is collected in a thin cannula, which is inserted into the uterus and injected. It is noteworthy that the procedure itself, despite the terrible description, is painless. The woman hardly feels anything. Feelings are comparable to ordinary gynecological examination. To do this, use special disposable flexible tools.

After the introduction of sperm, a cap is put on the cervix to prevent leakage. It is recommended to start sexual life 8 hours after removing the cap.

Statistics and Probability

It is recommended to resort to insemination no more than 3-4 times. In almost 90% of patients, the desired pregnancy occurs precisely in the first three attempts. The probability of getting pregnant in other women does not exceed 6% per attempt. It is noteworthy that the first three attempts in total account for almost 40% of the probability, while for six attempts only 50%.

Insemination success by age:

Up to 34 years, the first insemination gives up to 13% success, the second - 30%, and the third - 37%.
From 35 to 37 years old, the first gives 23%, the second - 35%, and the third - 57%.
From the age of 40, all attempts give 3% for the success of conception.

If three procedures are ineffective, it is advised to turn to other methods of artificial insemination.

Possible Complications

After artificial insemination, some complications are possible. So a woman can develop severe allergy for ovulation inducing drugs. Possible acute inflammatory processes and exacerbation of existing chronic diseases.

Directly with the introduction of sperm, a shock reaction is sometimes observed. After IUI, an increase in the tone of the uterus is possible. Also, the risk of ovarian hyperstimulation syndrome cannot be ruled out. Some patients experience multiple or ectopic pregnancies after artificial insemination with sperm.

If a couple decides to use artificial insemination, the first thing she needs to do is find a suitable reproductive health clinic, the second is to go through everything necessary procedures to decide whether the couple can take advantage of this reproductive method, the third - in case of a positive response, either proceed to 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 donating blood 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 urethra in a man;
testing functional diagnostics: in a woman - to characterize the menstrual cycle and the estimated time of ovulation (measured rectal temperature for at least three menstrual cycles, additional research: colpocytological, fallopian tube patency, dynamic determination of 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, ovarian stimulation is performed. hormonal drugs. 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 Chorionic Gonadotropin to induce ovulation, which occurs after an 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.