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

Artificial insemination with sperm is performed when it is impossible to have sexual intercourse or when spermatozoa are inactive, which cannot independently overcome the barrier properties of cervical mucus and reach the uterus. Carrying out artificial insemination is far from a new method and quite effective, since the technique has been perfected on millions of patients,

History of artificial insemination for pregnancy

The procedure of artificial insemination is the introduction of the sperm of a husband, partner or donor into the genital tract of a woman in order to achieve pregnancy.

The history of artificial insemination for pregnancy has been known since ancient times. This technique has been used for over 200 years. It is known that the Arabs in the XIV century used this technique in the cultivation of Arabian horses. The first scientific article on the effect of low temperatures on human sperm - on the freezing of sperm - was published in the 18th century. A century later, ideas about the possibility of creating a sperm bank appeared. The first attempts to freeze sperm with dry ice showed that at a temperature of -79 ° C, spermatozoa remain viable for 40 days. The first pregnancy and childbirth, which occurred during fertilization by artificial insemination with frozen spermatozoa, was obtained by Roger Bourges in 1953. Then, a long-term search for a method of sperm preservation led to the development of a method for storing sperm in vessels with liquid nitrogen in sealed "straws". This contributed to the creation of sperm banks. In our country, the introduction of the technique of artificial insemination dates back to the 70-80s of the last century.

Carrying out vaginal and intrauterine artificial insemination

There are two methods of artificial insemination: vaginal (introduction of sperm into the cervical canal) and intrauterine (introduction of sperm directly into the uterus). Each of the methods has its positive and negative sides. So, for example, the vaginal method is the simplest, can be performed by a qualified nurse. But the acidic vaginal environment is hostile to spermatozoa, bacteria interfere with the linear progression of spermatozoa, and vaginal leukocytes will eat most of the sperm in the first hour after its introduction.

Therefore, despite the technical simplicity, the effectiveness of this technique is not higher than the onset of pregnancy in a natural sexual intercourse.

The introduction of sperm into the cervical canal brings the spermatozoa closer to the goal, but the barrier properties of the cervical (cervical) mucus stop half of the spermatozoa on their way to the uterus, and here the spermatozoa may encounter antisperm antibodies - an immune factor in female infertility. Antibodies in the cervical canal are in the highest concentration and they literally destroy the spermatozoa. In the presence of an immunological factor in the cervical canal, only the method of intrauterine insemination remains.

Artificial intrauterine insemination brings the sperm much closer to the meeting with the egg. But! Remember the danger of abortion: when instruments are inserted into the uterus, even disposable ones, microbes from the vagina and cervical canal are introduced there, but they should not be there.

How to do artificial insemination

Before doing artificial insemination, it is necessary to conduct a study of infertility factors. The main importance there is given to sexual infections, STIs, bacterial vaginosis - a violation of the microflora of the vagina. In addition, it is necessary to comprehensively examine the uterus and ovaries for the presence of polyps in the uterus, fibroids, endometriosis, tumor diseases of the ovaries. These diseases must be pre-treated. In case of violation of the maturation of the egg, simultaneously with insemination, one of the methods for stimulating the growth of the egg is carried out - inducing ovulation. This helps eliminate the negative factors that can reduce the effectiveness of artificial insemination in infertility, and fertilization with greater efficiency.

The introduction of catheters into the uterus can cause painful contractions, cramping pains. This is how the intrauterine device works. Such contractions can cause sperm to be ejected from the uterus, which not only ruins this attempt, but also reduces the effectiveness of subsequent attempts. Despite this, intrauterine insemination (IUI) is now the most used. Currently, the softest catheters are used, without capturing the cervix with surgical forceps, antispasmodic (relieving spasms) drugs. In addition, a preliminary explanatory conversation is held with the patient with hypnosis and meditation techniques to achieve maximum relaxation of all muscles. Then the cervical canal also relaxes to pass a soft catheter into the uterus. The procedure is performed in a regular doctor's office, without surgery or anesthesia. The patient's feelings are the same as during a regular gynecological examination.

Watch how artificial insemination is carried out in the video below:

Oddly enough, the seminal fluid with which spermatozoa enter the woman's vagina during male orgasm and ejaculation (ejection of sperm) during intercourse is the most unsuitable environment for spermatozoa, where they not only die quickly (two to eight hours after ejaculation) , but also not able to quickly move linearly to meet the egg. In addition, seminal fluid is even toxic. If you introduce half a gram of seminal fluid into any part of the female body, then this will cause a severe indisposition of the woman. The introduction of all sperm into the uterus along with seminal fluid is precisely the factor that causes strong cramping contractions of the uterus.

Being in the seminal fluid, spermatozoa are completely incapable of fertilizing the egg. The mobility and fertilizing ability of spermatozoa can be increased by simply washing it in physiological saline (0.9% saline solution). But the most perfect is used - the cultural environment. This is a medium for culturing cells outside the human body, including eggs and sperm.

Artificial insemination (fertilization) using donor sperm

Insemination is carried out with the sperm of the husband or sexual partner with a normal spermogram. If a man has a decrease in total sperm count, a decrease in actively motile and normally formed spermatozoa, and if a woman does not have a sexual partner, then donor sperm can be used. Material for fertilization with donor sperm is obtained from men younger than 35 years old, physically and mentally healthy, who do not have hereditary diseases from relatives of the first degree of kinship (mother and father, brothers, sisters). When selecting donor sperm for artificial insemination, group and Rh blood affiliation, testing for STIs and venereal diseases are taken into account. At the request of the woman, the height, weight, color of the eyes and hair of the donor are taken into account.

In the presence of an immunological factor of infertility - detection of antisperm antibodies - intrauterine insemination is recommended, combined with ovarian stimulation with follicle-stimulating hormone (FSH) preparations.

FSH in the follicular phase and the LH surge that causes ovulation and the onset of the second phase of the cycle, in addition, perform very important functions. Early stimulation with FSH preparations helps the egg grow and form a protective shiny zone, and then causes the follicle containing the egg to fill with follicular fluid rich in female hormones - estrogen. Estrogens prepare the endometrium, the lining of the uterus, and cervical mucus for sperm invasion. The endometrium thickens up to 13-15 mm according to ultrasound.

Cervical mucus becomes more fluid and permeable to sperm chains. Following a surge of LH, the luteinizing hormone, causes not only ovulation, but also the division of the egg, as a result of which the number of chromosomes is halved - from 46 (full set) to 23, which is absolutely necessary before fertilization, since the spermatozoa that can fertilize the egg also have half a set of chromosomes. During fertilization, the halves again add up to a whole, ensuring the manifestation of the hereditary characteristics of the mother and father in the new little man.

Due to the stimulation of egg growth with FSH preparations and the induction of ovulation with LH preparations, not only ovulation occurs, but much more.

After insemination with donor sperm, women are advised to lie down for three to four hours. Two days later, women who have undergone insemination are prescribed hormone preparations of the second phase of the cycle in order to maintain as close to natural a possible pregnancy as possible at the earliest stage of its development. Instead of painful oil injections of progesterone, tablets of chemically derived natural progesterone, the hormone of the second phase of the cycle, are now used.

Initially, it was believed that by injecting "improved" washed spermatozoa into the uterus, passing through the cervix with a cervical fluid barrier and antisperm antibodies, a higher pregnancy rate could be obtained in a simpler way than in vitro fertilization.

This technique gives 20-30% of cases of pregnancy. Every infertile patient undergoes a series of intrauterine insemination procedures using donor sperm along with ovarian stimulation.

Many couples go through 6 to 12 courses of intrauterine insemination and ovarian stimulation until they are completely mentally and physically exhausted. It would be better for such couples to refrain from so many attempts at artificial insemination with donor sperm and, if three courses of intrauterine insemination and ovarian stimulation did not work, turn to IVF.

The statistics are disappointing - every year the number of infertile couples only increases, and how many of them want children! Thanks to the latest technologies and progressive methods of treatment, babies are born, although it would seem that this is impossible. Artificial insemination is a procedure that allows a woman diagnosed with infertility to become a mother with the help of donor sperm. What is the essence of the technology, to whom it is contraindicated, and how great are the chances of giving birth to a child - more on that later.

What is artificial insemination

Being one of the methods of artificial insemination, insemination helps parents to find a long-awaited child. The procedure significantly increases the likelihood of conception, since it is preceded by a careful selection of material for the operation. Among spermatozoa, the most active ones are selected, and the weak ones are removed. The protein components of the ejaculate are removed, because they can be perceived by the female body as foreign.

Intrauterine insemination is not a panacea for infertility, but only one of the ways to get pregnant artificially. According to studies, the positive effect is estimated at a maximum of 30-40 percent. A single session does not guarantee the development of pregnancy, so the operation is performed up to 3 times per monthly cycle. If conception does not occur after several procedures, it is recommended to turn to other methods of artificial insemination. The very same pregnancy with intrauterine insemination is no different from the usual.

Why is artificial insemination possible?

It would seem why women cannot become pregnant, and with the artificial introduction of ejaculate, fertilization occurs. One of the features lies in the female body. The fact is that antibodies to male sperm are produced in the cervical mucus. It turns out that it simply kills the spermatozoa, and does not contribute to their penetration to the egg. The procedure helps to deliver the processed material directly to the uterus, bypassing the cervical canal. In this way, even if the spermatozoa are immobile, the chance of getting pregnant increases.

Indications

As can be seen from the above, the main indication for artificial intrauterine insemination is the immunological incompatibility of partners. In fact, there are much more individual reasons for resorting to the procedure, so it is worth considering them in more detail. The main problems in women are considered to be inflammatory processes in the cervical canal. The disease prevents the passage of sperm into the uterus, preventing a woman from becoming pregnant.

Artificial insemination is used for vaginismus - a problem when sexual intercourse is not possible due to spasms and pain. Injuries and pathologies of the genital organ that prevent pregnancy, anomalies in the position of the uterus, infertility of an obscure nest, surgical interventions on the cervix are another of the many reasons to go to the clinic for an insemination procedure.

Until recently, the cause of female infertility was sought only in the weaker sex, but, as studies have shown, male problems are often dominant in this matter. Low motility and a small number of spermatozoa, which are difficult to reach the end point, and azoospermia are one of the main diseases due to which artificial insemination is prescribed if the previous treatment has not given any results. Disorders with potency and ejaculation can also become an indication for the procedure.

Genetic diseases, due to which there is a risk of the birth of a patient or with the psychophysical characteristics of a baby, is another reason why artificial insemination is prescribed. True, then the procedure is performed with the donor's sperm, to which the husband (and the future official father) gives written consent. Fertilization with seminal fluid from the base of the clinic is also carried out for single women who want to get pregnant.

Advantages

Intrauterine insemination is the first of the methods that is used for problems with conception. The main advantage is the absence of great harm to the female body. Artificial insemination can be carried out even if the exact cause of infertility has not been established. The procedure does not require long preparation, and its implementation does not take much time. The main advantage of using this method is its low cost.

Training

Like any operation, and medically intrauterine insemination is such, the procedure requires preparation. One desire to do artificial insemination is not enough, you need to come to an appointment with a doctor who will prescribe an action plan after compiling a family history and a thorough analysis of the situation during the conversation. Then it is necessary to sign certain papers confirming the consent of the spouses to carry out the conception. If it is necessary to use donor sperm, the number of documents for approval increases significantly.

Tests before insemination

Previously, in order to find out the preparedness for the artificial insemination procedure, the couple is tested:

HIV AIDS);
torch infections;
hepatitis;
passive hemagglutination reaction (RPHA).

After a 3-5 day period of abstinence, a man gives a spermogram, which determines the mobility of spermatozoa. In women, the patency of the fallopian tubes is checked, with the help of hysterosalpingography, the uterus is examined. An ultrasound scan detects ovulation. If there are problems, then hormones stimulate the production of an egg. Sowing of microflora is carried out to determine the presence of papillomavirus, ureplasma, group B streptococcus, which can cause the impossibility of bearing a fetus.

Semen preparation

Immediately before the insemination procedure, seminal fluid is artificially surrendered, after which it is examined and processed. There are 2 ways to prepare cells: centrifugation and flotation. The first option is preferable because it increases the chances of conception. Preparation of sperm consists in removing acrosin from it, a substance that inhibits sperm motility. To do this, portions are poured into cups and left to liquefy, and after 2-3 hours they are activated with special preparations or passed through a centrifuge.

What day is insemination done

According to doctors specializing in these issues of gynecology, the best option for artificial insemination is the introduction of spermatozoa into the uterus three times:

1-2 days before ovulation;
On the day of ovulation;
After 1-2 days in the presence of several maturing follicles.

How is the procedure

Artificial insemination can be carried out independently or directly with the participation of a specialist in the clinic. To do this, the woman is placed on a gynecological chair, with the help of a mirror, access to the cervix is opened. The doctor inserts a catheter, and biological material is collected into a syringe connected to it. Then there is a gradual introduction of spermatozoa into the uterine cavity. After insemination, the woman should remain motionless for about 30-40 minutes.

Insemination with donor sperm

If serious diseases are detected in a woman's partner, such as hepatitis, HIV and other potentially dangerous diseases, including genetic ones, then donor sperm is used, which is stored frozen at a temperature of -197 ° C. Data about a person is not declassified, but a woman can always bring with her a person who has the right to donate seminal fluid for subsequent artificial insemination of the patient.

Husband's cum

When using the biological material of the spouse, sperm sampling takes place on the day of the insemination procedure. To do this, the spouses come to the clinic, where biological material is donated. After that, the seminal fluid is analyzed and prepared for use. It is important to understand that before donating sperm, a man must refrain from sexual intercourse for at least 3 days in order to improve the quality of spermatozoa.

Artificial insemination at home

Artificial insemination is allowed at home, although according to doctors, its effectiveness is considered minimal, however, judging by the reviews, successful attempts have been recorded. In the pharmacy, you can buy a special kit for manipulation at home. The algorithm differs from that carried out in the clinic in that the sperm is injected into the vagina, and not into the uterus. When carrying out insemination on your own, you cannot reuse the kit, it is forbidden to lubricate the labia with saliva or cream, and also to inject sperm directly into the cervix.

Method efficiency

A positive result in the procedure of intrauterine artificial insemination is achieved less frequently than in in vitro fertilization (IVF) and ranges from 3 to 49% (these are the most positive data). In practice, the number of attempts is limited to 3-4, since a larger number of attempts is considered ineffective. After that, it is necessary to conduct additional studies or correction of treatment. If there is no pregnancy, you should resort to another method of artificial conception or change the sperm donor.

Risks and possible complications

As such, intrauterine insemination does not cause complications, women are more at risk due to taking drugs that cause ovulation, so it is imperative to test for the possibility of allergies. In addition, the risk of having twins increases, less often triplets, due to the fact that several attempts are made to introduce sperm and stimulate the formation of more than one follicle.

Contraindications

Although artificial intrauterine insemination is a simple procedure with little or no consequences, there are still some restrictions on which it can be refused. Among them, there are problems with ovulation itself, which occurs with violations, tubal infertility (it is necessary that at least one intrauterine labor is capable), inflammation of the appendages and uterus, hormonal disruptions, infectious and viral diseases.

Price

It is impossible to say for sure how much artificial insemination costs, since prices will differ in each clinic in Moscow. It is important to understand that the procedure consists of several stages, including consultation, tests, treatment. It is necessary to take into account the price of the medicines that will have to be taken. If donor sperm is used, then it is worth adding to the price and its cost. To date, according to information provided on the Internet, the following figures can be named:

Video

Unfortunately, for a number of reasons, not all couples have the opportunity to conceive a child naturally. Nowadays, the level of infertility among young families has increased significantly. But fortunately, modern medicine has gone far ahead, and now assisted reproductive technologies are being used with great success for people who want to have their own child, thanks to which many families have found happiness. Among such technologies, intrauterine insemination is not the last.

Artificial insemination can be attributed to gentle methods of reproductive technologies, as it is as close as possible to natural fertilization. Conception with this method of treatment, as in nature, occurs inside the woman.

Since insemination is done without anesthesia, and the process does not cause pain and discomfort for the patient, a woman can go home a few hours after the procedure.

The essence of intrauterine insemination

Artificial insemination, the essence of which is the delivery of purified and enriched seminal fluid to the uterine cavity, bypassing the vagina and cervix, is quite effective among many couples. It has gained enough popularity all over the world as one of the methods of infertility treatment.

Insemination, how is the procedure:

the first step is to track the peak of ovulation in a woman's stimulated or natural cycle;
after that, the husband’s sperm is collected or the donor’s sperm is thawed, followed by its processing in the laboratory, where it is purified from plasma and pathological impurities;
then, using a special catheter, purified sperm is injected into the uterine cavity.

Scheme of intrauterine insemination

The portion of injected sperm is small and amounts to 0.2-0.5 ml. But this is enough, because the strongest spermatozoa, already cleared of mucus, are introduced into the cavity. Artificial insemination can be one, two or three times in one cycle. The doctor individually selects the optimal number of attempts per cycle based on the implantation window.

After intrauterine insemination, women are advised to lie down for a while. In different clinics, this time is different and varies from half an hour to three hours. Do not worry that after the "everything will flow back" procedure, the woman has a neck that closes tightly and prevents this phenomenon.

There are often no sensations after IUI, the procedure itself is painless and most women do not feel anything, there are rare cases that in the first minutes a subtle uplift is felt in the lower abdomen. Feelings after insemination depend on the individual characteristics of the body and the pain threshold of the woman.

Sperm preparation for IUI

In preparation for insemination, seminal fluid must be subjected to special laboratory processing. This is necessary due to the fact that semen, in addition to germ cells, contains plasma and pathological impurities. Plasma contains a large amount of prostaglandins, which cause uterine contractions, which in turn affects the effectiveness of this procedure and can cause pain. In addition, sperm purification is needed in order to remove anti-sperm antibodies and non-viable germ cells. In the natural process, the role of a filter for the seminal fluid is played by the cervix and the mucus specially produced in it.

Among other things, when processing seed material, it is enriched with a sterile nutrient medium containing a complex of proteins and minerals. This increases the concentration of mobile, healthy sperm, which in turn increases the chances of a successful conception.

The effectiveness of intrauterine insemination

If we talk about the effectiveness of this procedure, then you need to take into account some factors, the characteristics of the couple, age and diagnosis. By no means can it be said that the percentage of successful attempts for all families is the same.

On average, pregnancy after insemination occurs in 14-17% of cases. We can say that the chances are approximately equal to the chances of a natural pregnancy of a healthy couple.

Signs of pregnancy after insemination remain the same as during natural conception, therefore, as in normal pregnancy, they may not be at all.

For a correct assessment of the positive outcome of the intrauterine insemination protocol, the doctor must examine the condition of the fallopian tubes, the woman's uterus, and the parameters of the husband's spermogram. Checking the fallopian tubes takes first place in the examination of a woman before insemination. To avoid ectopic pregnancy and to increase the effectiveness of the procedure, at least one tube must be completely passable. In addition, it is important to exclude various inflammations of the fallopian tubes and pathologies such as hydrosalpinx.

In order to be convinced of the expediency and effectiveness of IUI, it is necessary to evaluate the parameters of the spermogram, including the morphology of spermatozoa. Suitable for this procedure is considered sperm with a sperm concentration of more than 10 million per 1 milliliter, with a motility of more than 25%.

Age plays an important role, it is known that the younger the patient, the greater the chances of a successful pregnancy.

Due to the fact that the pregnancy rate is higher at the first three attempts, it is generally accepted that after four unsuccessful attempts, the chances decrease. Therefore, it is advisable for couples who have undergone 4 unsuccessful insemination protocols to turn to other methods of ART. Pregnancy after insemination proceeds in the same way as a natural one, with the exception of the aggravating factors of a woman's infertility.

Indications for intrauterine insemination

The procedure of insemination requires its testimony. This is necessary to increase the chance of success and determine the feasibility of this procedure. Therefore, the doctor carefully examines the infertile couple to find out the reason for the failure and lack of natural pregnancies. Not all couples are shown insemination, the success rate may vary in each case.

The effectiveness of insemination is made up of a number of factors, the presence of various diagnoses that may prevent conception. During the preparation phase, the physician should assess the fertility of both partners.

Unfortunately, some deviations in a man or woman do not leave the opportunity for a couple to become pregnant naturally. Then the doctor suggests trying the methods of assisted reproductive technologies, in particular intrauterine insemination, to solve such an important problem. There are some factors that are indications for this method of infertility treatment. Intrauterine insemination significantly increases the chances of a successful pregnancy if the couple has indications for this procedure. The doctor must evaluate and study in detail the cause of independent failures.

Factors for prescribing IUI

The main indications for intrauterine insemination are:

cervical factor

Perhaps the most common indication for this manipulation is the cervical factor. To meet the egg and successfully conceive, the sperm needs to go through a difficult path, on which it will meet many obstacles. One of these barriers is cervical mucus, which is a kind of filter on the way to the uterine cavity. Ideally, cervical mucus is a breeding ground for spermatozoa, which helps them in transport to their desired destination. For a number of reasons, mucus can also be detrimental to male germ cells. This pathology can be the result of various reasons, including hormonal disorders. Then the spermatozoa die in the cervical region of the uterus, not reaching the egg. The presence of this pathology can be indicated by a postcoital test, which determines the mobility and survival of spermatozoa in the mucus after some time.

The use of insemination of couples with cervical factor remains quite effective. Due to the mechanical overcoming of the cervical mucus, the spermatozoa enter directly into the uterine cavity, then into the tube, where successful fertilization takes place.

Decreased morphology and motility of spermatozoa

Slight deviations in spermatogenesis may become indications for insemination. If men have abnormalities in the structure, mobility, or a short life cycle of spermatozoa, then getting pregnant naturally can be quite problematic. Thanks to the special processing of sperm in the laboratory, the seminal fluid becomes more suitable, and the reduction in the time period before meeting the egg, makes the chance of fertilization higher. But it is worth remembering that severe deviations in spermatogenesis are indications for treatment with more serious methods of assisted reproductive technologies.

Unexplained infertility

Sometimes, with an unknown cause of infertility, the procedure of artificial insemination remains quite effective. It is impossible to trace the exact mechanism and ways to solve this problem, but idiopathic infertility can become an indication for this procedure for a doctor.

Diseases and pathologies of the vagina

Another indicator for insemination can be various diseases of the vagina: vaginismus, diseases of external genital endometriosis, etc. These are the deviations that prevent spermatozoa from entering the uterine cavity naturally.

So, the indications for insemination can be different, the main ones are the above four factors of infertility. But also, there are indications for carrying out. This procedure is carried out in the case of a complete absence of sperm in the spouse or the presence of severe genetic abnormalities.

Intrauterine insemination in the natural cycle

Protocols for artificial insemination can take place in various ways. It all depends on the state of the hormonal background and the reproductive system of the woman. The doctor, at his discretion, can connect the preparation with hormonal preparations, or carry out the procedure in the natural cycle of a woman.

How does insemination occur in the natural cycle?

Artificial insemination in the natural cycle is the most gentle ART procedure, it is very similar in mechanism to spontaneous conception.

With this protocol, the maturation of the egg, its release from the follicle, the growth of the functional layer of the endometrium and further fertilization occur quite naturally.

The doctor, starting from the 10th day of the cycle, according to the results of folliculogenesis, begins to monitor the maturation of the dominant follicle and selects the most suitable days for intrauterine insemination. The most successful days are considered 1 day before ovulation, the peak of ovulation, and the next day after. At the physician's discretion, multiple infusions of processed semen may occur in one cycle. Despite the fact that the maturation of the follicle occurred naturally, after the procedure, hormonal support of the second phase can be prescribed, which lasts until the results of hCG.

Indications for IUI in the natural cycle

Due to the fact that insemination in the natural cycle occurs without medical adjustment, indications are necessary for its implementation.

To a greater extent, insemination in this protocol is indicated for couples:

with mild male infertility;
with severe male infertility and the use of donor sperm;
with cervical infertility factor;
for women who do not have a partner.

There should be no serious deviations from the female reproductive system, otherwise the procedure loses its effectiveness.

To increase the chances of a successful outcome of insemination in the natural cycle, some criteria must be met:

the presence of systematic full ovulation;
normal and timely maturation of the endometrium;
no hormonal imbalance.

Pros and cons of insemination in the natural cycle

Insemination in an unchanged, natural cycle has its own series of positive and negative points.

The permanent pluses are:

sparing effect on the woman's body and the absence of side effects;
proximity to the natural process of conception.

The disadvantages of this insemination protocol include:

more difficult to control the maturation of the follicle and endometrium;
reduced effectiveness of the procedure for some couples and persons over 30 years of age.

Which insemination cycle to choose can only be decided by a doctor, taking into account the individual characteristics of a woman, the regularity of her cycle, fluctuations in the frequency of ovulation and the usefulness of the endometrium.

Intrauterine insemination with stimulation

Intrauterine insemination can occur both in the natural cycle of a woman, and with the induction of ovulation. It all depends on some factors, including the fullness of the woman's cycle and the presence of her wealthy ovulation. More often, doctors use stimulated cycles to apply this procedure, since it is easier to control ovulation and get on the right days. Ovulation induction with IUI occurs in an easier way than with IVF, since the goal is not to create superovulation, but to achieve the maturation of 1-3 follicles.

Schematic diagram of a woman's reproductive organs during ovulation stimulation

How does IUI occur in a stimulated cycle

Insemination with ovulation induction occurs somewhat differently than in the natural cycle. As a rule, on the 2-5th day of the menstrual cycle, the doctor prescribes special preparations, with the help of which from one to three follicles mature in the ovaries. With the help of ultrasound, the maturation of the follicles and endometrium is monitored. After calculating the most suitable days, as a rule, when the follicle is from 18-24 mm, and the endometrium is from 9-14 mm, the doctor prescribes the insemination procedure with the purified sperm of the husband or donor. Clomiphene citrate, gonadotropins, or mixed regimens of both can be used for stimulation. The doctor selects drugs to stimulate ovulation and doses individually, based on the characteristics of the woman. In combination with them, estrogens can be used to correct the growth of the mucous layer, the endometrium.

Often, after intrauterine insemination, second phase support is prescribed with progesterone preparations, the dosage of which is also selected individually for each woman.

Indications for intrauterine insemination with stimulation

The chance of pregnancy with IUI with stimulation increases due to the fact that not one, but two or three follicles mature in this cycle.

But, just like any other procedure, insemination with stimulation has its own indications:

Age after 35 years. With age, the chance of pregnancy with one egg decreases, therefore, in clinics, ovulation stimulation is often used for insemination for such couples.
Late ovulation or its absence. The absence of full-fledged ovulation is a direct indication for the stimulation of ovulation during intrauterine insemination;
Irregular menstrual cycle. Any violation of the cyclical processes in a woman can cause the use of a stimulated cycle.

Pros and cons of insemination with ovulation stimulation

When carrying out intrauterine insemination, there are positive and negative sides.

The advantages of the procedure in this cycle include:

the efficiency of insemination is increased due to the maturation of several follicles;
the ability to control the growth and maturation of follicles, endometrium.

Despite all the positive aspects, the negative impact of ovulation stimulation with IUI remains:

risk of developing ovarian hyperstimulation syndrome;
the risk of multiple pregnancy.

The decision to stimulate ovulation in the IUI protocol is made only by the doctor and after collecting the entire history and examining the woman.

Intrauterine insemination with donor sperm

Intrauterine insemination with donor sperm is one of the effective methods of infertility treatment. Almost every clinic has its own database of donor material, which simplifies the process of finding the right donor.

Principles of intrauterine insemination with donor sperm

Artificial insemination with donor sperm is no different from insemination with husband's sperm. Before manipulation, the sperm is also processed in the laboratory, then, using a special catheter, it is introduced into the uterine cavity. More often, cryopreserved sperm is used, which is thawed before the injection itself. Insemination with donor sperm takes place both in a natural cycle and with the use of ovulation induction. This choice depends on the age of the patient and the condition of her reproductive apparatus.

Indications for IUI with donor sperm

The very first and most common indication for the use of donor sperm for intrauterine insemination is the absence of a sexual partner in a woman who wants to have a child. In this case, psychologically and physically this method is the most acceptable.

Also, artificial insemination with donor sperm is indicated in cases of serious genetic abnormalities in a partner, the complete absence of spermatozoa, or in the presence of other serious factors of male infertility that cannot be corrected. Among male factors, the most common for the use of donor sperm is the presence of serious genetic diseases in the partner, which can be passed on to offspring.

The effectiveness of intrauterine insemination with donor sperm

Insemination with donor sperm is quite effective if several factors are observed:

age up to 30 years;
the absence of obvious problems of the reproductive apparatus in a woman.

If we talk about the effectiveness of this procedure, it is worth noting that the percentage of positive results is quite high if there are no problems on the part of the woman. Donor material, as a rule, undergoes careful control, so the sperm parameters fit into the norms of spermatogenesis. Due to this, pregnancy after insemination with donor sperm occurs more often than with the use of partner sperm.

Intrauterine insemination and its results: my story. Review of a woman who did this procedure

Review of a woman who did this procedure

For many years my husband and I lived quietly, not thinking about children. There was neither desire nor opportunities: housing is modest, incomes are small, pedagogical abilities are not noted. And life is so full that it is not realistic to “squeeze” a child there. Once I came to the gynecologist with complaints about strange. After the examination and treatment, I heard: “Don’t you want a child?” I laughed, said that, firstly, it was too late, and secondly, I had never had a pregnancy, despite a regular sex life. Then the gynecologist suggested: “Let's try intrauterine. It happens that the reason for infertility is that the sperm simply do not get to the egg, they die along the way. We will “send” them directly to the uterus: there are more chances.” After discussing the unexpected proposal with my husband, I agreed.

background

Hysteroscopy was done one cycle before the IUI. The goal is to bring the functional layer of the endometrium into an ideal state. Sometimes hormones are additionally prescribed to make the endometrium “more magnificent”. In my case it was not required.

The documents

Before admitting a patient to this serious procedure (after all, this is an intervention in the body), doctors suggest signing a number of documents:

contract for the provision of medical services;
consent to the processing of personal data;
consent to the intervention.

Perhaps there was something else, I can’t remember now, because I was worried and didn’t delve into what I was signing. I don't recommend doing that. Suddenly something goes wrong - you need to know what to count on then.

Preparation for intrauterine insemination

In our case, preparation for IUI was not required, since no serious deviations were found in me and my husband.

Only some tests had to be repeated because, for example, smear results are taken into account for no more than 10 days. Hysteroscopy is valid for a year, so this (the most difficult in my case) part of the examinations was reliable. Doctors consider an analysis for tubal patency to be relevant for six months to a year (depending on the state of health, lifestyle, the presence or absence of stress).

Most blood tests are valid for 1-3 months.

What questions should you ask your doctor

I was interested in performance forecasts. She asked about this. The answer was expected: "Nothing can be predicted, but for healthy couples, the probability of pregnancy is 10-15%."

I was interested in pain relief, because I have a low pain threshold: I lose consciousness during menstruation, and besides, as it turned out, I have a curved cervix, which makes it difficult to access during research. During a pipel biopsy, I once felt such pain that I fainted, although I was told that everything would go “like a normal smear”.

Anesthesia for IUI is not needed and is not performed, as the procedure is considered painless. Due to the circumstances described above, the doctor promised me an injection of Ketorol, which was done. 2 hours before insemination, she drank 2 tablets of no-shpy.

Stimulation before IUI

The issue of stimulation is decided individually. It is carried out for those women whose follicles do not ripen well or it is difficult to determine the time when ovulation occurs.

I didn't need stimulation. But in order to be sure of the moment of ovulation, the doctor prescribed an injection of hCG at a dosage of 5000 36 hours before the procedure.

Abstinence before intrauterine insemination

There was no more preparation: in particular, I didn’t follow any diet, I habitually went in for sports (I run in the morning). Depilation was not required, no douching, drugs - too. Mentally I trembled with fear: I am afraid of any interventions, and knowing my low pain threshold, I start to shake before anything serious.

Folliculometry

Before the insemination program is required. Appointed on the 8th day of the cycle. For the first time in the ovaries there was a "sleepy kingdom": no hint of the allocation of the "main". The second time folliculometry was carried out on the 10th day - the picture is the same. The doctor and I decided that the cycle “fell out”, it happens (from fear, for example, and the age is not girlish), but just in case, the doctor ordered to come on the 12th day. And for sure: the follicle grew, as she said, “magnificent”, literally in a day. Moreover, I felt the whole process of its maturation, and when I went for an ultrasound scan, I already knew what the result would be. On the same day, hCG was injected and sent to wait for “Day X”.

"Day X": how it was

On the day of insemination, my husband and I went to the clinic together, where he donated sperm. The indicators were not bad: 25% of mobile, about 50% of slow-moving spermatozoa, in general, everything is normal.

Before introducing sperm into the uterus, it is cleaned, otherwise severe complications are possible - allergic reactions and inflammation. We sat on the couch in the hallway for a couple of hours, leafing through magazines and trying to chat at ease. The doctor said that due to the peculiarities of my cervix, she wants to clean the sperm as much as possible and inject me with very little of it in order to avoid undesirable consequences, such as spasm.

I had been trembling with terror since the evening before, as if I were about to undergo brain surgery. Drinking in the morning on the recommendation of a doctor, several tablets of Persen did not give any effect, but, in fact, I did not count on it.

I was invited to the doctor, my husband went home. We decided that he had nothing to waste time - then all the manipulations concern only me.

They gave out a disposable cap, shoe covers, a dressing gown and sent me to a clean, comfortable ward (as far as a hospital ward can be comfortable).

A few minutes later, after changing into "fashionable" attire, I was called into the treatment room. Sitting in a chair, very similar to an ordinary gynecological chair (more comfortable, because you practically lie in it), I prepared for an unknown horror, persuading myself to wait a bit with a faint - at least until the end of intrauterine insemination (otherwise it turns out that I was so nervous and in vain so much money "thrown to the wind").

The doctor carefully inserted a catheter (I don’t know how to call it correctly) into the cervix with a syringe without a needle. Oddly enough, she managed to easily get into the uterus, which she immediately joyfully informed me with a cry of “Hurrah! Got it!" I did not feel the introduction of sperm at all. In general, the whole procedure turned out to be absolutely painless (apparently, Ketorol worked).

On the monitor screen, you could see how the spermatozoa quickly scattered through the uterine cavity. I heard the doctors and the nurse talking about it, but due to my tendency to panic, I did not agree to look at the monitor in order to observe an interesting picture with my own eyes. Now I regret - after all, it is unlikely that there will be a chance to see this.

After removing the catheter, she lay down for 10 minutes in silence, at rest. I was allowed to get up and go to the ward, where I blissed for another half an hour in a pretty bed and even took a little nap. She drank water - she was thirsty on nervous grounds.

And then I got dressed, talked to the doctor and went to work. The doctor said that I would ovulate "just about", we guessed right, now it remains to wait 2 weeks before the moment when you can do a home test. But it is better to hand over HCG. For the next 14 days, you need to put Utrozhestan candles at night to prepare the endometrium.

They do not give sick leave after the procedure - there is no need to lie on the couch. The doctor advised me to avoid active sports for the next 14 days. I accepted the conditions with a sigh, because by nature a person is mobile.

Yes, another moment: on the day of intrauterine insemination, it was necessary to arrange a “holiday” for her husband, who had been on a “starvation diet” for the last three or four days. Why is sexual intercourse recommended after IUI? The doctor said that it is necessary to "explain" to the body that everything happens naturally. Then the chance of pregnancy is higher.

After the WMI program

The first 2-3 days I felt absolutely nothing and worked quietly. There was no fever or bleeding.

But then something strange began to happen. At work, I suddenly felt a sharp pain in the abdomen, which came from the covulsing ovary, spreading to the entire lower abdomen. The pain was severe and spasmodic. After ultrasound and examination, the diagnosis was made: "Hemorrhage into the corpus luteum, partial twist of the ovary." The ovary, in which there was ovulation, doubled in size and "twisted". A little more - and an urgent operation would be required. This is the complication of insemination that befell me.

She was prescribed antibiotics, anti-inflammatory drugs and sent home. Every day I visited the ultrasound room, where the situation was monitored. On the fourth day, the cyst decreased, the pain went away. By the next cycle, everything was back to normal.

Naturally, I no longer expected any “streaks” on the test and was generally glad that I was still alive. Menses came on time.

Why did it happen? Experts give different answers. Some believe that it was the body's reaction to the hCG injection, which provoked rapid ovulation with hemorrhage. Others do not rule out a reaction to progesterone, which is part of Utrozhestan. Let's note in parentheses that I was pricked with hCG before - without any consequences.

Still others believe that the body reacted to the introduction of sperm - a "foreign object" - as an "enemy", as a result, inflammation began.

Fortunately, everything ended well.

Future plans

If there were no such unpleasant consequences, it would be possible to conduct IUI three times. Such a number of procedures is considered optimal - according to statistics, many women become pregnant from the third time, because the first two are stressful, and the body "defends itself", while the third one "gets used" a little.

But, if three attempts were unsuccessful, you should forget about this technique and. More chances of pregnancy.

What conclusions did I draw after IUI? I think that this procedure is worth a try if there are no contraindications to it.

It involves minimal intervention in the body, is available to people with an average and below average income.

In the meantime, I’m “licking my wounds” and thinking about whether to move on or close the issue. It is impossible for the thought of children to turn into a “fixed idea” and make us unhappy. Life is diverse - we can find ourselves not only in children. The main thing is to tune in positively and go through life with wide eyes!

The problem of infertility in the modern world is very common, so artificial insemination is a necessary procedure. There are several types of fertilization, which are used depending on the age, health and desire of the woman.

Before carrying out artificial insemination, the couple must undergo an examination, the woman is sent for a pelvic ultrasound and testing, the man for a spermogram. If the cause of infertility is the poor quality of spermatozoa, then fertilization can be carried out by insemination. This method of fertilization is the simplest, cheapest and safest, but not always effective, unfortunately.

"Intrauterine insemination (IUI) - what is it?" - ask couples at the reception at the reproductologist. Insemination in gynecology is a technology for the treatment of infertility, in which artificial insemination is carried out without egg puncture. This method is quite old, but effective. According to historical data, intrauterine insemination was carried out even in the 19th century.

The procedure is quite simple. To carry out insemination, the husband needs to donate sperm, which, using a thin catheter, the doctor will subsequently introduce into the uterine cavity.

Artificial insemination significantly increases the chance of conception if it does not occur naturally for a long time, since sperm do not need to overcome the mucus in the cervix. In addition, sperm is pre-prepared, improving its quality.

Also, the chances of getting pregnant increase due to the fact that the introduction of sperm is carried out on the most favorable days of the cycle. The doctor monitors the condition of the woman, and prescribes the procedure on the day of ovulation, when the egg is ready for fertilization.

The big advantage of IUI is the relatively low cost of the procedure compared to in vitro fertilization. If IVF will cost a couple 100-150 thousand rubles, then IUI will cost no more than 30 thousand rubles.

Intrauterine insemination can be performed with the husband's or a donor's sperm. In the latter case, a woman needs to contact a sperm bank, where she can select a suitable donor and undergo the fertilization procedure.

Indications

The main disadvantage of IUI is not very high efficiency, because the procedure is not suitable for everyone. Intrauterine insemination can only be performed in the following cases:

Infertility for no apparent reason. In this case, when examining a man and a woman, no pathologies were found that would interfere with natural conception, but pregnancy still does not occur for more than a year.
Neck factor. In this case, the mucus in the cervix is too viscous, which is why the healthy sperm of the husband cannot get to the egg, and fertilization does not occur.
Anatomical features of the genital organs in a woman, as well as vaginismus - an involuntary contraction of the walls of the vagina for psychological reasons. In this case, sexual intercourse and natural conception become impossible.
Violation of ovulation in a woman, in this case, before IUI, ovulation is stimulated with the help of hormonal drugs.
Endometriosis at an early stage.
Poor sperm quality or insufficient ejaculate. If the spermatozoa are too slow, or there are not enough of them, they are not able to overcome the acidic environment of the vagina and cervical mucus.
Some diseases in men, such as retrograde ejaculation, when semen enters the bladder rather than exits.

Uterine insemination is not performed if a woman has inflammatory diseases of the pelvic organs, oncological pathologies of the uterus and ovaries. In this case, you must first cure the underlying disease, and then proceed to fertilization. If the IUI is not effective, the doctor will recommend IVF.

Contraindications to the procedure are mental pathologies, severe genetic diseases, as well as severe diseases of the genital organs, in which it is impossible to carry a pregnancy.

Methodology

Before proceeding with intrauterine insemination, the doctor directs the woman and the man for examination. It is necessary to undergo an ultrasound examination, know blood tests for various infections, sex hormones, smears. The doctor will check the fallopian tubes to confirm their patency, and you may also need an examination by an endocrinologist.

A man needs to undergo a spermogram, as well as take a swab from the urethra for sexually transmitted infections. If both future parents are healthy, then the day of insemination is scheduled. Before the procedure, it is recommended to lead a healthy lifestyle, not to engage in heavy physical labor and not to be nervous.

The scheme of intrauterine insemination depends on the condition of the woman. If infertility does not occur for a long time due to hormonal disorders in women and the absence of ovulation, then ovarian stimulation with hormonal drugs is indicated. If the woman is healthy, then fertilization will be carried out in a natural cycle, on the most favorable day.

Many are interested in the question, how many follicles should there be for insemination? In a healthy woman with ultrasound, from 7 to 16 follicles are found. If their number is less than four or more than 16, then it makes sense to suspect a pathology, for example, endocrine disorders. In the first case, ovulation stimulation may be needed, and in the second, treatment by an endocrinologist.

Stages

Intrauterine insemination is carried out in several stages:

If necessary, the preparation of the woman for the procedure is prescribed. To do this, the doctor recommends taking hormonal drugs to stimulate ovulation. During the preparation period, the doctor regularly monitors the growth of follicles using ultrasound, and also observes the quality of the endometrium.
On the day of the procedure, a man is scheduled to donate sperm, or it is given in advance and frozen.
Before the procedure, the doctor prepares the sperm: removes excess mucus and selects the strongest and most viable sperm for fertilization.
Fertilization is carried out using a very thin sterile catheter, which is inserted into the uterine cavity through the cervix. The procedure takes place on the day of ovulation.

The duration of fertilization is no more than 10 minutes, the procedure is painless and safe. In the clinic, a woman will have to stay on the day of the procedure for no more than one hour, after which you can return to normal life. But if there is such an opportunity, doctors recommend spending this day in a quiet and calm environment, relax more and not be nervous. To support pregnancy, doctors may prescribe hormonal drugs.

Result

You can talk about the results of the IUI as early as 10-14 days after the procedure. To do this, a woman is recommended to conduct a pregnancy test on her own, as well as donate blood for the amount of the hCG hormone.