Proper preparation for artificial insemination (AI). Stages of the artificial insemination method, indications, preparation, chances of getting pregnant

Insemination. Types and techniques of insemination. Possible complications after insemination. Where is artificial insemination done?

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How is the insemination procedure carried out?

On what day of the natural cycle is insemination done?

On average, ovulation occurs on the 14th day of the menstrual cycle, but in some cases it can occur earlier or later. However, it is impossible to predict the exact time of ovulation, and a woman cannot subjectively feel this. That is why, to maximize the effectiveness of artificial insemination, doctors use a number of diagnostic tests to calculate the time of ovulation.

To determine the time of ovulation, use:

• Ultrasound of ovarian follicles. Under normal conditions, during each menstrual cycle, one main follicle is formed in one of the ovaries - a vial of fluid in which the egg develops. This follicle is visible with ( ultrasound) ultrasound examination already on the 8th - 10th day of the cycle. After this follicle has been identified, it is recommended to perform daily ultrasound. If the follicle was visible the day before, but it cannot be determined at the next procedure, this indicates that ovulation has occurred.
• Determination of the level of luteinizing hormone ( LG) in blood. This hormone is secreted by a special gland ( pituitary gland) and is involved in the regulation of the menstrual cycle. An increase in the level of this hormone in the middle of the cycle indicates that ovulation will occur within the next 24 to 48 hours.
• Measurement of basal body temperature. During the period of ovulation, there is an increase in body temperature by about 0.5 - 1 degree, which is due to hormonal changes occurring in the body of a woman. However, in order to notice such a temperature jump, a woman must regularly ( within a few months) keep a graph of basal temperature, measuring it twice a day ( morning and evening at the same time).
• Study of cervical mucus. Under normal conditions, the mucus located in the cervical area is relatively dense, cloudy, and poorly extensible. During ovulation, under the influence of female sex hormones, it liquefies, becomes transparent and more viscous, which is used by doctors for diagnostic purposes.
• Subjective feelings of a woman. During ovulation, a woman may experience pulling pains in the lower abdomen, as well as increased sexual desire, which, together with other signs, can be used for diagnostic purposes.

Stimulation of ovulation ovaries) before insemination

To stimulate ovulation before insemination, a woman is most often prescribed recombinant follicle-stimulating hormone ( FSH). This is an analogue of the natural hormone produced by the pituitary gland during the first half of the menstrual cycle. Under its influence, the follicles in the ovaries are activated and develop. The FSH preparation should be used within 8 to 10 days ( more precise instructions can be given by the attending physician after a full examination, determining the regularity and other features of the menstrual cycle in a particular woman), followed by ovulation.

The danger of using this method lies in the fact that when prescribing too high doses of FSH, the so-called ovarian hyperstimulation syndrome may develop, when several follicles mature at once instead of one. In this case, during ovulation, 2 or more eggs can enter the fallopian tube, which can be fertilized during the artificial insemination procedure. The outcome of this phenomenon may be multiple pregnancy.

Types and techniques of artificial insemination ( intracervical, intrauterine, vaginal)

With natural insemination ( occurring during intercourse) male sperm is erupted into the woman's vagina. Then the spermatozoa during one sexual intercourse, about 200 million of them are erupted), which have mobility, begin to move towards the uterus. First, they must pass through the cervix, a narrow canal that separates the uterine cavity from the vagina. A special mucus is located in the cervix of a woman, which has protective properties. Passing through this mucus, most of the sperm die. The surviving spermatozoa enter the uterine cavity and then reach the fallopian tubes. In one of these tubes is a mature ( ready for fertilization) ovum ( female sex cell). One of the spermatozoa penetrates its wall earlier than the others and fertilizes it, as a result of which pregnancy begins. The rest of the spermatozoa die.

Artificial insemination can be:

• Intracervical ( vaginal). This is the simplest form of the procedure, which is as similar as possible to natural sexual intercourse. No special preparation before its implementation is required ( Naturally, before any insemination, one should refrain from smoking, taking alcohol, drugs, etc.). Insemination can be done with fresh unpurified seminal fluid ( in this case, it must be used no later than 3 hours after receipt), and frozen sperm ( from a sperm bank). The essence of the procedure is as follows. In the morning on the appointed day, a woman comes to the clinic, goes into a specially equipped room and lies down in a gynecological chair or on a special table. Special expanding mirrors are inserted into her vagina, which facilitates access to the cervix. Next, the doctor collects sperm in a special ( with a blunt tip) syringe, inserts it into the vagina and brings the tip as close as possible to the entrance to the cervix. After that, the doctor presses on the syringe plunger, as a result of which the sperm is squeezed out of it onto the cervical mucosa. The syringe and speculum are removed, and the woman must remain in the gynecological chair lying on her back for 60 to 90 minutes. This will prevent the leakage of seminal fluid, and will also facilitate the penetration of spermatozoa into the uterus and fallopian tubes. One and a half to two hours after the procedure, the woman can go home.
• Intrauterine. This procedure is considered more effective than intracervical insemination. Its essence lies in the fact that after the installation of mirrors in the vagina, the sperm is collected in a special syringe, to which a long and thin catheter is attached ( a tube). This catheter is inserted through the cervix into the uterine cavity, after which the sperm is squeezed into it. When performing this procedure, it is recommended to use specially prepared and purified sperm. The introduction of fresh seminal fluid into the uterine cavity can cause contraction of the uterine muscles ( which will reduce the chance of conception) or even cause severe allergic reactions.
• Intratubal. The essence of the procedure is that pre-prepared spermatozoa are injected directly into the fallopian tubes, in which the egg should be located. It should be noted that according to the results of recent studies, the effectiveness of this procedure does not exceed that of conventional intrauterine insemination.
• Intrauterine intraperitoneal. With this procedure, a certain amount of previously received and processed ( purified) male sperm is mixed with a few milliliters of a special liquid, after which the resulting mixture ( about 10 ml) is injected into the uterine cavity under slight pressure. As a result, the solution containing spermatozoa will penetrate into the fallopian tubes, pass through them and enter the abdominal cavity. Thus, the probability of fertilization of the egg, which can be located in the path of the injected solution, is significantly increased. Such a procedure is indicated for unidentified causes of infertility, as well as for the ineffectiveness of intracervical or intrauterine insemination. According to the technique of execution, it is no different from the previously described procedures.

Does insemination hurt?

Is it possible to perform artificial insemination at home?

Preparation includes calculating the day of the expected ovulation ( methods have been described previously.). When ovulation has occurred, you should proceed directly to the procedure itself.

To carry out artificial insemination at home, you will need:

• Disposable sterile syringe ( per 10 ml) - can be purchased at any pharmacy.
• Sterile container for collecting seminal fluid- for example, a container for testing, which can also be purchased at a pharmacy.
• Sterile disposable vaginal dilator- you can buy at a pharmacy, but you can perform the procedure without it.

After the introduction of sperm, the syringe and dilator are removed, and the woman is advised to remain in the “lying on her back” position for the next one and a half to two hours. Some experts recommend placing a small roller under the buttocks so that the pelvis is raised above the bed. In their opinion, this contributes to the promotion of spermatozoa to the fallopian tubes and increases the likelihood of pregnancy.

Why is utrogestan and duphaston prescribed after insemination?

If in the period after ovulation the concentration of this hormone in the blood of a woman is reduced ( which can be observed in some diseases of the ovaries, as well as in patients older than 40 years), this can disrupt the process of attaching a fertilized egg to the wall of the uterus, as a result of which pregnancy will not occur. It is in such cases that patients are prescribed utrogestan or duphaston. They prepare the uterine lining for egg implantation and also support the development of the fetus throughout pregnancy.

How to behave after insemination ( do's and don'ts)?

Can I take a bath after artificial insemination?

When performing intrauterine or other types of insemination, the patient is allowed to take a bath immediately after returning home. The fact is that in these cases, the seminal fluid is injected directly into the uterine cavity or into the fallopian tubes, which are normally reliably separated from the environment by the cervix. Even if the woman takes a bath immediately after the end of the procedure ( that is, after lying in the gynecological chair for one and a half to two hours), water or any other substances will not be able to penetrate the uterine cavity and in any way affect the fertilization of the egg.

Can I swim and sunbathe after insemination?

There are no specific guidelines for tanning. If a woman has no other contraindications, she can sunbathe in the sun or visit a solarium immediately after the procedure, which will not affect its effectiveness in any way.

Is it possible to have sex after artificial insemination?

How many hours after insemination does fertilization occur?

With intrauterine insemination, male germ cells are injected directly into the uterine cavity. They do not waste time getting through the mucosal barrier in the cervix, as a result of which, with this type of procedure, fertilization may occur earlier ( after 3 - 4 hours). If intratubal insemination is performed ( when sperm are injected directly into the fallopian tubes), the egg located there can be fertilized in a couple of hours.

Signs of pregnancy after artificial insemination

It is worth noting that after artificial insemination, pregnancy proceeds in exactly the same way as with natural conception. Therefore, the signs of pregnancy will be the same.

Pregnancy may be indicated by:

• change in appetite;
• taste disorders;
• impaired sense of smell;
• increased fatigue;
• increased irritability;
• tearfulness;
• an increase in the abdomen;
• engorgement of the mammary glands;
• absence of menstruation.

On what day after insemination should I do a pregnancy test and donate blood for hCG?

Despite the fact that hCG begins to be produced approximately 6-8 days after the fertilization of the egg, its diagnostically significant concentrations are observed only by the 12th day of pregnancy. It is from this period that hCG can be detected in the urine ( for this, standard express tests are used, which can be bought at any pharmacy) or in the blood of a woman ( To do this, you need to donate blood for analysis to the laboratory.).

Why is ultrasound prescribed after insemination?

The purpose of ultrasound after insemination is:

• Confirmation of pregnancy. If a fertilized egg attaches to the wall of the uterus and begins to develop, after a few weeks the embryo will reach a significant size, as a result of which it can be determined during an ultrasound examination.
• Identification of possible complications. One of the formidable complications of insemination can be an ectopic pregnancy. The essence of this pathology lies in the fact that the egg fertilized by the sperm is attached not to the wall of the uterus, but to the mucous membrane of the fallopian tube or even begins to develop in the abdominal cavity. Laboratory tests ( determination of hCG in the blood or urine of a woman) at the same time will indicate that the pregnancy is developing. At the same time, the prognosis in this case is unfavorable. With an ectopic pregnancy, the embryo dies in 100% of cases. Moreover, if this condition is not detected in a timely manner, it can lead to the development of complications ( for example, to rupture of the fallopian tube, to bleeding, and so on), which would endanger the woman's life. That is why during an ultrasound examination, the doctor not only detects the presence of an embryo in the uterine cavity, but also carefully examines other parts of the reproductive system in order to diagnose an ectopic pregnancy early.

Can twins be born after insemination?

Much less often, multiple pregnancy develops when one egg is fertilized by one sperm. In this case, at the initial stages of development, the future embryo is divided into 2 parts, after which each of them develops as a separate fetus. It should be noted that the probability of such a development of events is the same for both artificial and natural insemination.

Complications and consequences after artificial insemination

Artificial insemination may be accompanied by:

• Genital tract infection. This complication can develop if during the procedure the doctor used non-sterile instruments or did not comply with hygiene standards. At the same time, the reason for the development of infection may be a woman's failure to follow the rules of personal hygiene immediately before or after the procedure. It is important to remember that any infection is much easier to cure at the initial stage of development. That is why if you experience pain, burning or redness in the genital area, you should immediately consult with your doctor.

• Allergic reactions. May occur with intrauterine or intratubal insemination, when poorly prepared ( poorly cleaned) seminal fluid. Allergies can be manifested by anxiety, skin spots, muscle tremors, a marked drop in blood pressure, or even loss of consciousness. Extremely severe allergic reactions require immediate medical attention, as they pose a danger to the patient's life.
• A drop in blood pressure. The reason for the development of this complication may be careless, gross manipulations with the cervix during intrauterine insemination. The mechanism of development of this phenomenon is the irritation of special nerve fibers of the so-called autonomic nervous system, which is accompanied by a reflex expansion of blood vessels, a slowing of the heartbeat and a decrease in blood pressure. With the development of this complication, a woman is strictly forbidden to get up, as this will cause an outflow of blood from the brain, and she will lose consciousness. The patient is shown strict bed rest for several hours, drinking plenty of water, and, if necessary, intravenous fluids and medications to normalize blood pressure.
• Multiple pregnancy. As mentioned earlier, the risk of multiple pregnancy increases when insemination is performed after hormonal ovarian stimulation.
• Ectopic pregnancy. The essence of this phenomenon is described above.

Drawing pains in the abdomen

Chest pain ( sore nipples)

Temperature

At the same time, it is worth noting that an increase in temperature to 38 degrees and above, which occurs during the first or second day after insemination, may indicate the development of complications. One of the common causes of fever may be the development of an infection introduced during the procedure ( for example, if the doctor or patient does not comply with hygiene standards). The development of the infection is accompanied by the activation of the immune system and the release of many biologically active substances into the blood, which determine the temperature increase 12-24 hours after infection. The temperature can then reach extremely high values ​​( up to 39 - 40 degrees and more).

Another reason for the increase in temperature may be an allergic reaction associated with the introduction of poorly purified seminal fluid into the uterus. Unlike infectious complications, with an allergic reaction, body temperature rises almost immediately ( within the first minutes or hours after the procedure) and rarely exceeds 39 degrees.

Regardless of the cause, a temperature increase of more than 38 degrees is a reason to see a doctor. It is not recommended to take antipyretic drugs on your own, as this can distort the clinical picture of the disease and make it difficult to make a diagnosis.

Will there be periods after insemination?

Considering the foregoing, it follows that if menstruation appeared after insemination, conception did not occur. At the same time, the absence of menstruation may indicate in favor of a developing pregnancy.

Brown spotting ( bleeding)

The appearance of brown bloody) discharge, accompanied by moderate pain in the lower abdomen, can be observed 12 to 14 days after insemination. In this case, we will talk about menstrual bleeding, which normally begins 2 weeks after ovulation ( if the egg has not been fertilized). At the same time, it can be said with certainty that the attempt to conceive failed.

This bleeding does not require any treatment and usually stops on its own after 3 to 5 days, after which the next menstrual cycle begins.

Why is the pregnancy test negative after insemination?

Where ( in which clinic) is it possible to do artificial insemination in the Russian Federation?

In Moscow

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 become 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

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.

If the described process occurs during natural sexual intercourse, we are talking about natural ( natural) insemination. At the same time, artificial insemination can be used to develop pregnancy.
In this case, pre-obtained male seminal fluid is introduced into the female genital tract artificially ( using special tools and techniques), which can also lead to artificial insemination eggs and pregnancy. Sexual intimacy ( sexual contact) is excluded.

How is artificial insemination different from IVF and ICSI?

During in vitro fertilization, the process of fusion of male and female germ cells occurs outside the body of the expectant mother. Pre-obtained eggs are placed in a test tube, where optimal conditions are created to support their vital activity. Then pre-obtained male germ cells are added to the same test tube ( spermatozoa). After a certain time, one of the sperm enters the egg and fertilizes it. After that, the fertilized egg is injected into the uterine cavity and attached to its walls. Further pregnancy develops as usual.

One of the varieties of in vitro fertilization is the procedure of intracytoplasmic sperm injection ( ICSI). Its essence lies in the fact that a pre-selected and prepared sperm is injected directly into the female germ cell, which increases the chances of their successful fusion. If fertilization is successful, the fertilized egg is also placed in the uterine cavity, after which a normal pregnancy begins to develop.

Is it possible to choose the sex of a child with artificial insemination?

Indications for artificial insemination with husband's sperm ( homologous insemination) or donor ( heterologous insemination)

They speak of the homologous method in cases where the seminal fluid of the husband or the woman's permanent sexual partner is used during the procedure.
If the woman does not have a permanent sexual partner, and also if his sperm cannot be used for fertilization ( due to various diseases or anomalies), donor sperm can be injected into the uterine cavity. In this case, we are talking about heterologous insemination.

It is worth noting that regardless of whose seminal fluid is used for fertilization, the technique for performing the procedure does not change.

Testimony from a woman infertility)

Indications for artificial insemination by a woman are:

• Vaginismus. This is a disease of a woman in which the penetration of something into the vagina causes severe spasm ( reduction) muscles, which is accompanied by severe pain. Pain can occur both during sexual intercourse and when using hygienic tampons. It is extremely difficult or even impossible for such women to conceive a child naturally, as a result of which they may resort to artificial insemination. During the procedure, a woman can be put into a medical sleep, as a result of which she will not experience any pain.
• Endocervicitis. This is an inflammatory disease in which the mucous membrane of the cervical canal is affected. The cause of the pathology can be various infections, injuries, hormonal disorders, non-compliance with personal hygiene rules, and so on. As a result of the development of the inflammatory process, a woman may experience pain during intercourse. Moreover, it can impede the passage of spermatozoa into the uterine cavity, as a result of which the likelihood of pregnancy with natural insemination will be significantly reduced.
• Immunological incompatibility of the couple. The essence of this pathology lies in the fact that the body of a particular woman ( that is, her immune system, which normally provides protection against invading foreign bacteria, viruses, and other agents) begins to produce antibodies against the sperm of her sexual partner ( husband). At the same time, during natural insemination, spermatozoa will die before they can reach the egg and fertilize it.
• Operations in the region of the cervix. After surgery, scars may remain on the cervix, which can prevent the passage of sperm.
• Anomalies in the development and / or location of the female genital organs. As a result of improper development, there may be violations of the shape and location of the uterus, cervix and / or fallopian tubes. All this can impede the process of sperm entering the egg, thereby leading to infertility.
• With a lack of estrogen. Under normal conditions, cervical mucus is located in the cervical region, which prevents the penetration of infectious agents, as well as spermatozoa ( during natural intercourse) into the uterine cavity. during ovulation ( when the egg matures, that is, it becomes ready for fertilization and moves into the fallopian tube) releases large amounts of estrogen ( female sex hormones). Estrogens change the properties of cervical mucus, making it less thick and more stretchable, which makes it easier for sperm to pass into the uterine cavity. With a lack of estrogen, the mucus will remain thick all the time, as a result of which the spermatozoa will not be able to reach the egg and fertilize it.
• Unexplained infertility. If, after a full examination of a woman and her sexual partner, it is not possible to identify the cause of infertility, the doctor may also advise resorting to artificial insemination. For some couples, this may lead to pregnancy, while others may require more effective methods ( e.g. in vitro fertilization).
• Lack of a permanent sexual partner. If a woman is living on her own but wants to have a baby, she can also have an artificial insemination procedure in which her egg is fertilized with the sperm of another man ( donor).

Is artificial insemination indicated for obstruction of the fallopian tubes or with one passable tube?

With complete obstruction of both fallopian tubes, it is not advisable to perform artificial insemination, since the injected spermatozoa will not be able to reach the egg and fertilize it. In this case, it is recommended to treat the obstruction or perform the in vitro fertilization procedure.

At the same time, it should be noted that partial obstruction, as well as obstruction of only one tube, is not a contraindication for artificial insemination. With partial obstruction of both tubes, spermatozoa introduced into the uterine cavity or the tube itself can reach the egg and fertilize it. Also, the process of fertilization can occur with one passable tube, if at the time of the procedure it is in it that a mature egg is found.

Indications for insemination with husband's sperm

Indications for artificial insemination by the husband are:

• Inability to ejaculate ejaculation) in the vagina. The cause of this condition may be violations of the functions of the male genital organs. Also, this condition can be observed with damage to the spinal cord of a man, when the entire lower part of the body is paralyzed ( including genitals).
• Retrograde ejaculation. With this pathology, the process of normal ejaculation is disrupted, as a result of which sperm enters the male urinary tract. Insemination and fertilization do not occur, since the seminal fluid does not enter the female genital tract.
• Deformities of the male genital organs. In the presence of anatomical anomalies in the development of the penis, sexual intercourse may not be possible, as a result of which the couple may also resort to artificial insemination. Similar conditions can also occur after traumatic lesions of the penis.
• Oligospermia. Normally, during intercourse, a man releases at least 2 ml of seminal fluid. It is believed that with a smaller amount of sperm, it will not be enough for the spermatozoa to penetrate the cervical mucus and reach the egg.
• Oligozoospermia. With this pathology, the number of spermatozoa in the sperm of a man is reduced. Most of them die on the way to the egg, as a result of which the probability of fertilization decreases.
• Asthenozoospermia. With this pathology, sperm motility decreases, as a result of which they also cannot reach the egg. The problem will be solved by intrauterine or intratubal insemination.
• Performing chemotherapy/radiotherapy. If a patient has been diagnosed with a tumor disease, he can donate his sperm to a special storage before starting treatment. In the future, it can be used for artificial insemination.

Indications for insemination with donor sperm

Artificial insemination with donor sperm is indicated:

• With azoospermia in a husband. With this pathology, there are no spermatozoa in the seminal fluid of a man ( male reproductive cells), as a result of which the fertilization of the egg is impossible. It is worth noting that in the so-called obstructive form of azoospermia, the cause of the disease is a mechanical obstacle that forms in the way of semen excretion. In this case, the husband's sperm, obtained using special techniques, can be used.
• With necrospermia in a husband. With this pathology, there are no live spermatozoa in the male seminal fluid that could fertilize the egg.
• In the absence of a permanent sexual partner. If a single woman wishes to have a child, she can also resort to artificial insemination with donor sperm.
• If the husband has genetic diseases. In this case, there is a high risk that these diseases can be transmitted to the unborn child.

How many times can you do insemination and what are the chances of getting pregnant while doing this?

The success of artificial insemination is determined by:

• The quality of the preliminary examination. Before performing the procedure, it is extremely important to conduct a full examination of the couple and identify the cause of infertility. If you miss this moment and carry out the insemination of the husband's sperm to a woman who, for example, has a complete tubal obstruction, there will be no effect. At the same time, when using low-quality male sperm, the procedure will also be ineffective.
• Cause of infertility. If the cause of infertility is partial obstruction of the fallopian tubes, pregnancy can occur only after 2-3 inseminations. At the same time, if a man's sperm quality is poor, the chance of pregnancy also decreases.
• The number of attempts. It has been scientifically proven that the probability of pregnancy at the first insemination is about 25%, while at the 3rd attempt - more than 50%.

Contraindications to artificial insemination

Artificial insemination is contraindicated:

• In the presence of inflammatory diseases of the genital tract. Performing the procedure when there is an infection in the vagina, cervix, or uterus itself can make the procedure extremely painful. It also increases the risk of spreading the infection and developing severe complications. The likelihood of pregnancy in this case is reduced. That is why insemination should be performed only in the absence of these diseases.

• In the presence of ovarian tumors. During pregnancy, the ovaries produce sex hormones that maintain the pregnancy. With ovarian tumors, their hormone-producing function can be disrupted, which can cause complications during gestation.
• If there are contraindications to pregnancy or childbirth. This list includes many pathologies, from diseases of the uterus, cardiovascular, respiratory and other body systems to mental disorders of a woman, in which she cannot bear or give birth to a child.
• With akinospermia in a husband. The essence of this pathology is that the male germ cells are completely devoid of mobility. Such spermatozoa will not be able to reach the egg and fertilize it, as a result of which it makes no sense to perform artificial insemination with such seminal fluid. In this case, it is recommended to resort to in vitro fertilization, which is highly likely to lead to pregnancy.
• In the presence of infectious diseases in the husband. In this case, the risk of infection of the woman during the procedure remains.

Is artificial insemination possible with endometriosis?

Carrying out artificial insemination can contribute to the onset of pregnancy, but does not guarantee its successful development and outcome. The fact is that with endometriosis, the strength of the uterine wall can be violated. In this case, during the growth and development of the fetus, it can break, which will lead to the death of the fetus or even the mother. That is why, in the presence of endometriosis, you should first carry out a full diagnosis, assess all possible risks and perform the necessary treatment, and only after that proceed with artificial insemination.

Is insemination performed for polycystic ovaries?

Is artificial insemination performed for uterine fibroids?

Do they do artificial insemination after 40 years?

Is it possible to perform insemination with teratozoospermia?

Preparing women and men for artificial insemination

Before planning artificial insemination, consultation is necessary:

• therapist- to detect diseases of internal organs.
• Gynecologist ( for women) - in order to identify diseases of the female reproductive system.
• Andrologist ( for men) - in order to identify diseases or disorders of the male reproductive system.

• Urologist ( for women and for men) - in order to identify diseases of the genitourinary system, including infectious ones.
• Mammologist ( for women) - a specialist who is engaged in the identification and treatment of diseases of the mammary glands.
• Endocrinologist- a doctor who treats the endocrine glands ( his consultation is needed in violation of the production of certain hormones).

Tests before insemination

For artificial insemination, you must pass:

• General blood analysis. Allows you to determine the concentration of erythrocytes ( red blood cells) and hemoglobin. If a woman has anemia ( anemia, characterized by a decrease in the number of red blood cells and hemoglobin) should first identify and eliminate its cause, and only after that carry out insemination. Also, a general blood test allows you to identify possible active infectious and inflammatory processes in a woman's body ( this will be indicated by an increase in the concentration of leukocytes - cells of the immune system).
• General urine analysis. This study allows you to identify the presence of infection of the genitourinary system. Also, the presence of blood in the urine may indicate more serious kidney disease, which can adversely affect the course of pregnancy.
• Blood chemistry. This analysis allows you to evaluate the functional state of the liver, kidneys, pancreas, heart and many other organs. In case of a pronounced violation of their functions, the procedure is contraindicated, since terrible complications can develop during a subsequent pregnancy.
• Analysis for STIs ( sexually transmitted infections). These infections include HIV AIDS virus), gonorrhea, syphilis, chlamydia, and so on. Their presence in the future mother jeopardizes the development of pregnancy and the health of the fetus, as a result of which they should be cured before insemination ( if possible).
• Tests for sex hormones. A study of the sex hormones of a man and a woman is carried out to identify a possible cause of infertility. Moreover, an assessment of the functioning of the female reproductive system is necessary in order to determine whether a woman will be able to bear a child in the event of pregnancy. The fact is that the course of pregnancy, as well as the process of childbirth, is controlled by various hormones. If their excretion is impaired, this can lead to the development of complications during pregnancy or childbirth ( until the death of the fetus).
• Rh factor analysis.

Artificial insemination, at first glance, is an incomprehensible medical term. However, women who repeatedly try to get pregnant know about insemination firsthand. What is it and what is the peculiarity of this procedure?

Artificial insemination is the fertilization of an egg by introducing the sperm of a husband or a donor. This donor can be a husband, or maybe an outsider, if in a married couple it is the husband who has problems conceiving. Artificial insemination is abbreviated as AI, you can see this abbreviation on many Runet forums.

Artificial insemination should not be confused with IVF, although the word "artificial insemination" is often associated with IVF. In fact, this term is much more applicable to insemination, because during insemination, fertilization is carried out inside the woman's uterus, while IVF is in vitro fertilization, and this has nothing to do with the woman's body.

Types of intrauterine insemination

It would seem that this procedure cannot have several options, but nevertheless, they are. Here are the different options for insemination:

• vaginal;
• intracervical;
• intrauterine;
• in-line;
• intrafollicular;
• intracavitary, that is, insemination into the abdominal cavity;
• perfusion of sperm into the fallopian tubes.

Despite the fact that there are really many types of this procedure, its most common type is intrauterine insemination, or IUI for short.

Procedure

Intrauterine insemination (IUI) is a procedure in which the sperm of a husband or a donor is injected directly into the woman's uterus.

This procedure is carried out during the period of ovulation. In this case, ovulation can be both natural and induced with the help of hormonal drugs to increase the chances of conception.

Intrauterine insemination is usually performed with the husband's sperm, but donor sperm can also be used if fertilization with the husband's sperm is impossible for any reason.

For insemination with donor sperm, semen is used, preserved using cryotechnology. You can use sperm obtained from other banks and institutions. However, before using the donor's sperm, it is necessary, first of all, to carry out the necessary tests in order to exclude diseases such as HIV, hepatitis or syphilis. The duration of the analyzes takes more than six months, since after the first analysis, a second one is carried out after 6 months.

Advantages of artificial insemination

In some forms of infertility, the possibility of conception is affected by such female factors, in which the entry of sperm into the vagina and contact with cervical mucus is highly undesirable for sperm. Otherwise, spermatozoa may die. This is because the body of some women produces anti-sperm antibodies, or the level of acidity in the vagina is greatly exceeded.

All these factors are detrimental to spermatozoa, and as a result, the inability to conceive naturally. It is to prevent such an outcome that artificial intrauterine insemination is recommended for such couples.

Indications for insemination

Indications for women

The most common indication for insemination is the cervical factor, when spermatozoa are immobilized when they enter the cervical canal. These can be anatomical, structural or pathological changes in the cervix, which put an insurmountable barrier to sperm.

• cervical infertility factor;
• unexplained infertility, in which all tests are normal;
• chronic endocervicitis;
• operations on the cervix in history (conization, amputation, cautery, diathermy, cryotherapy);
• sperm allergy;
• antisperm antibodies produced by a woman's body;
• ovulatory dysfunction, amenable to therapy;
• vaginismus: spasm of the muscles of the vaults of the vagina and cervix.

Testimony from a man

Also, insemination is used when sperm counts decrease, when conception naturally becomes problematic. That is, the male factor is often an indication for insemination:

• subfertile sperm;
• retrograde ejaculation, in which semen enters the bladder;
• hypospadias;
• hypospermia: small volume of ejaculate;
• high viscosity of seminal fluid: semen is too thick;
• antisperm antibodies in a woman's body that cause the death of spermatozoa when they enter the vagina;
• unsuccessful attempts at intracervical insemination;
• condition after chemotherapy or vasectomy.

When is fertilization with donor sperm necessary?

Sometimes it also happens that fertilization with the husband's sperm is not possible. On the part of a woman, such a factor takes place if she is not married, she does not have a partner. Sometimes insemination is the only way out for a single woman who wants a child.

For a married couple, contraindications to insemination with the husband's sperm can only be if the husband's seminal fluid for some reason cannot be used for fertilization:

• male infertility;
• ejaculatory-sexual disorders;
• severe hereditary defects and diseases of the husband, which can be inherited by the child.

Along with this, there are contraindications for insemination with donor sperm. This is prohibited in the following cases:

• without written consent to insemination by the donor of both spouses;
• without the consent of the woman herself;
• without the knowledge of the spouse;
• under anesthesia;
• if infertility can be eliminated with surgery or therapeutic treatment.

How to find a donor for insemination

Choosing the right donor for artificial insemination is not an easy task. Here we present some criteria that will make it easier for you to select a donor, if necessary:

• the age of the donor is younger than 36 years;
• mental and physical health;
• absence of hereditary diseases;
• the absence of stillbirths and neonatal deaths and miscarriages in the donor's relatives in the past and present;
• the absence of diseases such as AIDS, syphilis and hepatitis.

Contraindications for insemination

Insemination, like any medical procedure, has its contraindications. There are conditions in which you can not even begin to carry out this procedure. Here are the contraindications for women:

• mental and extragenital diseases in which pregnancy is contraindicated;
• age over 40;
• ovarian tumors;
• cancer, malignant neoplasms;
• any surgical interventions in the pelvic cavity in the past;
• genital infection;
• pathology of the fallopian tubes, blockage, adhesions, obstruction;
• bleeding from the genital tract of an unclear nature;
• unsuccessful attempts of intrauterine insemination in the past;
• ovarian hyperstimulation syndrome due to past treatment with gonadotropins;
• luteinization of a non-ovulated follicle in two consecutive cycles;
• any inflammatory disease with an acute course.

What tests should be done before insemination

Preparing for insemination involves a lot of research on both spouses. This is necessary for successful insemination.

What examinations should a woman undergo?

Here is a list of mandatory examinations for a woman before the procedure:

• general and special gynecological examination;
• ultrasound examination of the pelvic organs;
• blood test for syphilis, HIV, hepatitis B and C;
• clinical blood test, including clotting time (valid for 1 month);
• conclusion of the therapist about the state of health and the possibility of carrying a future pregnancy;
• a study on the flora from the urethra and cervical canal, as well as the degree of purity of the vagina.

Studies that a woman should undergo only according to indications:

• hysterosalipingographic, hysterosalipingoscopic and laparoscopic studies of the condition of the uterus and fallopian tubes;
• biopsy of the endometrium of the uterus;
• cytological examination of smears of the cervix;
• bacteriological examination of material from the urethra and cervical canal;
• blood tests for hormones: FSH, LH, estradiol, prolactin, testosterone, cortisol, progesterone, T_3, T_4, TSH, growth hormone;
• infectious examination (chlamydia, uro- and mycoplasmosis, herpes simplex virus, cytomegaly, toxoplasmosis, rubella);
• examination for the presence of antisperm and antiphospholipid antibodies;
• conclusions of other experts according to indications.

What examinations should a man undergo?

Here is a list of mandatory examinations for a man:

• spermogram;
• blood test for syphilis, HIV, hepatitis B and C.

Analyzes and examinations that are carried out only according to indications:

• andrologist consultation;
• determination of blood group and Rh factor;
• infectious examination (chlamydia, uro- and mycoplasmosis, herpes simplex virus, cytomegaly).

If the age of both representatives of a married couple exceeds 35 years, then another necessary examination will be a consultation with a geneticist.

How is insemination done?

A special syringe is inserted into the cervical canal, with which sperm is injected directly into the uterine cavity. If a woman does not have tubal pathology, then conception should occur naturally: spermatozoa will penetrate the fallopian tubes, where fertilization will occur.

Before the procedure, it is recommended to stimulate the maturation of the egg, this will increase the chances of conception. For this, drugs with FSH, and sometimes anti-estrogens, are used. Insemination can be carried out without ovulation stimulation, but in this case, the chance of conception is reduced by 2-3 times compared with the use of ovulation stimulators.

But if a woman has adhesions in the tubes and obstruction of the tubes, then there is no point in inseminating, and then IVF will be the best way out for the couple.

Doctors recommend repeating this procedure no more than 3-4 times. According to statistics, about 87% of women become pregnant during the first 3 cycles of insemination. If the pregnancy did not occur, then further attempts will have only 6% success.

After insemination

After one attempt at this method of fertilization, pregnancy occurs in about 12-15%. But this is only one attempt out of four, so do not worry, as the number of attempts increases, the chance of getting pregnant also increases.

After the procedure, sometimes there are a number of complications. It is better to know about them in advance:

• allergic reactions to the drug to stimulate ovulation;
• shock reaction after the introduction of sperm into the uterine cavity;
• increased tone of the uterus;
• ovarian hyperstimulation syndrome;
• exacerbation of inflammatory diseases in the genital organs, or their occurrence after the fertilization procedure;
• occurrence of multiple pregnancy.

In the event of a multiple pregnancy, you will be offered a resection of one or more embryos. In other words, abortion. The decision in this case remains with the woman. In some cases, pregnancy with more than one fetus can be dangerous for the female body if there have been unsuccessful pregnancies in the past.

Can I inject sperm at home myself?

Under no circumstances should this be done. In specialized clinics, insemination is performed under sterile conditions. Self-introduction of a syringe or pipette into the cervix is ​​dangerous because of the risk of infection in the uterine cavity.

Insemination: cost

The cost of this procedure is much lower than the cost of IVF. The price of this method of fertilization is on average from 12 to 15 thousand rubles. The cost of insemination increases if it uses not the husband's sperm, but a donor's. If this is a donor procedure, its cost may increase by 5,000 rubles.