Artificial insemination (AI) is one the main assisted reproduction techniques (ART) together with in vitro fertilization (IVF). It basically consists in facilitating the encounter between sperm and ovum through the placement of a sample of semen inside the uterus. This sample will have been previously prepared in the laboratory, where technicians select and concentrate the sperm with higher mobility.
AI does not require to previously extract the ovules from the woman; ovarian stimulation and endometrial control are used to figure out the ideal moment in which to inseminate (AI).
AI can be done with the partner’s semen (AIP) or donor sperm (AID). Here the former is discussed.
AIP is indicated in the following cases:
- Altered semen.
- Poor ovulation or a mild endometriosis.
- Sterility of unknown origin.
Requirements to be able to undergo an IAC
- Women should be able to ovulate spontaneously or with treatment and have at least one permeable tube. To check the permeability of the tubes, a hysterosalpingogram is performed.
- Men need a minimum concentration of recovered mobile sperm – more than 3 million.
AIH: ovarian stimulation
1º. Ovulation is stimulated gently by intramuscular injections of hormones for 10-12 days. The goal is to produce two follicles and thus increase the chances of pregnancy, since women usually produce only one follicle in each menstrual cycle.
2º. Throughout this period, between 3 and 4 ultrasounds will be performed to monitor the evolution of the treatment and the growth and evolution of the follicles will be checked through estradiol levels in the blood.
3º. After the ultrasound control, which will allow to determine the moment in which the dominant follicle reaches a size of between 17 and 20 mm, the human chorionic gonadotropin hormone (hCG) will be administered to the woman via subcutaneous injection. This hormone will complete maturation of the follicle and induce ovulation.
4º. After about 35-37 hours after the injection of the hCG, the follicle must have reached the appropriate size -the vaginal ultrasound will be responsible for this verification- and artificial insemination will be scheduled.
5º. Around two hours before the AI the semen sample will be taken to the laboratory, where biologists will prepare the mobile sperm in a 0.2 ml container that will be later placed inside the woman’s uterus in a simple procedure that does not require sedation. With the help of a vaginal speculum, the specialist introduces the cannula with the sperm sample through the cervix into the uterus. The patient discomfort will be similar to the one caused by a Pap smear.
6º. After a few minutes rest the patient can go home. In the 15 following days a pregnancy test around the next 15 days will be done and medication -progesterone to favor implantation- may be prescribed. The patient may lead a normal life but should avoid high intensity physical activities.
The chances for success of AIP vary between 10 and 15% per cycle. Usually from 2 to 4 IUI cycles are performed.
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