Indications for artificial insemination with husband’s sperm (AIH) or partner’s sperm include:
- Male problems that prevent normal deposition of sperm into the vagina. Examples include premature ejaculation, impotence and retrograde ejaculation.
- Problems with the woman that prevent normal deposition of sperm into the vagina. Examples include painful intercourse and physical deformities.
- Cervical factors. Examples include a narrowed cervix and absent, abnormally thick or acidic cervical mucus. Intrauterine insemination will bypass cervical problems.
- Suboptimal semen quality. Artificial insemination can ensure that most of the sperm in an ejaculate of low volume will get past the vagina into the upper reproductive tract of the woman. If the number of motile sperm in the semen specimen is reduced, artificial insemination may improve the chance that pregnancy will occur. In order to yield a decent chance for conception, we must have at least two million actively progressing sperm in the specimen that we use for insemination.
- Use of frozen husband’s sperm. Sperm that has been frozen and stored prior to sterilization, radiation or chemotherapy may be utilized for artificial insemination.
ARTIFICIAL INSEMINATION – THE PROCESS
When a physician places semen into the reproductive tract of the patient, the process is called artificial insemination. The type of insemination and method of sperm processing depends on the details of each case. When sperm from the patient’s husband is used, we term the process artificial insemination with husband’s sperm (AIH). When sperm is obtained from an anonymous donor, the process is termed therapeutic donor insemination (TDI).
In our office, artificial insemination is most often performed by depositing a processed sperm specimen into the uterus (womb) of the patient (intrauterine insemination, IUI). In certain cases, sperm can be deposited in the cervix (ICI).
Because seminal fluid contains substances that may irritate the uterus, semen is usually processed before intrauterine insemination. Sperm can be “washed” by first diluting the seminal fluid with a modified salt solution (culture fluid) and then centrifuging the specimen so that the sperm cells are concentrated to the bottom of the centrifuge tube. The washed sperm cells are re-suspended in a small volume of culture fluid, loaded into a soft plastic catheter which is threaded through the patient’s cervix into the uterus and deposited within the uterus. Most patients experience mild cramping discomfort during intrauterine insemination. A little bit of vaginal bleeding will often be noted in the hours following insemination.
Alternative methods of separating sperm cells utilize density gradients or swim-up techniques which may separate the more active sperm within a specimen from the less motile cells.
Proper timing of artificial insemination is important to the success of the process. Once it is ovulated, an egg remains fertilizable for 12-24 hours. Once deposited in the reproductive tract of a woman, sperm retains the ability to fertilize an egg for up to 72 hours.
Usually, a single insemination is planned for the expected day of ovulation each cycle. In special situations, when the number of sperm for insemination is low, we will schedule insemination on two consecutive days. The day of insemination(s) may be determined by several means. Often, the woman will utilize a kit that detects the LH surge in her urine. Ovulation is most likely to occur on the day after the LH surge is first appreciated. Accordingly, patients are instructed to run an LH kit and call the office to schedule insemination for 18-30 hours after the LH surge is noted. An alternative means of scheduling insemination is to monitor the LH surge utilizing blood testing. Ultrasound evaluation of follicle growth on the ovary may be incorporated into cycle monitoring.
We may administer an injection of human chorionic gonadotropin (hCG) to some patients (who are usually receiving other fertility drugs) in order to “trigger” ovulation. When we do this, artificial insemination will usually be scheduled for 36-44 hours after the hCG injection when a single insemination is planned or at approximately 24 and 48 hours after the hCG injection when two inseminations are to be done.
Unless otherwise specified, we prefer the man to remain abstinent for several days prior to the insemination in order to store up his sperm. We usually encourage couples to have intercourse during the 24 hours after insemination.
The incidence of complications after artificial insemination is very low. Rarely, a patient can develop an infection or allergic reaction to the sperm. Signs of infection include fever, chills, and lower abdominal pain. Such symptoms should be reported to the physician if they occur within four or five days of an insemination.