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 of the patient (intrauterine insemination, IUI). In certain cases, sperm can be deposited in the vagina, in the cervix, in the fallopian tubes or within the peritoneal cavity.

Because seminal fluid contains substances that may irritate the uterus, semen is usually processed before intrauterine insemination. We will "wash" the sperm cells by diluting the seminal fluid with a semisynthetic culture fluid and spinning the specimen so that the sperm cells fall to the bottom of a centrifuge tube. The washed sperm cells are resuspended in a small volume of culture fluid, loaded into a soft plastic catheter, threaded through the patient's cervix into the uterus and deposited within the uterus. Most patients experience mild cramping 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 to isolate the more active sperm within a specimen .

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 24-72 hours. Therefore, a well-timed insemination might occur anytime between 24 hours before and 12 hours after the egg(s) is(are) released.

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 or the timing is uncertain we will schedule insemination on two consecutive days. The day of insemination(s) may be determined by several means. Some 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. These, 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 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 2-4 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.

Complications

Complications after artificial insemination are rare. A patient may 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 when they occur within four or five days of an insemination. The culture fluid that we use to wash sperm contains blood products such as human serum albumin. Due to the manner in which the blood products are processed, there is little l risk that viruses or bacteria could be transmitted from the blood products to the patients treated with this substance.