|Other names: Artificial insemination is also known as intrauterine insemination (IUI) and intracervical insemination (ICI).
What Is Artificial Insemination?
Well, despite the word 'artificial', it is not a fake procedure! Artificial insemination is where sperm is injected directly into the vagina or womb to aid pregnancy. It is a way of giving sperm a head start in the hope that the nearer it is placed to the egg, the more likely it is to fertilize it. It is commonly used where:
1. The woman has fertility problems.
2. The man has fertility problems.
3. Donor sperm is being used.
Insemination is a painless procedure that can be repeated as often as necessary. It can be performed using a natural cycle or a stimulated cycle.
Natural cycle: Doctors simply monitor your menstrual cycle with ovulation predictor kits and ultrasound. Insemination will be performed when your ovaries release an egg. Women who ovulate regularly are likely to be recommended a natural cycle because of the risk of multiple pregnancy associated with a stimulated cycle.
Stimulated cycle: After 2 to 3 natural cycles, if pregnancy is still not achieved, the doctor will recommend a more aggressive approach. Basically that means ovarian stimulation - the ovaries are stimulated to release more eggs than normal with the aim of increasing the chance of conception. To do this you will be given a fertility drug in pill form called Clomid and if this fails to work, injectable gonadotropins. If you do not ovulate regularly you will probably be offered a stimulated cycle straight away.
What Is The Pregnancy Success Rate?
Without severe female infertility issues, the overall success rate is about 12.5 percent per attempt. The rate is slightly higher with fertility medications and slighter lower without them. Artificial insemination will not increase your chance of pregnancy over timed intercourse if the sperm is normal and the woman ovulates regularly. Nor will it be effective if the there is severe male infertility such as low sperm count. In such instances ICSI procedure is the preferred treatment. If you have not become pregnant after 6 attempts, you will need to consider assisted reproductive technology (ART), such as IVF.
What Is The Procedure?
If you are not planning to use a sperm donor, your partner will need to provide a semen sample in a cup on the day of your procedure. Your fertility clinic will provide a container and a private room for this collection. Once the sample is collected, it needs to be washed. This washing process separates the best sperm from the semen, so only the strongest swimmers will survive (the process takes about 2 hours). It also removes prostaglandins hormones from the semen, reducing the risk of cramping. Timing is important when it comes to artificial insemination. Washed sperm do not survive as long as sperm ejaculated into the vagina in regular intercourse. At best, they are thought to live 24 hours compared to 3 to 5 days with regular sperm. This means the clinic will need to carefully time when the sperm is washed, with when the woman's eggs are released.
Monitoring Your Eggs
Some fertility centers do ultrasound scans (either transvaginal ultrasound or abdominal ultrasound) in the first two weeks of your cycle to monitor the progression of your ovarian follicles. These are little cells in the ovaries, each one contains an egg. At the start of your menstrual cycle some of these follicles will begin to grow as the egg inside them matures in preparation for release. By the time of ovulation only one follicle has grown big enough to burst open and release it's egg. Your doctor will see this follicle on the ultrasound scan it is usually about 22 to 25 millimeters in size at the time of ovulation. Exception: If you are taking fertility medications, multiple follicles will release an egg. On the day of your procedure another ultrasound scan will be done to check that the follicle has burst. When this happens it starts to shrink so it will look smaller again. If it hasn't burst, you will be asked to come back the next day. Pregnancy cannot be achieved unless the egg has been released.
Artificial insemination takes about 45 minutes and is performed by a physician or skilled nurse. There are two different techniques which are used:
Intracervical insemination: This is less common. Sperm is place in the cervix, the top part of the vagina, using a long tube called a catheter with a syringe attached. The sperm is injected through this tube into the cervix.
Intrauterine insemination: Most procedures are performed this way. A longer tube is fed through the vagina and into womb, where the sperm is released nearer to the egg. Intrauterine insemination is more expensive, but it has higher success rates. In both cases the patient is asked to remain lying down for 30 minutes after the sperm has been inserted - you don't want it seeping out again!
What Are The Risks?
The main risk of artificial insemination is the risk of infection from bacteria entering the uterus through the procedure (rare). There is also a risk of multiple births if fertility drugs are used.
How Much Does It Cost?
If you use your partner's sperm, the cost of one cycle is between $300 and $700. If you add the cost of ultrasounds and fertility drugs this increases to $1,500 to $4,000 per cycle. If you use donor sperm, you will also need to pay for those costs - the cost of one vial of donor sperm is between $150 and $300. You usually need to order at least 3 vials. One to two vials are used per cycle of artificial insemination. See sperm donation for more details.
What Are The Pros And Cons?
• For many couples, artificial insemination is the first step in infertility treatments. It is less invasive and cheaper than ART treatments such as IVF.
• Couples with unexplained infertility have a better success rate with artificial insemination than with just using fertility drugs alone.
• Men with fertility problems have a better chance of impregnating their partner via artificial insemination than through natural timed intercourse (that is, having intercourse on their partner's most fertile days).
• It is not painful, discomfort-wise it feels like a Pap smear test.
As timing is so critical, your partner needs to be on standby to dash to the clinic to provide a sperm sample. Usually though you will have a heads up about 24 to 36 hours before you ovulate.