| « Menu | |
Artificial InseminationTypes of Insemination Intrauterine Insemination This is a simple technique which the reproduction specialist can perform in his office. It requires ovarian stimulation with hormones to produce more than one egg (the ideal number is two or three, which considerably increases pregnancy chances). Then, at the moment of ovulation the semen (with motility and concentration improved in the laboratory) is introduced into the uterus with a very fine catheter through the vagina. Cervical Insemination The treatment is basically identical to intrauterine insemination, but in this case the semen is placed into the vagina without intervention from the laboratory. This technique is used when the couple presents intercourse difficulties preventing the sperm from being deposited into the vagina. Heterologous Insemination The technique is the same, but the difference is that a donor's semen from a sperm bank is used instead. This technique is prescribed for couples in which men have no sperm (azoospermia), or for women without male partner. Procedure Steps Ovarian stimulation is generally prescribed in this treatment. Even though it is not necessary to stimulate ovulation, as women usually produce one egg each month, we must bear in mind that these couples have long been seeking to enlarge their families. If we stimulate ovulation and thus make women produce between 2 and 4 eggs, the chances of pregnancy will be clearly higher and treatment duration and cost will be reduced. Stimulation is performed with hormones which are generally administered by injection (there are also some administered orally) during 7 days.
A transvaginal ultrasound control is performed to evaluate the quantity of eggs produced. The ultrasound will also help deciding the exact moment when the insemination will be performed, as the ovarian follicle growth will allow to evaluate the degree of egg maturation. Once the insemination is timed, the male partner will deliver a semen sample (collected by masturbation) to the laboratory, where it will be processed to concentrate and improve the sperm quality. Then the insemination will be performed. It consists in introducing the improved semen sample through a very fine catheter. This procedure is performed in the physician’s office. After inserting the speculum, he will introduce the catheter into the vagina and through the cervix, depositing the semen into the uterine fundus. This procedure is not painful, and does not need to be performed under anesthesia. Once the insemination is over, the woman will lie on the examination table for 5 or 10 minutes, and then she will leave the physician’s office and resume her usual activities. As the procedure does not require bed rest for the following days, this treatment becomes very viable for patients, who do not have to interrupt work. The following day the woman starts taking progesterone in an attempt to retain a probable pregnancy. Fourteen days after the insemination a pregnancy test will be performed.
For Whom Is This Procedure Indicated? Male Factor Infertility Insemination is indicated for cases of mild male factors. It is known that achieving pregnancy through intercourse requires, among other things, that the sperm quantity, motility and morphology should be adequate. If the count is lower than required, and the morphology and motility are altered, pregnancy will not be achieved spontaneously and then the couple may turn to artificial insemination. Alteration In Sperm Migration Spermatozoa must swim up from the upper part of the vagina through the cervical mucus and up the uterus to the fallopian tubes, where they meet the egg. The passage through the cervical mucus is sometimes impaired by infections or immunological disorders. As the insemination catheter goes through the cervix, these disorders are bypassed and pregnancy can be achieved. Unexplained Infertility Sometimes couples unable to have children undergo all kinds of tests but the reason for this inability cannot be found, that is, the tests results turn out to be normal. In these cases we can also perform inseminations, as it is proved that this procedure itself increases the chances of pregnancy. Women Without Male Partner Single women can be inseminated with donated sperm supplied by the sperm bank and so can lesbian couples.
Complications Derived From This Treatment The main complications derive from ovarian stimulation and are the following: ovarian hyperstimulation and multiple pregnancies. As explained, we perform ovarian stimulation with the purpose of producing 2-4 oocytes, but sometimes oocyte production is very much higher and this causes a clinical condition known as hyperstimulation syndrome, consisting of ovarian enlargement with accumulation of fluid in the belly, multiple kinds of discomfort and disorders in the blood test results. Very rarely does the patient have to be hospitalized and the syndrome is generally cured spontaneously. The second complication, multiple pregnancies, also derives from an excessive stimulation. It is known that twin pregnancies are not considered a complication, for risks for the mother and babies are only slightly increased. However, pregnancies with triplets and more (high-order multiple pregnancies) really imply serious complications both for the pregnant woman and the babies. The delivery will be pre-term and the babies will be premature, with the huge risks involved, weeks or months of NICU (Neonatal Intensive Care Unit) and the possibility of permanent problems for the babies. However, these two complications, (hyperstimulation syndrome and multiple pregnancy) can be prevented if a very precise control through transvaginal ultrasound is followed during ovarian stimulation. With this control, if an excessive response is observed, with the presence of many follicles (which contain the eggs), the insemination will be cancelled to prevent the above risks. Then, the next month a new ovarian stimulation cycle will begin, but this time with a lower hormonal dose.
Insemination Pregnancy Rate At CEGyR, artificial insemination treatments have a success rate of 15%, meaning that out of 100 couples undergoing an insemination treatment, 15 get pregnant. Chances are increased if the treatment is repeated several times: if you repeat it six times, the success rate rises to 50%. If pregnancy is not achieved after 6 inseminations, the physician may want to re-evaluate the diagnosis, examining the couple again to propose a high-tech treatment such as IVF. I personally consider insemination a very useful treatment for mild male factor problems, cervical mucus disorders and unexplained infertility. It is also a viable, inexpensive treatment for patients, who can go on with their activities as usual. Artificial Insemination is still one of the most frequently used and simple treatments that has provided me a great deal of professional satisfaction in the form of many successful pregnancies. |
|
