Artificial insemination is one of the oldest and simplest fertility treatments. It is used when there is a slight sperm motility problem, when the sperm count is a little low, if the cause of infertility is due to a cervical factor, in cases of ovulation problems and when the infertility is unexplained. It is important to choose the patients that undergo artificial insemination carefully. Women over 38 achieve very low pregnancy rates.
Artificial insemination can be performed with the partner’s sperm or donor sperm. The success rate is about 10-15% in the first cycle. The pregnancy rate increases the more cycles that are performed levels off at the 3rd or 4th cycle. In a group of women under 38, after 4 cycles pregnancy is achieved in 25-30% of the patients.
Artificial insemination takes place in 3 phases:
1. The process starts with ovulation induction. Medication is administered that helps the ovaries mature one or more eggs. When one or two follicles measure 17 mm or more an hCG shot is prescribed. Insemination is performed 36 hours.
2. The day of the insemination the man brings a semen specimen to the lab at least 2 hours before the insemination. The semen is capacitated in the lab to better the specimen. If the insemination is with donor sperm, the sperm is prepared in the lab.
3. In the last phase, the insemination is performed. The patient lies in gynecological position and a speculum is placed in the vagina. The doctor then introduces a catheter through the cervical canal into the uterus and injects the capacitated semen into the uterus.
Risks
Ovarian hyperstimulation syndrome is an exaggerated response to the stimulation treatment. It can be classified in 3 degrees: mild, moderate and severe. It can be prevented by correct dosage of stimulation medication, but some patients are hypersensitive to these meds and even with a very low dosage develop an elevated number of follicles. In this case, to prevent hyperstimulation the cycle is cancelled and hCG is not administered. If hCG has been administered, egg retrieval is performed and embryos are frozen and there is no replacement of fresh embryos. At other times, hyperstimulation develops after embryo transfer.
The risk of multiple pregnancy increases with the number of embryos that are replaced. At present, there is a clear tendency to replace fewer embryos thus achieving a lower number of multiple pregnancies.
Ectopic pregnancy is an embryo that implants outside the uterus. Ectopic pregnancies are slightly higher in women who undergo assisted reproduction techniques than those women who conceive spontaneously.
There is a small risk of hemorrhage, infections, ovarian torsion and complications from anesthesia.
