AI may be used for a wide variety of reasons for couples or women having assistance with conception: In cases of unexplained infertility.
Known as AI, this is the process by which sperm are injected either into the vagina, cervix or more usually, the uterus, near the time of ovulation. It is usually indicated if sperm donation is needed. It is best done by direct injection into the uterus (intrauterine insemination/ IUI). This improves the chance of sperm getting into the fallopian tubes, where fertilisation normally occurs.
Although insemination causes little physical discomfort, there may be emotional pain. The process is clinical and the man may find it hard to masturbate to order and, if requested, collecting a split ejaculate is difficult.
All insemination requires timing of ovulation. Temperature charting is inadequate. Blood tests or ultrasound, or both, are advised. Insemination may be repeated two or three times each month and most couples take several months to conceive. Some find it so disruptive that they give up after a few months. If insemination has not worked after six attempts it is appropriate to try IVF.
Semen is injected directly into the vagina through a small tube and deliberately placed in or near the cervical canal. The woman lies with her knees up for a few minutes, but insemination causes no discomfort. It can be used for basic routine insemination, but is mostly indicated in some couples having difficulties with sex or if there is an anatomical problem with the cervix preventing the sperm getting to the right place. This treatment has little point for men with a low sperm count.
The collected sperm are ‘washed’ (repeatedly mixed in special media), then centrifuged in a tube to removes débris. Sperm can be separated and their numbers enriched by the ‘swim’ process. When the sperm are placed at the bottom of a tube of medium and healthy sperm may swim up to the surface. From there they are collected by suction through a fine tube. Injecting neat, unwashed semen into the uterus can be dangerous because it can cause allergic reactions.
Intrauterine insemination or IUI can be a bit uncomfortable, but shouldn’t cause pain. It is most effective when the ovaries are stimulated by either clomiphene tablets or injections of FSH. Stimulation of egg production must be gentle to avoid the risk of multiple follicles. If this occurs, the insemination may need to be abandoned for that cycle, and treatment recommended in the following month. To avoid this risk most units monitor FSH injections with regular ultrasound, usually four to six visits before insemination.
Occasionally a split ejaculate will obtain richer sperm. Some men with a low sperm count may have a concentration of their most active sperm during the first part of the ejaculate. To produce a split ejaculate the man masturbates the first part of his ejaculate into one pot and then switches to a new pot for the rest.
Artificial insemination or AI may be used for a wide variety of reasons:
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