Artificial insemination as a fertility treatment
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Professor Robert Winston
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Fertility expert and one of the world's pioneers of IVF and Fertility Medicine. BAFTA award-winning television presenter and Member of The House of Lords in the UK.
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Conception / Infertility Treatments

Artificial insemination as a fertility treatment

Artificial insemination is also known as AI.  AI is the process by which sperm or semen is injected either into the vagina, cervix or more usually, the uterus, near the time of ovulation. It is usually considered if sperm donation is needed as part of fertility treatment. AI is best done by direct injection into the uterus (intrauterine insemination or IUI). This improves the chance of sperm getting into the fallopian tubes, where fertilisation normally occurs. 
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In Short

AI may be used for a wide variety of reasons for couples or women having assistance with conception:

In cases of unexplained infertility.

Low sperm count but sperm are capable of fertilization.

When there may be problems with intercourse – or having sex at the fertile time.

Retrograde ejaculation.

When the woman has severe upper vaginal or cervical scarring or if the cervix is unable to produce the normal mucus.

If the woman does not ovulate regularly but ovulates in response to drugs and drug treatment alone has failed.

For donor insemination.

Artificial insemination

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.

Vaginal or cervical insemination

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.

Intrauterine insemination (IUI)

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.

When should artificial insemination be used?

Artificial insemination or AI may be used for a wide variety of reasons:

  • In cases of unexplained infertility.
  • If a man has a marginally low sperm count or sperm antibodies. If IVF shows that the sperm are capable of fertilization and IVF treatment fails, it may be worth persisting with Al.
  • When there may be problems with intercourse – or having sex at the fertile time. AI with frozen sperm may be justified if the male partner is away from home.
  • When a man is able to have normal intercourse but has retrograde ejaculation (sperm are not ejaculated from the end of the penis but into the bladder). A drug can be taken orally to make the urine alkaline so that the sperm will survive. After orgasm, urine is collected, the sperm are filtered, washed and used for insemination.
  • When both partners both have a minor problem – for example, irregular ovulation, inability to have intercourse regularly or a marginal sperm count.
  • When the woman has severe upper vaginal or cervical scarring or if the cervix is unable to produce the normal mucus that provides a satisfactory environment for the sperm to swim.
  • If the woman does not ovulate regularly, but ovulates in response to drugs like clomiphene or FSH injections and drug treatment alone has failed
  • For donor insemination.

The Genesis Research Trust

Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.

Professor Robert Winston’s Genesis Research Trust raises money for the largest UK-based collection of scientists and clinicians who are researching the causes and cures for conditions that affect the health of women and babies.

Essential Parent is proud to support their wonderful work. You can learn more about them here.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.