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Insemination

What is insemination?

Intrauterine insemination (IUI) involves the injection of suitably prepared semen directly to the uterine cavity during ovulation. The procedure is intended to limit the distance between the sperm, whose parameters have been improved, and the oocyte in order to facilitate fertilization. Insemination may be performed using husband (AIH - Artificial Insemination by Husband)) or donor (AID - Artificial Insemination by Donor) semen.

Scientific societies recommend no more that 4-6 insemination attempts. The limit is due to the fact that the chances of achieving pregnancy drop after 6 procedures.

Insemination can be performed during successive cycles or one cycle apart. 

For whom is insemination the suitable method of treatment?

Indications:

  • idiopathic infertility,
  • hostile cervical mucus,
  • ovulation disorders (including PCOS), following ovulation induction using anti-oestrogens
  • minor husband semen quality issues - not less than 5 million normal and motile sperm in semen,
  • stage 1 or 2 endometriosis,
  • ejaculation disorders,
  • inability to have intercourse,
  • azoospermia when the female partner’s reproductive system is healthy- Artificial Insemination by Donor.

The final decision about the appropriate treatment method is reached by the couple and their doctor after considering general health (especially the reproductive system), age and duration of infertility in both partners.

Preparing for insemination

Correctly ovulating patients can be inseminated in their natural cycle, however due to the higher success rate the procedure is usually performed after induced ovulation.  During the preparation period the doctor monitors ovarian follicles using the ultrasound. If the ovulation is being induced the doctor might adjust the medication dosage if necessary. When the ovarian follicle is fully-grown the patient receives medication which induces ovulation. Insemination is performed 32-38 hours after the drugs are administered. 

Insemination

On the day of the insemination, an hour or two before the procedure, the partner is asked to show up at the andrology lab where he is directed to a private room to provide a semen sample for preparation (the sterile container is provided at the laboratory). 

After the semen has been prepared (a hour or two later) the couple meets with the doctor who might perform an ultrasound to judge the size of the follicle. Then the couple and their doctor head for the andrology lab where they observe a sample of the prepared semen under a microscope. The insemination is performed in a gynaecological chair. The semen is introduced to the uterine cavity using a fine, disposable catheter - the procedure is painless and does not require the use of anaesthesia. After the insemination the patient remains in the chair for approximately 10 minutes and is then discharged to returns to her regular daily life.

The process involving donor semen is identical. Semen is selected based on the blood type of the couple and, if possible, donor characteristics and traits (phenotype).

Over the next 14 days the patient will take vaginal suppositories containing progesterone. This is the so-called supplementation of the luteal phase and is intended to allow the implantation of the embryo. If the procedure is performed in a natural cycle, progesterone supplementation may not be prescribed. 14 days later the patient takes a pregnancy test. If the test confirms pregnancy, progesterone might continue to be administered until the completion of the first trimester (10 - 12 weeks from the procedure), although that is not always the case. An ultrasound examination confirming pregnancy is performed twice: on the 25th day after the procedure to determine if the gestational sac is to be found in the uterus, and on the 35th day after the insemination to confirm the foetal heart rate. If the examination is performed at nOvum this will be the last visit with the attending doctor in charge of the treatment. nOvum offers pregnancy care, but only with an obstetrician specialising in antenatal care. If a pregnancy has been confirmed by a clinic other than nOvum, please let us know - you can use the "I’m pregnant!" form.

If the urine test does not confirm a pregnancy (please let us know!) and menstruation does not occur when expected, hCG levels will need to be marked after 2 days. The patient will stop taking progesterone when menstruation occurs or when the test shows a negative result on two separate occasions. Bleeding will start at a normal time relative to the patient’s cycle, or several days after progesterone is no longer administered.


After insemination