Artificial Insemination (AI)
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Artificial Insemination (AI) is the collective name given to a range of relatively simple procedures which increase the chances of conception. Essentially, sperm from a male partner or sperm donor, is deposited into a part of the female genital (reproductive) tract around the time of ovulation for conception to occur naturally. Therefore, this is not classed as Assisted Reproduction Technology (ART) since conception occurs naturally inside the female and not in a laboratory.
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Description of Artificial Insemination (AI)
Artificial insemination (AI) refers to a range of methods which involve sperm being placed into the female. The range of methods differ from each other only in the location chosen for sperm deposition. The options available are;
* Intrauterine Insemination (IUI) which places sperm into the uterus (womb),
* Intracervical Insemination which places the sperm into the neck of the womb (the cervix),
* Intrafallopian Insemination which places sperm into the fallopian tubes,
* Intraperitoneal Insemination which places sperm near the opening of the fallopian tubes next to the ovary,
* Intravaginal Insemination which places sperm into the vagina.
The above methods assume that the male partner's own sperm will be used in the artificial insemination process. In some instances, this is not possible and other sources of sperm are then required. This is called Donor Insemination (DI) where sperm is collected from a donor and used for AI in exactly the same ways as outline above.
The commonest AI technique is IUI followed by intracervical. The others are rarely used nowadays.
When is Artificial Insemination (AI) Used ?
The various AI techniques can be used when;
* the male suffers from premature ejaculation. Sperm are therefore not deposited into the vagina naturally.
* the male suffers from retrograde ejaculation. Sperm flow backwards into the bladder instead of into and through the penis.
* subfertility is caused by a low sperm count (oligospermia).
* the male suffers from an abnormality of the penis such as hypospadia. In this condition, sperm exit from the base of the penis rather than from the tip.
* the male suffers from penile trauma such that sexual intercourse is either compromised or is not possible.
* the male has undergone cancer therapy such as chemotherapy or radiotherapy. Frozen sperm may then be used.
* there is an incompatibility between the male sperm and the female cervical mucus causing the sperm to die as they try to pass through the cervix. This may be caused by sperm antibodies or if the mucus is too thick or sticky or if there is not enough mucus.
* the female suffers from endometriosis. The pelvic organs may become inflamed and passage of the sperm at any stage through the genital tract may be obstructed by scar tissue.
* the female has anatomical abnormalities of her vagina, cervix, uterus or fallopian tubes such that sperm cannot pass through these organs to fertilise the egg.
AI then allows sperm to bypass these obstructions and get close enough to the egg for fertilisation to occur naturally. However, for conception to occur, sperm must be present when an egg is also likely to be present. Ovulation must therefore also occur at approximately the same time as insemination. Ovulation may occur naturally in women who have regular ovulatory menstrual cycles or can be induced using fertility drugs (please read Drugs Used in Infertility Treatment) in a stimulated cycle for women who either cannot ovulate naturally or have irregular and unpredictable ovulation.
How is AI Performed?
All methods of AI should be performed as close to ovulation as possible. The exact method of carrying out AI depends on which type of AI is chosen. The three most frequent types are discussed below.
1. Intracervical Insemination
The male will usually be asked to abstain from sex (including masturbation) for 3 days before the procedure in order to increase the number of sperm in the sample. Semen is then obtained by masturbation. This must be done near or at the clinic in order to obtain a fresh sample.
Insemination then occurs as the female is asked to lie down and semen is injected into the cervical opening at the top end of the vagina. Sometimes, a plastic cap is inserted into the vagina after insemination to prevent backward seepage of the injected semen. This can be removed after approximately six hours.
2. Intrauterine Insemination (IUI)
This type of AI has a higher success rate than others and is therefore the most frequently used approach. As before, a fresh sample of semen is collected at or near the clinic. But for IUI, the sperm must be washed in a laboratory before insemination can take place. This is done within one hour of ejaculation. Sperm washing is a specialised technique which separates the semen into its 2 constituent parts, plasma and sperm. The plasma is removed so that only sperm are used in the insemination process. Non-separated semen can cause severe uterine pain, cramps and even fainting in women.
Once washing is complete and the best sperm are left, a catheter is introduced through the vagina, on through the cervix and into the uterus. Sperm are then injected through this catheter and deposited high up in the uterus as close to the fallopian tubes as possible.
3. Donor Insemination (DI)
Donor Insemination is usually carried out in exactly the same way as described above for IUI. However, as the sperm are from a donor, some extra precautions are necessary. The most important of these is to make sure that the sample of sperm is free from infections such as hepatitis and HIV. It therefore undergoes various screening tests. HIV screening involves freezing the donated sperm and keeping it under quarantine for 6 months.
Many clinics will keep a record of some useful characteristics of the donor. This includes, hair and eye colour, build and height. These traits are then matched to the male in the couple.
DI is usually necessary if;
* the male partner produces no sperm himself,
* the male partner produces poor quality sperm,
* the male partner has a low sperm count,
* there is an unacceptable risk of inherited disease from the male partner,
* there is no male partner; such as in a single woman or in a lesbian couple.
Most types of AI are relatively simple and straight forward. The actual process of insemination takes only a few minutes once the sperm are prepared. It is also a relatively pain free procedure though some mild cramps may sometimes be felt. Occasionally, women may experience some light vaginal spotting of blood.
What are the Success Rates for AI?
Each cycle of AI has a success rate of between 5-30%. Therefore, in most case, approximately 3 attempts are required before pregnancy occurs although up to 6 attempts may be tried. These attempts may involve stimulated or non-stimulated cycles. However, certain factors increase the chances of success. These include;
* AI in women aged under 35 years,
* using sperm of good quality,
* having an adequate number of sperm, usually more than 5 million,
* women having regular ovulation,
* a lack of conditions such as endometriosis in the woman,
* having patent (non-obstructed) fallopian tubes which are free from damage.
What are the Risks of AI?
1. Infection: although sperm washing removes the majority of infections from sperm used in IUI, the sperm cannot be completely sterilised. In addition, the process of introducing the catheter into the uterus may also introduce infections into the womb, even though this procedure is done under sterile conditions. Infection in the uterus can lead to a condition called endometritis. This is rare. Symptoms may include lower abdominal or pelvic pain, vaginal discharge, vaginal bleeding and fever. Treatment usually involves oral or intravenous antibiotics depending on the severity of the infection.
2. Multiple pregnancies: if hormonal drugs are used to stimulate ovulation, multiple eggs may develop and become fertilised. The chances of having a multiple pregnancy and multiple births therefore increases. Donor insemination tends always to be accompanied by these stimulated cycles. Multiple pregnancies have a greater chance of complications through pregnancy including low birth weight, premature delivery and disability. The chances of the babies being delivered by Caesarian Section are also increased when compared with single pregnancies. Furthermore, the risk of neonatal death is also greater (death of the baby within 28 days of birth).
3. Side Effects of Hormonal Drugs: these are discussed in detail in the page entitled "Drugs Used in Infertility Treatment". But common symptoms include; hot flushes, headaches, abdominal pain and mood swings.
4. Ovarian Hyper-Stimulation Syndrome (OHSS): this is discussed in detail in the page entitled "Drugs Used in Infertility Treatment".
If AI is unsuccessful, couples will need to consider other methods such as IVF. For further details please read the relevant pages.
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