Artificial insemination

Artificial insemination, or AI, is the process by which sperm is placed into the reproductive
tract of a female for the purpose of impregnating the female by using means other than sexual
intercourse . In humans, it is used as assisted reproductive technology, using either sperm from
the woman's male partner or sperm from a sperm donor (donor sperm) in cases where the
male partner produces no sperm or the woman has no male partner (i.e., single women
and lesbians). In cases where donor sperm is used the woman is the gestational and genetic
mother of the child produced, and the sperm donor is the genetic or biological father of the
child.

Artificial insemination is widely used for livestock breeding, especially for dairy cattle and pigs.
Techniques developed for livestock have been adapted for use in humans.

Specifically , freshly ejaculated sperm, or sperm which has been frozen and thawed, is placed in
the cervix (intracervical insemination – ICI) or, after washing, into female's uterus (intrauterine
insemination – IUI) by artificial means.

In humans, artificial insemination was originally developed as a means of helping couples to

conceive where there were 'male factor' problems of a physical or psychological nature
affecting the male partner which prevented or impeded conception. Today, the process is also
and more commonly used in the case of choice mothers, where a woman has no male partner
and the sperm is provided by a sperm donor.

Preparations
 A sperm sample will be provided by the male partner of the woman undergoing artificial
insemination, but sperm provided through sperm donation by a sperm donor may be
used if, for example, the woman's partner produces too few motile sperm, or if he
carries a genetic disorder, or if the woman has no male partner. Sperm is usually
obtained through masturbation or the use of an electrical stimulator, although a
special condom, known as a collection condom, may be used to collect the semen
during intercourse.

 The man providing the sperm is usually advised not to ejaculate for two to three days
before providing the sample in order to increase the sperm count.
  A woman's menstrual cycle is closely observed, by tracking basal body temperature
(BBT) and changes in vaginal mucus, or using ovulation kits, ultrasounds or blood tests.

 When using intrauterine insemination (IUI), the sperm must have been “washed” in a
laboratory and concentrated in Hams F10 media without L-glutamine, warmed to 37C.
The process of “washing” the sperm increases the chances of fertilization and removes
any mucus and non-motile sperm in the semen. Pre and post concentration of motile
sperm is counted.

 If sperm is provided by a sperm donor through a sperm bank, it will be frozen and
quarantined for a particular period and the donor will be tested before and after
production of the sample to ensure that he does not carry a transmissible disease.
Sperm samples donated in this way are produced through masturbation by the sperm
donor at the sperm bank. A chemical known as a cryoprotectant is added to the sperm
to aid the freezing and thawing process. Further chemicals may be added which
separate the most active sperm in the sample as well as extending or diluting the
sample so that vials for a number of inseminations are produced. For fresh shipping,
a semen extender is used.

 If sperm is provided by a private donor, either directly or through a sperm agency, it is

usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided
in this way may be given directly to the recipient woman or her partner, or it may be
transported in specially insulated containers. Some donors have their own freezing
apparatus to freeze and store their sperm. Private donor sperm is usually produced
through masturbation, but some donors use a collection condom to obtain the sperm
when having sexual intercourse with their own partners.
Procedure
 When an ovum is released, semen provided by the woman's male partner, or by
a sperm donor, is inserted into the woman's vagina or uterus. The semen may be fresh
or it may be frozen semen which has been thawed. Where donor sperm is supplied by a
sperm bank, it will always be quarantined and frozen and will need to be thawed before
use. Specially designed equipment is available for carrying out artificial inseminations.

 In the case of vaginal artificial insemination, semen is usually placed in the vagina by
way of a needleless syringe. A longer tube, known as a 'tom cat' may be attached to the
end of the syringe to facilitate deposit of the semen deeper into the vagina. The woman
is generally advised to lie still for a half hour or so after the insemination to prevent
seepage and to allow fertilization to take place.
  A more efficient method of artificial insemination is to insert semen directly into the
woman's uterus. Where this method is employed it is important that only 'washed'
semen be used and this is inserted into the uterus by means of a catheter. Sperm banks
and fertility clinics usually offer 'washed' semen for this purpose, but if partner sperm is
used it must also be 'washed' by a medical practitioner to eliminate the risk of cramping.

 Semen is occasionally inserted twice within a 'treatment cycle'. A double intrauterine

insemination has been theorized to increase pregnancy rates by decreasing the risk of
missing the fertile window during ovulation. However, a randomized trial of
insemination after ovarian hyper stimulation found no difference in live birth rate
between single and double intrauterine insemination.

 An alternative method to the use of a needless syringe or a catheter involves the placing
of partner or donor sperm in the woman's vagina by means of a specially designed
cervical cap, a conception device or conception cap. This holds the semen in place near
to the entrance to the cervix for a period of time, usually for several hours, to allow
fertilization to take place. Using this method, a woman may go about her usual activities
while the cervical cap holds the semen in the vagina. One advantage with
the conception device is that fresh, non-liquified semen may be used.

 If the procedure is successful, the woman will conceive and carry to term a baby. A
pregnancy resulting from artificial insemination will be no different from a pregnancy
achieved by sexual intercourse. However, there may be a slight increased likelihood of
multiple births if drugs are used by the woman for a 'stimulated' cycle.

Donor variations
Either sperm provided by the woman's husband or partner (artificial insemination by husband,
AIH) or sperm provided by a known or anonymous sperm donor (artificial insemination by
donor, AID or DI) can be used.

Techniques
Intrauterine insemination, Intravaginal insemination, Intracervical insemination, and Intratubal
insemination
 Intracervical insemination
ICI is the easiest way to inseminate. This involves the deposit of raw fresh or frozen semen
(which has been thawed) by injecting it high into the cervix with a needle-less syringe. This
process closely replicates the way in which fresh semen is directly deposited on to the neck of
the cervix by the penis during vaginal intercourse. When the male ejaculates, sperm deposited
this way will quickly swim into the cervix and toward the fallopian tubes where an ovum
recently released by the ovary(s) hopefully awaits fertilization. It is the simplest method of
artificial insemination and 'unwashed' or raw semen is normally used. It is probably therefore,
the most popular method and is used in most home, self and practitioner insemination
procedures.

Timing is critical as the window and opportunity for fertilization, is little more than 12 hours
from the release of the ovum. For each woman who goes through this process be it AI (artificial
insemination) or NI (natural insemination); to increase chances for success, an understanding of
her rhythm or natural cycle is very important. Home ovulation tests are now available. Doing
and understanding Basal Temperature Tests over several cycles; there is a slight dip and quick
rise at the time of ovulation. She should note the color and texture of her vaginal mucous
discharge. At the time of ovulation the protective cervical plug is released giving the vaginal
discharge a stringy texture with an egg white color. A woman may also be able check the
softness of the nose of her cervix by inserting two fingers. It should be considerably softer and
more pliable than normal.

Advanced technical (medical) procedures may be used to increase the chances of conception.

When performed at home without the presence of a professional this procedure is sometimes
referred to as intravaginal insemination or IVI.
 Intrauterine insemination
'Washed sperm', that is, spermatozoa which have been removed from most other components
of the seminal fluids, can be injected directly into a woman's uterus in a process
called intrauterine insemination (IUI). If the semen is not washed it may elicit uterine
cramping, expelling the semen and causing pain, due to content of prostaglandins.
(Prostaglandins are also the compounds responsible for causing the myometrium to contract
and expel the menses from the uterus, during menstruation.) The woman should rest on the
table for 15 minutes after an IUI to optimize the pregnancy rate.

To have optimal chances with IUI, the female should be under 30 years of age, and the man
should have a TMS of more than 5 million per ml. In practice, donor sperm will satisfy these
criteria. A promising cycle is one that offers two follicles measuring more than 16 mm,
and estrogen of more than 500 pg/mL on the day of hCG administration. A short period of
ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy
rates. However, GnRH agonist administration at the time of implantation does not improve
pregnancy outcome in intrauterine insemination cycles according to a randomized controlled
trial.

It can be used in conjunction with ovarian hyperstimulation. Still, advanced maternal

age causes decreased success rates; Women aged 38–39 years appear to have reasonable
success during the first two cycles of ovarian hyperstimulation and IUI. However, for women
aged ≥40 years, there appears to be no benefit after a single cycle of COH/IUI. It is therefore
recommended to consider in vitro fertilization after one failed COH/IUI cycle for women aged
≥40 years.
 Intrauterine tuboperitoneal insemination
Intrauterine tuboperitoneal insemination (IUTPI) is insemination where both the uterus
and fallopian tubes are filled with insemination fluid. The cervix is clamped to prevent leakage
to the vagina, best achieved with the specially designed Double Nut Bivalve (DNB) speculum.
The sperm is mixed to create a volume of 10 ml, sufficient enough to fill the uterine cavity, pass
through the interstitial part of the tubes and the ampulla, finally reaching the peritoneal
cavity and the Pouch of Douglas where it would be mixed with the peritoneal and follicular
fluid. IUTPI can be useful in unexplained infertility, mild or moderate male infertility, and mild
or moderate endometriosis.[9]
 Intratubal insemination
IUI can furthermore be combined with intratubal insemination (ITI), into the Fallopian
tube although this procedure is no longer generally regarded as having any beneficial effect
compared with IUI. ITI however, should not be confused with gamete intrafallopian transfer,
where both eggs and sperm are mixed outside the woman's body and then immediately
inserted into the Fallopian tube where fertilization takes place.

Artificial insemination is a term that covers a range of techniques of placing sperm into the
female genital tract. Such inseminations may include intravaginal insemination, intracervical
insemination, intrauterine insemination, intraFallopian insemination and intraperitoneal
insemination, where sperm are placed inside the pelvis near the mouth of the Fallopian tubes
and ovaries).

The most commonly used techniques are intrauterine insemination followed by intracervical
and intravaginal insemination.

Artificial insemination may use the husbands sperm (AIH) or donor sperm (AID).
 Who might benefit from insemination?

There are selected groups of patients to whom sperm donation is recommended.

 Men who are unable to ejaculate inside their wife’s vagina for whatever reasons. This is the
classical indication. Causes for ejaculation failure include diabetes, multiple sclerosis, spinal
cord injury and retrograde ejaculation, where sperm are released backward into the bladder
instead of urethra. Retrograde ejaculation may be due to diabetes, trauma or operation in the
bladder neck or a side effect of certain drugs.
 Men with mildly low sperm count, poor quality sperm or antisperm antibodies.
 Men who wish to freeze their sperm for possible future use
before vasectomy, chemotherapy orradiotherapy for cancer.
 Women with mild endometriosis.
 Women with cervical mucus hostility or poor cervical mucus.
 Couples with unexplained infertility.
 Some infertility clinics may offer intrauterine insemination of a HIV negative woman with
washed and prepared sperm of her HIV positive husband/partner.
Evaluation of couples seeking insemination treatment

The doctor will review in depth the medical history, perform physical and internal examination.
The husband or male partner will be asked to produce a semen sample for semen
analysis and MAR test to check for the presence or absence of antisperm antibodies.
Some infertility clinics will only accept couple for treatment if both partners have negative
screen for HIV (AIDS) Hepatitis B and Hepatitis C. The female partner may also be tested for
immunity to German Measles (rubella).
Intravaginal insemination

This is very rarely performed, but still has a place for couples in whom the female’s partner
ovulates regularly. The male partner is unable to ejaculate into his wife’s vagina but can
ejaculate by other means such as by masturbation or by using a penile vibrator and the sperm
count and quality are good.

Timing of intravaginal insemination

The precise timing of insemination is important. Inseminations should be timed to occur around
ovulation. Ovulation predictors such as 'clear plan' to predict urine LH surge are more accurate
than measurement of basal body temperature or evaluating your cervical mucus. Insemination
is performed about 24 hours after the surge.

The intravaginal insemination procedure

The male partner collects his semen into a sterile pot and then withdraws the whole specimen
into a sterile syringe. Thereafter, the female partner or wife places the semen into her vagina
using the syringe 'self insemination'. Care should be taken not to inject air into the vagina. The
biggest advantages of this procedure are convenience and privacy of being performed at home
and it only cost the price of a 'clear plan', a sterile pot and a syringe.

Process of Artificial Insemination

The process of artificial insemination involves preparing and placing sperms directly into the
cervical canal or the reproductive tract of the female and does not involve sexual intercourse.
Artificial insemination is useful in treating infertility caused due to a low sperm count, problems
in the cervical mucus or sperms that are not active. You will need to consult a gynecologist to
determine if artificial insemination is the right procedure to treat your infertility problems.
Once it is determined that you can go ahead with the procedure, certain medical tests would be
conducted for the couple as a part of the preparation for the artificial insemination process. It
would be advisable to determine the artificial insemination cost and the time schedule required
prior to the commencement of the procedure. Read more on human artificial insemination.
How does Artificial Insemination Work?

There are several artificial insemination steps involved in this fertility treatment procedure.
Once all the tests have been conducted, the doctor will be able to recommend which artificial
insemination method should be opted for. There are three different methods of artificial
insemination, the intrauterine insemination (IUI), the intracervical insemination (ICI) and the
intratubal insemination. Of these, the IUI and the ICI are the most common methods of artificial
insemination, which are easy and safe as well. The intratubal insemination method is
comparatively rare due to its low success rates. The following will brief you about the artificial
insemination steps.

Step# 1: Based on the medical reports, the doctor may or may not advice the female partner to
take fertility medication that stimulates production and maturation of eggs. This fertility
medication needs to be taken just before the commencement of the menstrual cycle.

Step# 2: The woman's ovulation cycle is determined, using body basal temperature and
ultrasound and, the hormone levels are closely monitored.

Step# 3: A sperm sample is obtained from the male partner, which is 'washed' and
concentrated. This needs to be done so that the mucus and non-motile sperms are removed
which will increase the possibility of fertilization.

Step# 4: At the beginning of ovulation, the sperm is inserted into the woman's reproductive
tract, using a catheter in the IUI method or a needle less syringe in the ICI method. Both these
methods are painless, but the ICI is a quicker method. If the egg is fertilized, that is,
if pregnancy occurs, it can be detected 2 weeks later.

The number of artificial insemination cycles that you would need to undergo would depend
upon the cause and extent of the infertility problem. Consuming fertility medication during the
artificial insemination process will increase your chances of getting pregnant. In case of failure
of this process, the stimulated artificial insemination process can be opted for.