How to fertilize a woman. Artificial insemination of a woman - preparation and procedure
Many couples faced with the problem of conception are looking for ways to become parents, in which case the question often arises of which method to choose.
Despite the fact that there are many methods in modern medicine, it is important to start with less radical procedures.
Note!
To achieve the greatest chance of conception, it is important to know your ovulation date. Its occurrence can be determined in different ways, for example, by maintaining a schedule, tests, etc.
Before taking action, many women do not go to the doctor, but start asking questions in an Internet search engine, for example, how insemination is done at home; reviews from experienced people help gain confidence before the procedure.
However, it is worth consulting with your doctor to have an accurate idea of what you can and cannot do during insemination.
What is needed for the procedure
Before starting the manipulations, it is necessary to prepare a sterile container for collecting sperm, a disposable syringe without a needle with a volume of 10 ml, and, if necessary, purchase a disposable sterile vaginal dilator.
The spouse or partner should collect the sperm in a pre-prepared container. You can’t use it right away, you need to wait until it becomes a little thinner.
This takes approximately 10-20 minutes. During this time, the container can be wrapped in a towel to keep it warm, avoiding too high temperatures and shaking.
You can store sperm in this way for no more than two hours.
Step-by-step instruction
It is worth understanding that it will be impossible for a person without special education to introduce sperm into the uterine cavity without damaging it.
Therefore, artificial insemination at home is only possible if the syringe is inserted into the vagina as deeply as possible without damaging the cervix.
Pressing the syringe plunger must be done carefully, without damaging the sperm.
If a vaginal dilator was used or it is also called a speculum, the procedure will be slightly different. For ease of administration, it is permissible to use a lubricant without a spermicidal lubricant.
The dilator is inserted with a downward slope, at an angle of 45°. The legs of the mirror should be spread 2-3 cm so that the cervix becomes visible. Using a lock, the expander is secured in this position for further actions.
Note!
Do not spread the legs of the dilator too wide so as not to injure the surface of the vagina.
The pressure on the piston should be applied smoothly. The contents of the syringe should not get into the cervical area, but only at its base, as this can lead to injury. After the manipulation, it is necessary to smoothly loosen the dilator and close it, only then remove it from the vagina.
Probability of success after home insemination
Both with natural fertilization and with insemination, no one can give a 100% guarantee that everything will work out the first time.
According to statistics, if artificial insemination of a woman is carried out at home, the chances of success are no more than 20%.
It may take not one, but two or three attempts. If a woman experiences the growth of several eggs, it is best to carry out several similar procedures during one cycle, this will increase the chances of successful conception.
As a rule, when infertility is diagnosed with unknown causes, it is recommended to first resort to a procedure such as artificial insemination without stimulation.
That is, when eggs are produced by the body independently, without the need to take hormonal drugs (for example, duphaston or).
In this case, it will be possible to carry out a similar procedure for no more than six months in a row. If pregnancy does not occur, you will have to resort to the method.
Conclusion
As can be seen from the article, the procedure itself is not very complicated and can be done at home. The percentage of success depends not only on the physical, but also on the psychological state of the couple.
You can combine the procedure with sexual intercourse, since there is a possibility that when a woman has an orgasm, there is a greater chance of successful fertilization.
However, you should not be upset if the attempt was unsuccessful the first time; it is important to have a positive attitude and conserve your strength so that the body is healthy and strong before pregnancy.
Video: Artificial insemination. Pros and cons
Is artificial insemination a real chance for infertile couples to find parental happiness or an unnatural procedure, the chances of success of which are negligible?
Motherhood is the greatest happiness and joy for a woman, her calling and the most natural state. When, for some objective reason, a woman cannot become a mother, then artificial insemination comes to the rescue. What is it, what methods of artificial insemination exist, what are the features of the procedure, as well as other issues that concern women will be discussed in this article.
The importance of artificial insemination
Artificial insemination is a modern method of solving the problem of infertility, when conceiving a child cannot occur naturally. The artificial insemination procedure can be performed for a number of reasons, in which both one or both partners are infertile.
The main indications for artificial insemination are:
- polycystic ovary syndrome
- endometriosis
- low quality of the partner’s sperm, which can manifest itself in low sperm motility, low concentration and a large number of pathological units
- hormonal infertility
- tubal infertility
- infertility, the causes of which are not established
Thanks to progress in medicine, hundreds of thousands of infertile couples can finally experience the joy of motherhood and fatherhood, because artificial insemination makes it possible to have children with forms of infertility that in the past put an end to reproductive function.
Video: In vitro conception
Artificial insemination methods
When it comes to artificial insemination, many people think about the common and popular IVF procedure. In fact, there are several methods of artificially solving the problem of infertility:
- ISM is a method in which the sperm of her husband is transferred into a woman’s uterus. This technique is used in cases where a woman’s reproductive functions are not impaired and she cannot become a mother due to the low quality of her husband’s sperm, or when the mucus in a woman’s vagina is an aggressive environment for the existence of sperm and they die before reaching the egg.
- ISD - if the husband’s sperm is unsuitable for conception or he is completely infertile, then the spouses are offered the method of artificial insemination with donor sperm. The procedure itself for this method is practically no different from the previous one: the woman is also injected with sperm into the uterus, but the sperm donor is not her husband
- GIFT - when the cause of infertility lies in the fact that a woman’s egg does not exit into the fallopian tube for fertilization, then the method of intratubal transfer of gametes is effective. It consists of transferring an egg previously taken from a woman into the fallopian tube, artificially connected with male sperm. Male reproductive cells can belong to both the spouse and the donor
- ZIFT is a method in which a fertilized egg is introduced into the uterus prepared by hormones. First, a healthy egg suitable for conception is taken from a woman by puncture of the ovary and fertilized outside the female body with sperm. The embryo is then inserted through the cervix
- ICSI is an effective artificial insemination method that involves fertilizing an egg with a sperm using a very thin needle. Through a puncture of the testicles, the most active sperm is removed and implanted into the egg
- IVF is the most common type of artificial fertilization of an egg outside the woman’s body, after which the embryo is implanted into the uterus
IVF method of fertilization
In vitro fertilization is a modern reproductive technology that is most often used not only in our country, but throughout the world. What explains such popularity of the method? Firstly, this technique gives the best results; secondly, with the help of IVF it is possible to achieve pregnancy even in very difficult cases of infertility, when both partners have serious problems with reproductive function.
Artificial insemination procedure
IVF requires multiple eggs. But since only one egg can be formed in a woman’s body during one cycle, the amount of egg production is stimulated by hormones.
When an ultrasound determines that the ovary is enlarged and eggs have formed in it, they are removed. After this, the oocytes are washed from the follicular fluid and placed in an incubator, where the eggs are kept until artificial insemination.
If it is not possible to obtain eggs from a woman, then donor eggs are used.
On the same day, sperm are collected, which are obtained by masturbation or interrupted sexual intercourse. Spermatozoa are isolated from the resulting sperm and the most active ones are selected. After this, the required number of active sperm is added to the test tube with eggs, at the rate of 100-200 thousand per egg. It is also possible to use donor sperm.
Within 2-3 hours, the sperm fertilizes the egg. Next, the resulting embryo is placed in a favorable environment, where it remains for 2 to 6 days. All this time, the necessary vitamins, physiological ions, substrates and amino acids are introduced into the test tube. After this, the embryos are directly transferred into the uterus, which is carried out in a matter of minutes on a gynecological chair.
If a woman cannot carry a pregnancy herself, then they resort to surrogacy.
Video: In vitro fertilization. Komarovsky
In vitro fertilization pros and cons
Despite the fact that IVF opens up the opportunity for people suffering from infertility to have children, this procedure can also have negative consequences, which sometimes become disastrous:
- hormonal imbalance
- ovarian hyperstimulation
- fetal malformations
- multiple pregnancy, in which it is necessary to kill “extra” embryos for the survival of at least one or two
In addition, the IVF procedure is an expensive undertaking that not everyone can afford, and sometimes childless couples have to give up any hopes of becoming parents, since the amount is simply unaffordable for them.
On the other hand, in society there is a prejudiced attitude towards the procedure of artificial insemination - “test tube children” are mistakenly mistaken for inferior and developmentally delayed.
Today, the IVF procedure is being improved in many ways. New technologies are used, the exact dosage of hormones is established, which ensures the necessary processes and at the same time causes the least harm to the woman’s body.
It is also important that it is extremely rare that a large number of embryos are placed into the uterine cavity, usually only two, which prevents the need to eliminate an extra embryo. And the joy of motherhood itself exceeds all possible risks and undesirable consequences that the IVF procedure can cause.
How much does artificial insemination cost?
The price of the issue depends on the method of artificial insemination. It may vary in different clinics, but on average the price list looks like this:
- IGO from 28 to 40 thousand rubles
- IVF from 40 to 100 thousand rubles
- ICSI from 100 to 150 thousand rubles
Other methods of artificial insemination are not common in Russia due to lower efficiency.
Artificial insemination of single women
For women who do not have a partner to conceive a child, but desperately want to have a child, the procedure of artificial insemination will help. During this procedure, active donor sperm are placed into the woman's uterus, after which the egg is fertilized.
Immediately before the procedure, the woman undergoes examinations and tests, and, if necessary, hormonal stimulation is performed.
Artificial insemination at home
The artificial insemination procedure can also be performed at home. Its essence lies in the fact that a dose of sperm obtained during ejaculation is injected into the woman’s uterus using a syringe and catheter. Thanks to this manipulation, the chance of fertilization increases significantly, because all the sperm are sent to the egg, whereas during natural fertilization, part of the seed is poured out and neutralized by the vaginal mucus, without even entering the uterus.
To carry out artificial insemination at home, you need sterile:
- syringe
- catheter
- gynecological speculum
- pipette
- disinfectant
- tampons
- towel
- gynecological gloves
It is important to carry out the procedure during ovulation, which can be determined using a special test.
The problem of artificial insemination
Detailed instructions on how artificial insemination is carried out at home can be obtained from a gynecologist, but it is important to understand that carrying out such an important process at home may carry the risk of introducing various infections into the uterine cavity, due to the possible unsterility of the devices used.
Artificial insemination: reviews
Having analyzed the reviews of women who decided to undergo artificial insemination, several key aspects of the procedure can be identified:
- pregnancy does not always occur. There are couples who decided to undergo IVF five or six times in a row, but never achieved their desired goal.
- Many infertile women are concerned about the moral aspect, because the problem of artificial insemination still causes discussions in various circles, especially from the church, which considers such events unnatural, and condemns families who do not have children, since they must bear their cross and not go against the will of God
- artificial insemination is a colossal burden on a woman’s body, both morally and physically
- Despite the problems faced by married couples who still decide to undergo artificial insemination, the positive result and joy of having a child exceeds all the risks and negative aspects, and many are stopped only by the cost of the procedure from having a child artificially again.
Video: Types of artificial insemination
Artificial insemination- this is a real miracle for those couples who cannot conceive a child themselves.
If many years of unsuccessful attempts lead to zero results, then the spouses experience despair. In this case, artificial insemination becomes the only option.
The achievements of modern medicine make it possible to make dreams of children come true. These days, no one is surprised to hear about IVF.
What do you need to know?
If you want to use artificial insemination, then you need to familiarize yourself with its basic principles. Reviews from people who have gone through this procedure are always a good help.
According to statistics, Most infertile couples prefer artificial insemination. This procedure has an affordable cost. It is done in many Russian clinics.
average price for artificial insemination (artificial insemination) fluctuates around 15,000 rubles.
The advantage of this procedure- it does not require a break from your usual life. That is, immediately after the session the woman can begin her work.
Reviews about this procedure, usually positive. Here we must understand that success depends not only on the skills of doctors. The health status of the spouses is the most important factor, which determines the outcome of the session.
Concerning in vitro fertilization, then sometimes such a procedure is the only way out. Judging by the reviews, women who have gone through IVF recommend choosing a clinic carefully.
It is important to determine what medical equipment the center is equipped with. It is equally important to find out the level of qualifications of embryologists.
If the embryology of the clinic is at a low level, then the procedures may fail. In this case, treatment turns into a banal pumping of money out of an infertile couple.
But IVF performed by professionals works wonders. There are excellent specialists in Russia who have helped many people become happy parents. Therefore, choose a medical center need recommendations, and not by the cost of services.
Methods and types of artificial insemination
Under artificial insemination understand a whole range of special methods for treating infertility.
This includes in vitro fertilization with transplantation of fragmented embryos into the uterus and fertilization by artificial insemination.
What is artificial insemination?
This method is also called insemination. In this option, sperm is injected into the lumen of the fallopian tubes or into the uterine cavity.
Artificial insemination is used in the following cases:
- for certain diseases of men (impotence, hypospadias, lack of ejaculation, etc.);
- anatomical changes in the cervix;
- vaginismus that cannot be treated;
- if antisperm antibodies are detected in a woman’s cervical mucus.
Before the procedure specialists examine the man's sperm. They find out the cause of infertility.
Insemination is carried out 2-3 times during one cycle. The procedure is repeated for at least 3 cycles.
If the examination revealed that the husband’s sperm has pathological changes (a decrease in the number of sperm or no sperm at all), then we are talking about the donor’s sperm.
Sometimes the reason for using donor sperm becomes, which cannot be treated, as well as genetic diseases in the husband’s closest relatives.
Thus, the man’s seed is introduced into the female reproductive tract, bypassing barriers that are harmful to it. The procedure mechanism here is as follows: sperm are placed in the genital tract or uterine cavity.
Further one of them fertilizes a mature egg (artificial insemination). After this, it is implanted into the wall of the uterus, and the embryo continues to develop. With such fertilization there is no problem of “extra” embryos.
The positive result of the procedure largely depends on the diseases that the couple has. Sometimes a woman may miss her period even though she is not pregnant. Therefore, you can definitely find out about conception only with the help.
If ovarian stimulation is not performed, then insemination can be performed several times.
Usually, after insemination with donor sperm, pregnancy occurs in 80% of cases. Women who have undergone artificial insemination are under the supervision of a specialist from the antenatal clinic.
Typically, pregnancy and childbirth proceed without complications. Anomalies of fetal development in such cases do not occur more often than in other pregnant women.
What is in vitro fertilization (IVF)?
This method involves fertilization performed outside the body. Simply put, it is performed in laboratory conditions (in vitro).
The first test tube baby was born back in 1978. Today, in vitro fertilization is the most important method of treating infertility.
Every year there are born in the world more than 200 thousand children conceived through IVF.
This procedure is used in the following cases:
- if a woman is infertile due to removed fallopian tubes;
- with obstruction and low patency of the fallopian tubes;
- in the absence of effect from long-term conservative treatment (more than 5 years);
- surgical treatment did not bring positive results;
- cases of unexplained infertility.
To carry out IVF, the uterus must fully retain its functions. That is, it is important that there are conditions for implantation of the embryo and for bearing the fetus.
Besides, the patient should have no contraindications for pregnancy and childbirth(here we mean chronic diseases of women).
The ovaries must also retain the ability to respond to stimulation of the ovulation process. An important aspect is the absence of neoplasms, inflammation and anatomical changes in the reproductive organs. Women over 40 years old IVF is contraindicated.
The procedure (process) of artificial insemination includes next steps:
- obtaining eggs from the patient;
- fertilization of eggs with the spouse's sperm;
- observation of developing embryos in the laboratory;
- transfer of embryos into the uterine cavity.
You can take a hormone test or buy one.
If you want to carry out insemination on your own, then Please note that sperm remains active for no more than 2 hours. It cannot be properly frozen and stored at home.
That is, it will not be possible to completely imitate the conditions of a clinic. Therefore, sperm should be used immediately after ejaculation.
The procedure is carried out using a syringe without a needle. To collect sperm you will need a sterile and dry container. You can use a vaginal dilator.
After receiving sperm from the donor, wait for it to liquefy (no more than 20 minutes). After that sperm is drawn into a syringe and inject it into the vagina.
Wherein is strictly prohibited inject sperm into the uterine cavity. Independent manipulations should not affect the sterile cavity. This can lead to infection or injury.
If home insemination is successful, the result will be pregnancy.
Despite the fact that artificial insemination does not always result in conception, don't despair. Persistent attempts, patience and professional approach of specialists are important factors for success.
The reward for your work will be a long-awaited baby.
ECO. School of Doctor Komarovsky.
Content
The statistics are disappointing - every year the number of infertile couples only increases, and how many of them want children! Thanks to the latest technologies and progressive treatment methods, babies are born, even though it would seem that this is impossible. Artificial insemination is a procedure that allows a woman diagnosed with infertility to become a mother using donor sperm. What is the essence of the technology, to whom it is contraindicated and how great are the chances of having a child - more on this later.
What is artificial insemination
As one of the methods of artificial insemination, insemination helps parents find their long-awaited child. The procedure significantly increases the likelihood of conception, since it is preceded by a careful selection of material for the operation. Among the sperm, the most active ones are selected, and the weak ones are removed. The protein components of the ejaculate are removed because they can be perceived by the female body as foreign.
Intrauterine insemination is not a panacea for infertility, but only one way to get pregnant artificially. According to research, the positive effect is estimated at a maximum of 30–40 percent. A single session does not guarantee the development of pregnancy, so the operation is performed up to 3 times per monthly cycle. If conception does not occur after several procedures, it is recommended to turn to other methods of artificial insemination. Pregnancy itself with intrauterine insemination is no different from normal.
Why is artificial insemination possible?
It would seem why women cannot get pregnant, but with the artificial introduction of ejaculate, fertilization occurs. One of the features lies in the female body. The fact is that cervical mucus produces antibodies to male sperm. It turns out that it simply kills sperm, and does not facilitate their penetration into the egg. The procedure helps deliver the treated material directly to the uterus, bypassing the cervical canal. In this way, even with low sperm motility, the chance of getting pregnant increases.
Indications
As can be seen from the above, the main indication for artificial intrauterine insemination is the immunological incompatibility of partners. In fact, there are many more individual reasons for resorting to the procedure, so it is worth considering them in more detail. The main problems in women are considered to be inflammatory processes in the cervical canal. The disease prevents sperm from passing into the uterus, preventing a woman from becoming pregnant.
Artificial insemination is used for vaginismus, a problem where sexual intercourse is not possible due to spasms and pain. Injuries and pathologies of the reproductive organ that interfere with getting pregnant, abnormalities in the position of the uterus, infertility of an unclear socket, surgical interventions on the cervix are another of the many reasons to contact the clinic for an insemination procedure.
Until recently, the cause of female infertility was sought only among the weaker sex, but, as studies have shown, male problems are often dominant in this issue. Low motility and a small number of sperm that find it difficult to reach the end point, and azoospermia are some of the main diseases due to which artificial insemination is prescribed if previous treatment does not produce any results. Disorders with potency and ejaculation can also be an indication for the procedure.
Genetic diseases, due to which there is a possible risk of having a sick child or with psychophysical characteristics of the baby, are another reason why artificial insemination is prescribed. True, then the procedure is carried out with the donor’s sperm, to which the husband (and the future official father) gives written consent. Fertilization with seminal fluid from the clinic’s database is also carried out for single women who want to become pregnant.
Advantages
Intrauterine insemination is the first method that is used for problems with conception. The main advantage is the absence of great harm to the female body. Artificial insemination can be carried out even if the exact cause of infertility has not been established. The procedure does not require lengthy preparation, and its implementation does not take much time. The most important advantage of using this method is its low cost.
Preparation
Like any operation, and intrauterine insemination by medical means is such, the procedure requires preparation. Just the desire to do artificial insemination is not enough; you need to come to an appointment with a doctor, who will prescribe an action plan after drawing up a family history and a thorough analysis of the situation during a conversation. Then it is necessary to sign certain papers confirming the consent of the spouses to carry out the conception. If it is necessary to use donor sperm, the number of documents for approval increases significantly.
Tests before insemination
Previously, to determine whether the couple is prepared for the artificial insemination procedure, the following tests are taken from the couple:
- HIV AIDS);
- stick infections;
- hepatitis;
- passive hemagglutination reaction (RPHA).
After a 3-5 day period of abstinence, the man takes a spermogram, which determines sperm motility. In women, the patency of the fallopian tubes will be checked, and the uterus will be examined using hysterosalpingography. Ultrasound detects the presence of ovulation. If there are problems, hormones are used to stimulate egg production. The microflora is cultured to determine the presence of papillomavirus, ureplasma, group B streptococcus, which can cause the impossibility of bearing a fetus.
Sperm preparation
Immediately before the insemination procedure, seminal fluid is given artificially, after which it is examined and processed. There are 2 ways to prepare cells: centrifuge processing and flotation. The first option is preferable, since this increases the chances of conception. Sperm preparation involves removing acrosin from it, a substance that inhibits sperm motility. To do this, portions are poured into cups and left to liquefy, and after 2-3 hours they are activated with special preparations or passed through a centrifuge.
On what day is insemination done?
According to doctors specializing in these gynecological issues, the best option for artificial insemination is to inject sperm into the uterus three times:
- 1-2 days before ovulation;
- On the day of ovulation;
- After 1-2 days, if there are several maturing follicles.
How does the procedure work?
Artificial insemination can be carried out independently or directly with the participation of a specialist in the clinic. To do this, the woman is placed on a gynecological chair, and access to the cervix is opened with the help of a mirror. The doctor inserts a catheter, and biological material is drawn into a syringe connected to it. Then there is a gradual introduction of sperm into the uterine cavity. After insemination, the woman should remain motionless for about 30-40 minutes.
Insemination with donor sperm
If serious diseases are detected in a woman's partner, such as hepatitis, HIV and other potentially dangerous diseases, including genetic ones, then donor sperm is used, which is stored frozen at a temperature of -197°C. Information about a person is not declassified, but the wife can always bring with her a person who has the right to donate seminal fluid for subsequent artificial insemination of the patient.
Husband's sperm
When using biological material from a spouse, sperm collection occurs on the day of the insemination procedure. To do this, the spouses come to the clinic, where biological material is donated. After this, the semen is analyzed and prepared for use. It is important to understand that before donating sperm, a man must abstain from sexual intercourse for at least 3 days in order to improve the quality of sperm.
Artificial insemination at home
Artificial insemination at home is allowed, although according to doctors its effectiveness is considered minimal, however, judging by the reviews, successful attempts have been recorded. At the pharmacy you can buy a special kit for performing manipulations at home. The algorithm differs from that carried out in the clinic in that the sperm is injected into the vagina, and not into the uterus. When performing insemination on your own, you cannot reuse the kit; you must not lubricate your labia with saliva or cream, or inject sperm directly into the cervix.
Efficiency of the method
A positive result with the intrauterine artificial insemination procedure is achieved less frequently than with in vitro fertilization (IVF) and ranges from 3 to 49% (these are the most positive data). In practice, the number of attempts is limited to 3–4, since more trials are considered ineffective. After this, it is necessary to conduct additional research or treatment adjustments. If pregnancy does not occur, you should resort to another method of artificial conception or change the sperm donor.
Risks and possible complications
As such, intrauterine insemination does not cause complications; women are more at risk due to taking medications that cause ovulation, so it is necessary to conduct tests for the possibility of allergies. In addition, the risk of having twins, or less often triplets, increases, due to the fact that several attempts are made to introduce sperm and stimulate the formation of more than one follicle.
Contraindications
Although artificial intrauterine insemination is a simple procedure with virtually no consequences, there are still some restrictions due to which it may be refused. Among them are problems with ovulation itself, which occurs with disturbances, tubal infertility (it is necessary for at least one intrauterine device to be functional), inflammation of the appendages and uterus, hormonal imbalances, infectious and viral diseases.
Price
It is impossible to say definitely how much artificial insemination costs, since prices will differ in each clinic in Moscow. It is important to understand that the procedure consists of several stages, including consultation, tests, and treatment. It is necessary to take into account the price of the medications that you will have to take. If donor sperm is used, then its cost should be added to the price. Today, according to the information provided on the Internet, the following figures can be cited:
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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.
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Artificial intrauterine insemination with husband's or donor's sperm - indications, preparation for surgery and price
(Insemination Artificial) is a combination of several methods, the essence of which boils down to the introduction of a male seed or a 3-5-day embryo into the female genital tract during medical procedures. Artificial insemination is performed to achieve pregnancy in women who cannot conceive naturally for various reasons.
In principle, methods of artificial insemination come down to various methods and options for fertilizing an egg outside a woman’s body (in vitro in the laboratory) with subsequent implantation of the finished embryo into the uterus for the purpose of its engraftment and, accordingly, the further development of pregnancy.
During artificial insemination, germ cells are first removed from men (sperm) and women (eggs), followed by their artificial union in the laboratory. After the eggs and sperm are combined in one test tube, fertilized zygotes, that is, embryos of the future person, are selected. Then such an embryo is implanted into the woman’s uterus and the hope is that it will be able to attach to the wall of the uterus, resulting in the desired pregnancy.
Artificial insemination - the essence and brief description of the manipulation
For an accurate and clear understanding of the term “artificial insemination,” it is necessary to know the meaning of both words of this phrase. Thus, fertilization means the fusion of an egg and a sperm to form a zygote, which, when attached to the wall of the uterus, becomes a fertilized egg from which the fetus develops. And the word “artificial” implies that the process of fusion of an egg and a sperm does not occur naturally (as provided by nature), but is provided purposefully by special medical interventions.
Accordingly, we can generally say that artificial insemination is a medical way to ensure pregnancy in women who, for various reasons, cannot conceive in the usual way. When using this method, the fusion of the egg and sperm (fertilization) does not occur naturally, but artificially, during a specially designed and targeted medical intervention.
Currently, the term “artificial insemination” at the everyday colloquial level usually means the procedure of in vitro fertilization (IVF). However, this is not entirely true, since specialists in the field of medicine and biology by artificial insemination mean three techniques (IVF, ICSI and insemination), which are united by a common principle - the fusion of an egg and a sperm does not occur naturally, but with the help of special medical technologies, which ensure successful fertilization with the formation of a fertilized egg and, accordingly, the onset of pregnancy. In the further text of the article, by the term “artificial insemination” we will mean three different fertilization techniques performed using medical technologies. That is, the term will have its medical meaning.
All three methods of artificial insemination are united by one common principle, namely, fertilization of an egg by a sperm does not occur completely naturally, but with the help of medical manipulations. The degree of interference in the fertilization process during artificial insemination using various techniques varies from minimal to very significant. However, all methods of artificial insemination are used to ensure pregnancy in a woman who, for various reasons, cannot conceive in the usual, natural way.
Artificial insemination to ensure conception is used only in cases where a woman is potentially capable of bearing a child throughout her pregnancy, but is unable to become pregnant in the usual way. The causes of infertility for which artificial insemination is indicated are different and include both female and male factors. Thus, doctors recommend resorting to artificial insemination if a woman has no or obstructed fallopian tubes, has endometriosis, rare ovulations, infertility of unknown origin, or other treatment methods have not led to pregnancy within 1.5 - 2 years. In addition, artificial insemination is also recommended in cases where a man has low sperm quality, impotence or other diseases due to which he is unable to ejaculate into a woman’s vagina.
To carry out the artificial insemination procedure, you can use your own or donor germ cells (sperm or eggs). If the sperm and eggs of the partners are viable and can be used for conception, then they are used for artificial insemination techniques, having previously been isolated from the genital organs of the woman (ovaries) and men (testes). If sperm or eggs cannot be used for conception (for example, they are completely absent or have chromosomal abnormalities, etc.), then donor germ cells obtained from healthy men and women are taken for artificial insemination. Each country has a donor cell bank where those wishing to obtain biological material for artificial insemination can apply.
The artificial insemination procedure is voluntary, and all women and married couples (in both official and civil marriages) over 18 years of age can use this medical service. If a woman who is officially married wants to resort to this procedure, then the consent of her spouse will be required to carry out fertilization. If a woman is in a civil marriage or single, then only her consent is necessary for artificial insemination.
Women over 38 years of age may immediately request artificial insemination to achieve pregnancy without prior treatment or attempts to conceive naturally. And for women under 38 years of age, permission for artificial insemination is given only after documented confirmation of infertility and the absence of effect from treatment carried out for 1.5 - 2 years. That is, if a woman is under 38 years of age, then artificial insemination is resorted to only when pregnancy has not occurred within 2 years, subject to the use of various infertility treatment methods.
Before artificial insemination, a woman and a man undergo an examination, the results of which determine their fertility and the ability of the fair sex to bear a fetus during 9 months of pregnancy. If everything is in order, then the procedures are carried out as soon as possible. If any diseases have been identified that can interfere with the normal development of the fetus and pregnancy, then they are first treated, achieving a stable condition for the woman, and only after that artificial insemination is performed.
All three methods of artificial insemination are short in time and well tolerated, which allows them to be used several times without interruption to ensure pregnancy.
Methods (methods, types) of artificial insemination
Currently, specialized medical institutions use the following three methods for artificial insemination:
- In vitro fertilization (IVF);
- Intracytoplasmic sperm injection (ICSI or ICSI);
- Artificial insemination.
For example, if a woman has all her genital organs functioning normally, but the mucus in the cervix is too aggressive, as a result of which sperm cannot liquefy it and enter the uterus, then artificial insemination is performed by insemination. In this case, sperm is injected directly into the uterus on the day of ovulation in a woman, which leads to pregnancy in most cases. In addition, insemination is indicated for low quality sperm, in which there are few motile sperm. In this case, this technique allows sperm to be delivered closer to the egg, which increases the likelihood of pregnancy.
If pregnancy does not occur against the background of any diseases of both the genital area (for example, obstruction of the fallopian tubes, lack of ejaculation in a man, etc.) and somatic organs (for example, hypothyroidism, etc.) in a man or woman, then For artificial insemination, the IVF method is used.
If there are indications for IVF, but in addition the man has very few high-quality and motile sperm in his sperm, then ICSI is performed.
Let us take a closer look at each method of artificial insemination separately, since, firstly, the degree of interference in the natural process when using different methods varies, and secondly, in order to get a holistic idea of the type of medical intervention.
In Vitro Fertilization - IVF
IVF (in vitro fertilization) is the most famous and widespread method of artificial insemination. The name of the method "IVF" stands for in vitro fertilization. In English-speaking countries, the method is called in vitro fertilization and is abbreviated IVF. The essence of the method is that fertilization (fusion of sperm and egg to form an embryo) occurs outside the woman’s body (extracorporeal), in a laboratory, in test tubes with special nutrient media. That is, sperm and eggs are taken from the organs of a man and a woman, placed on nutrient media, where fertilization occurs. It is because of the use of laboratory glassware for IVF that this method is called “in vitro fertilization.”
The essence of this method is as follows: after preliminary special stimulation, eggs are taken from a woman’s ovaries and placed on a nutrient medium that allows them to be maintained in a normal, viable state. Then the woman’s body is prepared for pregnancy by imitating natural hormonal changes. When the woman's body is ready for pregnancy, the man's sperm are obtained. To do this, a man either masturbates with ejaculation of sperm into a special cup, or sperm are obtained during puncture of the testicles with a special needle (if ejaculation of sperm is impossible for some reason). Next, viable sperm are isolated from the semen and placed in a test tube under the control of a microscope on a nutrient medium with eggs previously obtained from the woman’s ovaries. They wait for 12 hours, after which fertilized eggs (zygotes) are isolated under a microscope. These zygotes are introduced into a woman's uterus in the hope that they will be able to attach to her wall and form a fertilized egg. In this case, the desired pregnancy will occur.
2 weeks after the embryos are transferred into the uterus, the level of human chorionic gonadotropin (hCG) in the blood is determined to determine whether pregnancy has occurred. If the hCG level increases, then pregnancy has occurred. In this case, the woman registers for pregnancy and begins to visit a gynecologist. If the hCG level remains within normal limits, then pregnancy has not occurred and the IVF cycle must be repeated.
Unfortunately, even if a ready-made embryo is introduced into the uterus, pregnancy may not occur, since the fertilized egg will not attach to the walls and will die. Therefore, several IVF cycles may be needed to achieve pregnancy (no more than 10 are recommended). The likelihood of an embryo attaching to the uterine wall and, accordingly, the success of an IVF cycle largely depends on the woman’s age. So, for one IVF cycle, the probability of pregnancy in women under 35 years of age is 30-35%, in women 35-37 years old - 25%, in women 38-40 years old - 15-20% and in women over 40 years old - 6-6. 10%. The probability of pregnancy with each subsequent IVF cycle does not decrease, but remains the same; accordingly, with each subsequent attempt, the total probability of becoming pregnant only increases.
Intracytoplasmic sperm injection - ICSI
This method is the second most frequently used after IVF and, in fact, is a modification of IVF. The abbreviation of the name of the ICSI method is not deciphered in any way, since it is a tracing paper from the English abbreviation - ICSI, in which the sounds of the letters of the English language are written in Russian letters that convey these sounds. And the English abbreviation stands for IntraCytoplasmic Sperm Injection, which is translated into Russian as “intracytoplasmic sperm injection”. Therefore, in the scientific literature, the ICSI method is also called ICSI, which is more correct, because the second abbreviation (ITSIS) is formed from the first letters of the Russian words that make up the name of the manipulation. However, along with the name ICSI, the not entirely correct abbreviation ICSI is used much more often.
The difference between ICSI and IVF is that the sperm is precisely introduced into the cytoplasm of the egg with a thin needle, and is not simply placed with it in the same tube. That is, with conventional IVF, eggs and sperm are simply left on a nutrient medium, allowing male gametes to approach female ones and fertilize them. And with ICSI, spontaneous fertilization is not expected, but is achieved by introducing a sperm into the cytoplasm of the egg with a special needle. ICSI is used when there are very few sperm, or they are immotile and are unable to fertilize an egg on their own. Otherwise, the ICSI procedure is completely identical to IVF.
Intrauterine insemination
The third method of artificial insemination is insemination, during which a man’s sperm is injected directly into a woman’s uterus during ovulation using a special thin catheter. Insemination is used when sperm cannot enter a woman’s uterus for some reason (for example, when a man is unable to ejaculate in the vagina, when sperm motility is poor, or when cervical mucus is excessively viscous).
How does artificial insemination occur?
General principles of artificial insemination using the IVF-ICSI method
Since all IVF and ICSI procedures are performed in the same way, with the exception of the laboratory method of egg fertilization, we will consider them in one section, if necessary, clarifying the details and distinctive features of ICSI.
So, the IVF and ICSI procedure consists of the following sequential stages that make up one cycle of artificial insemination:
1.
Stimulation of folliculogenesis (ovaries) in order to obtain several mature eggs from a woman’s ovaries.
2.
Retrieval of mature eggs from the ovaries.
3.
Sperm collection from a man.
4.
Fertilization of eggs with sperm and production of embryos in the laboratory (with IVF, sperm and eggs are simply placed in one test tube, after which the strongest male gametes fertilize the female. And with ICSI, sperm are injected using a special needle into the cytoplasm of the egg).
5.
Growing embryos in the laboratory for 3 – 5 days.
6.
Transfer of embryos into a woman's uterus.
7.
Monitoring pregnancy 2 weeks after embryo transfer to the uterus.
The entire IVF or ICSI cycle lasts 5–6 weeks, with the longest stages being the stimulation of folliculogenesis and the two-week wait to control pregnancy after transfer of embryos into the uterus. Let's look at each stage of IVF and ICSI in more detail.
The first stage of IVF and ICSI is stimulation of folliculogenesis, for which a woman takes hormonal drugs that act on the ovaries and cause the growth and development of several dozen follicles at once, in which eggs are formed. The goal of stimulating folliculogenesis is the formation of several eggs in the ovaries at once, ready for fertilization, which can be selected for further manipulation.
For this stage, the doctor chooses a so-called protocol - a regimen of taking hormonal drugs. There are different protocols for IVF and ICSI, differing from each other in dosages, combinations and duration of taking hormonal drugs. In each case, the protocol is selected individually, depending on the general condition of the body and the cause of infertility. If one protocol was unsuccessful, that is, after its completion the pregnancy did not occur, then for the second cycle of IVF or ICSI the doctor may prescribe another protocol.
Before stimulating folliculogenesis, the doctor may recommend taking oral contraceptives for 1 to 2 weeks in order to suppress the production of a woman’s own sex hormones by the ovaries. It is necessary to suppress the production of your own hormones to prevent natural ovulation, in which only one egg matures. And for IVF and ICSI, you need to obtain several eggs, not just one, which is why folliculogenesis is stimulated.
Next, the actual stage of stimulating folliculogenesis begins, which is always timed to coincide with days 1–2 of the menstrual cycle. That is, you need to start taking hormonal drugs to stimulate the ovaries on the 1st – 2nd day of your next menstruation.
Ovarian stimulation is carried out according to various protocols, but always involves the use of drugs from the group of follicle-stimulating hormone, human chorionic gonadotropin and agonists or antagonists of gonadotropin-releasing hormone agonists. The order, duration and dosage of using drugs from all of these groups are determined by the attending fertility specialist. There are two main types of ovulation stimulation protocols – short and long.
In long protocols, ovulation stimulation begins on the 2nd day of the next menstruation. In this case, the woman first makes subcutaneous injections of follicle-stimulating hormone preparations (Puregon, Gonal, etc.) and agonists or antagonists of gonadotropin-releasing hormone (Goserelin, Triptorelin, Buserelin, Diferelin, etc.). Both drugs are administered daily as subcutaneous injections, and once every 2–3 days a blood test is performed to determine the concentration of estrogen in the blood (E2), as well as an ultrasound of the ovaries to measure the size of the follicles. When the concentration of estrogen E2 reaches 50 mg/l, and the follicles grow to 16–20 mm (on average, this happens in 12–15 days), stop the injections of follicle-stimulating hormone, continue the administration of agonists or antagonists of gonadotropin-releasing hormone and add injections of human chorionic gonadotropin ( hCG). Next, ultrasound monitors the response of the ovaries and determines the duration of human chorionic gonadotropin injections. The administration of gonadotropin-releasing hormone agonists or antagonists is stopped one day before the cessation of human chorionic gonadotropin injections. Then, 36 hours after the last injection of hCG, mature eggs are removed from the woman’s ovaries using a special needle under general anesthesia.
In short protocols, ovarian stimulation also begins on the 2nd day of menstruation. In this case, the woman simultaneously administers three drugs daily - follicle-stimulating hormone, agonist or antagonist of gonadotropin-releasing hormone and human chorionic gonadotropin. Every 2 - 3 days, an ultrasound is performed to measure the size of the follicles, and when at least three follicles of 18 - 20 mm in diameter appear, the administration of follicle-stimulating hormone and gonadotropin-releasing hormone agonists or antagonists is stopped, but they are administered for another 1 - 2 days human chorionic gonadotropin. 35 - 36 hours after the last injection of human chorionic gonadotropin, eggs are collected from the ovaries.
Egg retrieval procedure It is performed under anesthesia, therefore it is completely painless for the woman. The eggs are collected using a needle that is inserted into the ovaries through the anterior abdominal wall or through the vagina under ultrasound guidance. The cell collection itself lasts 15–30 minutes, but after the manipulation is completed, the woman is left in a medical facility under observation for several hours, after which she is sent home, recommended to refrain from work and driving for 24 hours.
Next, sperm is obtained for fertilization. If a man is able to ejaculate, then the sperm is obtained by regular masturbation directly in a medical facility. If a man is not capable of ejaculation, then sperm is obtained by puncture of the testicles, performed under anesthesia, similar to the manipulation of collecting eggs from a woman’s ovaries. In the absence of a male partner, the donor sperm selected by the woman is retrieved from storage.
The sperm is taken to a laboratory where it is prepared by isolating the sperm. Then according to the IVF method Eggs and sperm are mixed on a special nutrient medium and left for 12 hours for fertilization. Typically, 50% of the eggs that are already embryos are fertilized. They are selected and grown in special conditions for 3 to 5 days.
According to the ICSI method, after preparing the sperm, the doctor selects the most viable sperm under a microscope and injects them directly into the egg with a special needle, after which he leaves the embryos on a nutrient medium for 3 to 5 days.
Ready 3-5 day embryos are transferred to the woman’s uterus using a special catheter. Depending on the age and condition of the woman’s body, 1–4 embryos are transferred to the uterus. The younger the woman, the fewer embryos are implanted into the uterus, since the likelihood of their implantation is much higher than that of older representatives of the fair sex. Therefore, the older the woman, the more embryos are implanted into the uterus so that at least one can attach to the wall and begin to develop. Currently, it is recommended that women under 35 years old transfer 2 embryos into the uterus, women 35–40 years old – 3 embryos, and women over 40 years old – 4–5 embryos.
After embryo transfer to the uterus You must monitor your condition and consult a doctor immediately if the following symptoms appear:
- Foul-smelling vaginal discharge;
- Abdominal pain and cramps;
- Bleeding from the genital tract;
- Cough, shortness of breath and chest pain;
- severe nausea or vomiting;
- Pain of any localization.
Whether pregnancy has taken place is determined by the concentration of human chorionic gonadotropin (hCG) in the blood. If the hCG level corresponds to pregnancy, then an ultrasound is performed. And if the ultrasound shows a fertilized egg, then pregnancy has occurred. Next, the doctor determines the number of embryos, and if there are more than two, then reduction of all other fetuses is recommended to avoid multiple pregnancies. Embryo reduction is recommended because in multiple pregnancies the risks of complications and unfavorable pregnancy completion are too high. After establishing the fact of pregnancy and embryo reduction (if necessary), the woman goes to an obstetrician-gynecologist for pregnancy management.
Since pregnancy does not always occur after the first attempt of IVF or ICSI, several cycles of artificial insemination may be required for a successful conception. It is recommended to carry out IVF and ICSI cycles without interruptions until pregnancy (but no more than 10 times).
During IVF and ICSI cycles, you can freeze embryos that turned out to be “extra” and were not transplanted into the uterus. Such embryos can be thawed and used for the next attempt to become pregnant.
Additionally, during the IVF-ICSI cycle, you can perform prenatal diagnostics embryos before they are transferred into the uterus. During prenatal diagnosis, various genetic abnormalities are identified in the resulting embryos and embryos with gene disorders are culled. Based on the results of prenatal diagnostics, only healthy embryos without genetic abnormalities are selected and transferred into the uterus, which reduces the risk of spontaneous miscarriage and the birth of children with hereditary diseases. Currently, the use of prenatal diagnostics makes it possible to prevent the birth of children with hemophilia, Duchenne myopathy, Martin-Bell syndrome, Down syndrome, Patau syndrome, Edwards syndrome, Shershevsky-Turner syndrome and a number of other genetic diseases.
Prenatal diagnosis before embryo transfer into the uterus is recommended in the following cases:
- The birth of children with hereditary and congenital diseases in the past;
- The presence of genetic abnormalities in the parents;
- Two or more unsuccessful IVF attempts in the past;
- Hydatidiform mole during previous pregnancies;
- A large number of sperm with chromosomal abnormalities;
- The woman is over 35 years old.
General principles of artificial insemination using the insemination method
This method allows conception to occur in conditions that are as close to natural as possible. Due to its high efficiency, low invasiveness and relative ease of implementation, artificial insemination is a very popular method of infertility treatment.
The essence of the technique Artificial insemination involves the introduction of specially prepared male sperm into the woman’s genital tract during ovulation. This means that for insemination, the day of ovulation in a woman is calculated based on the results of ultrasound and disposable test strips, and based on this, the date of introduction of sperm into the genital tract is determined. As a rule, to increase the likelihood of pregnancy, sperm is injected into a woman's genital tract three times - one day before ovulation, on the day of ovulation and one day after ovulation.
Sperm is taken from a man directly on the day of insemination. If a woman is single and does not have a partner, then donor sperm is taken from a special bank. Before injection into the genital tract, the sperm is concentrated, pathological, immobile and non-viable sperm, as well as epithelial cells and microbes are removed. Only after processing, sperm containing a concentrate of active sperm without impurities of microbial flora and cells is introduced into the woman’s genital tract.
The insemination procedure itself is quite simple, so it is carried out in a clinic on a regular gynecological chair. For insemination, the woman sits on a chair, a thin elastic flexible catheter is inserted into her genital tract, through which concentrated, specially prepared sperm is injected using a regular syringe. After introducing the sperm, a cap with sperm is placed on the cervix and the woman is left to lie in the same position for 15 to 20 minutes. After this, without removing the cap with sperm, the woman is allowed to get up from the gynecological chair and do normal business. The cap containing sperm is removed by the woman herself after a few hours.
Depending on the cause of infertility, the doctor can inject prepared sperm into the vagina, cervix, uterine cavity and fallopian tubes. However, most often sperm is injected into the uterine cavity, since this option of insemination has an optimal balance of efficiency and ease of implementation.
The artificial insemination procedure is most effective in women under 35 years of age, in whom pregnancy occurs in approximately 85–90% of cases after 1–4 attempts to introduce sperm into the genital tract. It must be remembered that women of any age are recommended to make no more than 3 to 6 attempts at artificial insemination, since if all of them fail, then the method should be considered ineffective in this particular case and move on to other methods of artificial insemination (IVF, ICSI).
Lists of medications used for various methods of artificial insemination
Currently, the following medications are used at various stages of IVF and ICSI:
1. Gonadotropin-releasing hormone agonists:
- Goserelin (Zoladex);
- Triptorelin (Diferelin, Decapeptyl, Decapeptyl-Depot);
- Buserelin (Buserelin, Buserelin-Depot, Buserelin Long FS).
- Ganirelix (Orgalutran);
- Cetrorelix (Cetrotide).
- Follitropin alfa (Gonal-F, Follitrop);
- Follitropin beta (Puregon);
- Corifollitropin alfa (Elonva);
- Follitropin alfa + lutropin alfa (Pergoveris);
- Urofollitropin (Alterpur, Bravelle);
- Menotropins (Menogon, Menopur, Menopur Multidose, Merional, HuMoG).
- Chorionic gonadotropin (Chorionic gonadotropin, Pregnyl, Ecostimulin, Choragon);
- Choriogonadotropin alfa (Ovitrel).
- Progesterone (Iprozhin, Crinon, Prajisan, Utrozhestan).
- Dydrogesterone (Duphaston);
- Megestrol (Megais).
For artificial insemination, the same drugs can be used as for IVF and ICSI cycles if it is planned to introduce sperm into the genital tract against the background of induced rather than natural ovulation. However, if insemination is planned during natural ovulation, then, if necessary, only preparations of pregnene and pregnadiene derivatives are used after introducing sperm into the genital tract.
Artificial insemination: methods and their description (artificial insemination, IVF, ICSI), in what cases they are used - video
Artificial insemination: how it happens, description of methods (IVF, ICSI), comments from embryologists - video
Artificial insemination step by step: egg retrieval, fertilization using ICSI and IVF methods, embryo transplantation. The process of freezing and storing embryos - video
List of tests for artificial insemination
Before starting IVF, ICSI or insemination In order to select the optimal method of artificial insemination, the following studies are carried out:
- Determination of the concentrations of prolactin, follicle-stimulating and luteinizing hormones and steroids (estrogens, progesterone, testosterone) in the blood;
- Ultrasound of the uterus, ovaries and fallopian tubes via transvaginal access;
- The patency of the fallopian tubes is assessed during laparoscopy, hysterosalpingography or contrast echohysterosalpingoscopy;
- The condition of the endometrium is assessed during ultrasound, hysteroscopy and endometrial biopsy;
- Spermogram for the partner (in addition to the spermogram, a mixed antiglobulin reaction of sperm is performed if necessary);
- Tests for the presence of sexually transmitted infections (syphilis, gonorrhea, chlamydia, ureaplasmosis, etc.).
- Blood test for syphilis (MRP, ELISA) for a woman and a man (sperm donor);
- Blood test for HIV/AIDS, hepatitis B and C, as well as herpes simplex virus for both women and men;
- Microscopic examination of smears from the vagina of women and the urethra of men for microflora;
- Bacterial culture of smears from the genital organs of men and women for Trichomonas and gonococci;
- Microbiological examination of the discharge of the genital organs of men and women for chlamydia, mycoplasma and ureaplasma;
- Detection of herpes simplex viruses types 1 and 2, cytomegalovirus in the blood of women and men using PCR;
- General blood test, biochemical blood test, coagulogram for women;
- General urine test for women;
- Determining the presence of type G and M antibodies to the rubella virus in a woman’s blood (if there are no antibodies in the blood, a rubella vaccine is given);
- Analysis of a smear from a woman’s genital organs for microflora;
- Cytological smear from the cervix;
- Ultrasound of the pelvic organs;
- Fluorography for women who have not had this examination for more than 12 months;
- Electrocardiogram for a woman;
- Mammography for women over 35 years of age and breast ultrasound for women under 35 years of age;
- Consultation with a geneticist for women whose blood relatives have had children with genetic diseases or congenital malformations;
- Spermogram for men.
Indications for artificial insemination
Indications for IVF are the following conditions or diseases in both or one of the partners:
1. Infertility of any origin that cannot be treated with hormonal drugs and laparoscopic surgical interventions performed over a period of 9–12 months.
2. The presence of diseases in which pregnancy is impossible without IVF:
- Absence, obstruction or structural anomalies of the fallopian tubes;
- Endometriosis that cannot be treated;
- Lack of ovulation;
- Ovarian exhaustion.
4. Low sperm motility.
Indications for ICSI are the same conditions as for IVF, but with the presence of at least one of the following factors on the part of the partner:
- Low sperm count;
- Low sperm motility;
- A large number of pathological sperm;
- The presence of antisperm antibodies in semen;
- A small number of eggs received (no more than 4);
- Inability of a man to ejaculate;
- Low percentage of egg fertilization (less than 20%) in previous IVF cycles.
1. From the man's side:
- Sperm with low fertilization ability (small quantity, low mobility, high percentage of defective sperm, etc.);
- Low volume and high viscosity of sperm;
- Presence of antisperm antibodies;
- Impaired ability to ejaculate;
- Retrograde ejaculation (release of sperm into the bladder);
- Anomalies in the structure of the penis and urethra in men;
- Condition after vasectomy (ligation of the vas deferens).
- Infertility of cervical origin (for example, too viscous cervical mucus, which prevents sperm from penetrating the uterus, etc.);
- Chronic endocervicitis;
- Surgical interventions on the cervix (conization, amputation, cryodestruction, diathermocoagulation), leading to its deformation;
- Unexplained infertility;
- Antisperm antibodies;
- Rare ovulation;
- Allergy to sperm.
Contraindications for artificial insemination
Currently, there are absolute contraindications and restrictions to the use of artificial insemination methods. If there are absolute contraindications, the fertilization procedure cannot be performed under any circumstances until the contraindication factor has been removed. If there are restrictions on artificial insemination, it is not advisable to carry out the procedure, but it is possible with caution. However, if there are restrictions to artificial insemination, it is recommended to first eliminate these limiting factors, and only then carry out medical procedures, as this will increase their effectiveness.
So, according to the order of the Ministry of Health of the Russian Federation, contraindications for IVF, ICSI and artificial insemination are the following conditions or diseases in one or both partners:
- Active tuberculosis;
- Acute hepatitis A, B, C, D, G or exacerbation of chronic hepatitis B and C;
- Syphilis (fertilization is delayed until the infection is cured);
- HIV/AIDS (at stages 1, 2A, 2B and 2B, artificial insemination is postponed until the disease enters a subclinical form, and at stages 4A, 4B and 4C, IVF and ICSI are postponed until the infection enters the remission stage);
- Malignant tumors of any organs and tissues;
- Benign tumors of the female genital organs (uterus, cervical canal, ovaries, fallopian tubes);
- Acute leukemia;
- Myelodysplastic syndromes;
- Chronic myeloid leukemia in the terminal stage or requiring treatment with tyrosine kinase inhibitors;
- Blast crises in chronic myeloid leukemia;
- Severe aplastic anemia;
- Hemolytic anemia during periods of acute hemolytic crises;
- Idiopathic thrombocytopenic purpura, refractory to therapy;
- An acute attack of porphyria, provided that the remission lasted less than 2 years;
- Hemorrhagic vasculitis (Henoch-Schönlein purpura);
- Antiphospholipid syndrome (severe);
- Diabetes mellitus with end-stage renal failure if kidney transplantation is not possible;
- Diabetes mellitus with progressive proliferative
- Polyarteritis with pulmonary involvement (Churg-Strauss);
- Polyarteritis nodosa;
- Takayasu syndrome;
- Systemic lupus erythematosus with frequent exacerbations;
- Dermatopolymyositis requiring treatment with high doses of glucocorticoids;
- Systemic scleroderma with a highly active process;
- Sjögren's syndrome in severe cases;
- Congenital defects of the uterus that make pregnancy impossible;
- Congenital defects of the heart, aorta and pulmonary artery (atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic stenosis, coarctation of the aorta, pulmonary artery stenosis, transposition of the great vessels, complete form of atrioventricular communication, common truncus arteriosus, single ventricle of the heart
- Low ovarian reserve according to ultrasound or the concentration of anti-Mullerian hormone in the blood (only for IVF and ICSI);
- Conditions for which the use of donor eggs, sperm or embryos is indicated;
- Complete inability to carry a pregnancy to term;
- Hereditary diseases linked to the female sex X chromosome (hemophilia, Duchenne muscular dystrophy, ichthyosis, Charcot-Marie amyotrophy, etc.). In this case, it is recommended to perform IVF only with mandatory pre-implantation diagnostics.
Complications of artificial insemination
Both the artificial insemination procedure itself and the medications used in various techniques can, in very rare cases, lead to complications, such as: 
To carry out any artificial insemination technique, the sperm of both the woman’s partner (official or common-law husband, cohabitant, lover, etc.) and the donor can be used.
If a woman decides to use her partner's sperm, then he will have to undergo an examination and submit biological material to the laboratory of a specialized medical institution, indicating the necessary information about himself (full name, year of birth) in the reporting documentation and signing an informed consent to the desired method of artificial insemination. Before donating sperm, a man is advised not to have sex or masturbate with ejaculation for 2–3 days, and also to refrain from drinking alcohol, smoking and overeating. Typically, sperm donation occurs on the same day that the woman's eggs are collected or the insemination procedure is scheduled.
If a woman is single or her partner cannot provide sperm, then you can use donor sperm from a special bank. The sperm bank stores frozen sperm samples from healthy men aged 18–35 years, from which you can choose the most preferable option. To facilitate the selection of donor sperm, the data bank contains template cards that indicate the physical parameters of the male donor, such as height, weight, eye and hair color, shape of the nose, ears, etc.
Having chosen the desired donor sperm, the woman begins to make the necessary preparations for artificial insemination procedures. Then, on the appointed day, laboratory staff thaw and prepare the donor sperm and use it for its intended purpose.
Currently, only donor sperm is used from men with negative tests for HIV and herpes simplex virus in the blood;
For each sperm donor, in accordance with Order 107n of the Ministry of Health of the Russian Federation, the following individual card is created, which reflects all the basic and necessary parameters of the man’s physical data and health status:
Individual sperm donor card
FULL NAME.___________________________________________________________________
Date of birth________________________Nationality______________________
Race__________________________________________________________
Place of permanent registration _____________________________________________________
Contact number_____________________________
Education_________________________Profession___________________________
Harmful and/or dangerous production factors (yes/no) Which:_________
Marital status (single/married/divorced)
Presence of children (yes/no)
Hereditary diseases in the family (yes/no)
Bad habits:
Smoking (yes/no)
Drinking alcohol (frequency___________________)/I don’t drink)
Use of narcotic drugs and/or psychotropic substances:
Without a doctor's prescription
(never used/with frequency ______________________)/regularly)
Syphilis, gonorrhea, hepatitis (not sick/sick)
Have you ever had a positive or indeterminate response when tested for HIV, hepatitis B or C virus? (Not really)
Is/is not under dispensary observation at the dermatovenerological dispensary/psychoneurological dispensary________
If so, which specialist?________________________________________________
Phenotypic traits
Height Weight__________________
Hair (straight/curly/curly) Hair color___________________________
Eye shape (European/Asian)
Eye color (blue/green/gray/brown/black)
Nose (straight/humped/snub/wide)
Face (round/oval/narrow)
Presence of stigmas______________________________________________________________
Forehead (high/low/regular)
Additional information about yourself (not required to fill out)
_________________________________________________________________________
What have you been sick with in the last 2 months___________________________________________
Blood type and Rh factor ________________(________) Rh (________).
Artificial insemination of single women
According to the law, all single women over the age of 18 are allowed to use artificial insemination to have a child. To perform artificial insemination in such cases, as a rule, they resort to the use of donor sperm.
Price of procedures
The cost of artificial insemination procedures varies in different countries and for different methods. So, on average, IVF in Russia costs about 3–6 thousand dollars (including medications), in Ukraine – 2.5–4 thousand dollars (also including medications), in Israel – 14–17 thousand dollars (including medications) ). The cost of ICSI is approximately 700 - 1000 dollars more expensive than IVF in Russia and Ukraine, and 3000 - 5000 in Israel. The price of artificial insemination ranges from 300 – 500 dollars in Russia and Ukraine, and about 2000 – 3500 dollars in Israel. We have given prices for artificial insemination procedures in dollar terms to make it convenient to compare and also easy to convert into the required local currency (rubles, hryvnias, shekels).
