Artificial insemination is a procedure used in assisted reproduction programs as the first alternative for sterile couples.
The main objective of artificial insemination is to bring sperm closer to the egg in the female genital tract. The potential fertility of the sperm needs to be improved and increased by a set of laboratory procedures, called sperm capacitation.
The aim of capacitation is to eliminate cell debris, bacteria, leucocytes, dead and slow sperm and seminal secretions from the seminal fluid while also selecting and concentrating the most fertile sperm in a approximate quantity of 0.5 ml. This is introduced in the uterus to increase the possibility of fertilisation. The most common techniques used are wash and centrifugation, “swim-up” and Percoll gradients.
Artificial insemination is used to treat couples who have not been able to achieve pregnancy if:
• the woman has issues with the cervix such as: abnormal cervical mucus, presence of antisperm antibodies, stenosis (narrowing), consequences of laser treatment or cryosurgery, etc.
• the man shows alterations in semen such as decrease in number of sperm and/or mobility, decrease in volume of seminal fluid, excessive increase in number of sperm, defects in the reproductive system or ejaculation disorders.
• the couple suffers unexplained infertility (when studies show that everything is normal but the couple is still not able to conceive)
Artificial insemination can be HOMOLOGOUS or HETEROLOGOUS
• Homologous artificial insemination is when the sperm is from the partner
• Heterologous artificial insemination is when frozen sperm from a bank is used.
Depending on where the sperm is placed the artificial insemination can be INTRAVAGINAL, INTRACERVICAL, INTRAUTERINE, INTRAPERITONEAL or INTRATUBAL.
With intrauterine insemination the highest pregnancy rate is achieved, there is a 20-25% chance of pregnancy each try. Four consecutive cycles of artificial insemination are recommended to exhaust all possibilities.
Once conception has been achieved, the risk of miscarriage, premature birth or a baby with a congenital malformations is the same as with a pregnancy by vaginal intercourse.
To increment the possibility of success it is recommended to increase the amount of eggs in the female genital tract by stimulating ovaries with medication which induces ovulation (ovarian stimulation). Follicular monitoring will indicate the moment of ovulation and the ideal day of insemination.
With homologous insemination, the sperm sample is obtained by masturbation the day of insemination. Sexual abstinence for 3- 5 days before collecting sample is recommended to maximise the sperm count and quality. The sperm capacitation technique is chosen depending on the quality of the sperm sample.
When the sample is ready for insemination it is placed on a special catheter connected to a syringe. The patient lays down as she would for a pelvic exam, a sterile vaginal mirror is used to locate the cervix (exactly as in a routine vaginal examination) and the catheter is introduced in the uterus where the sperm is deposited (intrauterine insemination). Sperm can also be deposited inside the cervix (intracervical insemination).
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