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Artificial and Intrauterine Insemination

Artificial insemination treatment is a form of assisted reproductive technology (ART), which is performed to treat infertility and help achieve pregnancy. It involves the introduction of sperm into a woman’s reproductive tract for fertilisation and achieving a potential pregnancy. The most common method is called intrauterine insemination (IUI), which involves the insertion of the sperm directly into the uterus. The aim of IUI is to allow the maximum number of healthy sperm to reach the fallopian tubes and increase the chances of fertilisation.

Condition

The normal process of reproduction involves a chain of events. The woman releases an egg from one of her ovaries (ovulation). The egg travels through a fallopian tube toward her uterus (womb). A man’s sperm is introduced into the vagina through intercourse. It travels up the uterus and into the fallopian tube to join with (fertilise) the egg. The fertilised egg then attaches to the inside of the uterus, initiating pregnancy.

The female reproductive system is made up of the following parts:

  • Vagina: opening of the reproductive system, which allows the entry of sperm towards the uterus
  • Cervix: narrow region that connects the vagina to the uterus
  • Uterus or womb: where a fertilised egg implants and grows to develop into a baby
  • Ovaries: organs on either side of the uterus, which release an egg each month to fertilise with a sperm
  • Fallopian tubes: narrow tubes that open out at the ovaries to pick up the released egg for fertilisation

The male reproductive system consists of the following:

  • Testicles: produce and store sperm
  • Epididymis and vas deferens: ducts that transport sperm from the testicles
  • Scrotum: sac of skin that contains the testes and epididymis outside the pelvic cavity in order to maintain the optimal temperature needed for sperm to survive
  • Accessory glands: seminal vesicles and prostate gland lubricate and form a part of the semen, which is the liquid part of the ejaculate that contains sperm
  • Urethra: carries sperm to the outside and is also a part of the urinary system
  • Penis: muscular organ containing the urethra, and responsible for the ejaculation of sperm into a woman’s uterus

Infertility is a condition characterised by the inability to achieve pregnancy and a healthy live birth. It occurs when one or more of the processes of a normal reproductive cycle fail to occur.

Male and female infertility affects the respective reproductive processes and ultimately, the ability to conceive and give birth to a baby.

Treatment

What are the consequences of not treating infertility?
Left untreated, you may not be able to have biological offspring.

Artificial insemination is considered for the following cases:

  • Unexplained infertility
  • Retrograde ejaculation (backward release of sperm into the urinary bladder)
  • Absent, low quality or poor quality sperm
  • Hostile cervical environment for sperm
  • Cervical scar tissue
  • Single women and same-sex couples using donor sperm
  • Endometriosis
  • Semen allergy

The process of artificial insemination is performed in coordination with the menstrual cycle. Timing is crucial to the outcome. You will be monitored for signs of ovulation; either at home with an ovulation predictor kit that measures the urine for specific hormones, or in the clinic through transvaginal ultrasound. Your doctor may also administer human chorionic gonadotropic hormone (HCG) to initiate the release of one or more eggs at the right time.

At the same time, the semen sample from your partner or frozen donor sperm is thawed and prepared. The sperm is washed within 1 hour of ejaculation, and concentrated by selecting the highly active and healthy sperm. You are advised to avoid intercourse 2 to 5 days before the procedure to ensure a high sperm count.

The artificial insemination is performed the day after or after two days of ovulation.

Artificial insemination is usually performed in the clinic and takes about 15 to 20 minutes. You will lie on your back with your legs supported in stirrups. A speculum is inserted into your vagina. A vial containing the healthy sperm is attached to a catheter (thin, long tube). This catheter is inserted into your vagina, cervix or uterus (intrauterine insemination) to place the sperm. You will not experience pain. The catheter and speculum are then removed.

After artificial insemination, you are asked to lie on your back for some time, after which you can go about your normal activities, but avoid strenuous activities. You may experience cramping and/or spotting.

You are advised to wait for two weeks and then take a home pregnancy test and confirm with a blood test for pregnancy. If your test results show negative, the artificial insemination process is repeated. You may have to undergo 3 to 6 cycles of treatment.

The advantages of artificial insemination are:

  • Increased number of sperm reaching the fallopian tube
  • Only healthy sperm are introduced for fertilisation
  • Less invasive
  • Useful for single women and same-sex couples who choose to have a biological baby
  • Takes few minutes and is relatively painless

The success of artificial insemination depends on many factors such as maternal age, and egg and sperm quality. It will not help if your fallopian tubes are blocked.

As with all procedures, artificial insemination may be associated with certain complications such as infection, multiple pregnancies, ectopic pregnancy and spontaneous abortion.

You will be able to resume your normal activities after the procedure.

Any costs involved will be discussed with you prior to your surgery.

Extensive research is being done to find better treatment outcomes for artificial insemination. Some of the recent studies are listed below:

  • Thijssen A, Creemers A, Van der Elst W, et al. Predictive factors influencing pregnancy rates after intrauterine insemination with frozen donor semen: a prospective cohort study. Reprod Biomed Online. 2017 Mar 23. pii: S1472-6483(17)30144-X.
  • Scholten I, van Zijl M, Custers IM, et al. The effectiveness of intrauterine insemination: A matched cohort study. Eur J Obstet Gynecol Reprod Biol. 2017 May;212:91-95.

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