Artificial insemination (AI) involves the placement of sperm in the female reproductive tract by means other than sexual intercourse. AI is a simple and painless procedure that can be an effective treatment for some types of infertility.
The sperm sample can be placed in the vagina (vaginal insemination), the cervix (cervical insemination or ICI) or inside the uterus (intrauterine insemination or IUI). For vaginal insemination and ICI the sperm sample doesn’t need any special preparation prior to insemination. For IUI a “sperm wash” is needed prior to insemination.
During the “sperm wash” the sperm is separated from the seminal fluid, is concentrated, and then contained within a very small amount of liquid. This very concentrated sperm sample is gently inserted through the cervix into the uterus. The main advantage of the IUI over the other types of insemination is the higher concentration of sperm that is achieved within the uterus. This is not possible with the vaginal or cervical insemination, and is responsible for the higher pregnancy rate seen with IUI as compared to the other types of insemination. For this reason vaginal and cervical inseminations are rarely performed. IUI is commonly performed for mild to moderate male infertility, therapeutic donor insemination, retrograde ejaculation, male or female sexual dysfunction, cervical abnormalities, and “hostile” cervical mucus. In addition, IUI is in combination with Controlled Ovarian Hyperstimulation (COH) is frequently employed for the treatment of unexplained infertility.
The timing of the insemination is critical since once ovulation takes place the egg (oocyte) is only viable for approximately 24 hours. As a result, we like to perform the insemination ahead of the ovulation. This is best accomplished with active follicular monitoring followed by the induction of ovulation by the administration of a medication called Human Chorionic Gonadotropin (hCG).
Active follicular monitoring consists of sequential transvaginal ultrasound exams to monitor changes in ovarian follicle size to determine when an egg (or eggs) is (are) ready for ovulation. Once the egg (or eggs) is (are) ready the ovulation is triggered with the injection of hCG, a substance quite similar to LH, the hormone that normally triggers ovulation. The insemination is then performed 36-40 hours after this injection when the induced ovulation is expected to occur.
Basal Body Temperature (BBT) Charts and Ovulation Detector Kits are not recommended for the timing of insemination. With the BBT chart the basal body temperature is recorded everyday and in ovulatory cycles an increase in basal body temperature is noted after ovulation. Progesterone released by the ovary after ovulation is responsible for this increase in body temperature. BBT charts are a good for telling that ovulation has taken place but not for ovulation detection since you know that you have ovulated after the fact. Ovulation Detector Kits are great for the timing of sexual activity at home, but not for the precise timing of insemination. Frequently, patients have difficulty with the interpretation of the results, get false positive or negative results, and end with the insemination being performed at the wrong time. We consider active follicular monitoring far superior for the timing of inseminations.
We want you to understand what all your options are (including IVF) in order that you might make an informed decision. Ultimately, our goal is to match you with the best treatment option consistent with your personal goals.
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Fertility Sucess Rates
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In Vitro Fertillization - IVF
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