Artificial insemination (insemination)

Artificial insemination (fertilization) is the introduction of foreign genetic material in the form of sperm into the female reproductive tract with the aim of causing her to become pregnant.

Depending on the method of sperm introduction, the following methods of artificial insemination are used:

• vaginal, in which sperm is injected into the posterior fornix of the vagina using a syringe;
• the intracervical method, when sperm is introduced into the cervical canal, avoids contact with vaginal contents;
• The uterine method involves introducing sperm directly into the uterine cavity;
• transabdominal introduction of plasma-free spermatozoa together with one or two eggs into the infundibulum of the fallopian tube (GIFT).

Each method has its positive and negative sides. Although the vaginal method is the simplest, the vaginal contents (pH, bacteria, etc.) have an adverse effect on spermatozoa, which reduces the chances of pregnancy. With the intracervical method, an immunological conflict may develop due to the presence of antisperm antibodies in the cervical mucus. The introduction of sperm into the uterus can also contribute to the entry of infection, and is often accompanied by painful contractions.

To improve the ejaculate (increase its concentration) before insemination, its fractionation is recommended.

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Indications for insemination with husband's sperm

Artificial insemination with the husband's sperm is used in cases of urethral hypospadias, impotence, absence of ejaculation, oligospermia with preserved normal sperm motility and absence of morphological changes. In such cases, the ejaculate is centrifuged and the sperm-enriched fraction is introduced into the cervical canal. In addition, it is possible to accumulate concentrates of several ejaculates, which does not require complex equipment.

For artificial insemination with the husband's sperm, the husband's sperm taken for cryopreservation immediately before his sterilization, before the administration of treatment with cytostatic drugs or before his irradiation can be used.

In women with some forms of anatomical-functional, immunological and inflammatory changes of the cervix, which cause so-called cervical antagonism, artificial insemination with the husband's sperm is indicated. Vaginismus, diseases of the hip joints can also be the basis for insemination with the husband's sperm.

Indications for insemination with donor sperm

Artificial insemination with donor sperm is performed for medical reasons, which can be absolute and relative. Azoospermia is an absolute reason, and relative reasons include:

• oligozoospermia and oligoasthenoteratozoospermia with morphological changes in spermatozoa and impaired motility, not amenable to treatment;
• Rh factor incompatibility of spouses;
• hereditary diseases in the husband that can be passed on to offspring.

There are also contraindications to artificial insemination with donor sperm. It is unacceptable to perform the procedure under anesthesia, without written confirmed consent for insemination of both spouses, without a thorough examination of the spouses and the establishment of indisputable indications for the intervention, with any contraindications to pregnancy, with the possibility of eliminating infertility by treatment or surgery, more than once in the same woman, except in cases where the child has died.

Contraindications to artificial insemination are general diseases that contribute to the woman's disability or pose a threat to pregnancy, childbirth and her life. Before artificial insemination with the husband's sperm, an examination using functional diagnostic tests or determination of the blood progesterone level in the middle of the luteal phase of the menstrual cycle is indicated for 2-3 cycles. This allows determining the presence of ovulatory cycles, as well as periovulatory days. In the case of anovulation, the possibility of ovulation induction is determined before artificial insemination.

Timing of artificial insemination

Since there may be inaccuracies in determining the exact date of ovulation, it is recommended to perform artificial insemination up to 3 times during the cycle. With a 27-day menstrual cycle, insemination should begin on the 2nd day, and with a 28-day cycle - on the 13th day of the cycle and repeat 2-3 times with an interval of 2 days.

After insemination, it is recommended to remain in a lying position for one hour or use a cervical cap to retain sperm.