Insemination is one of the first and simplest forms of infertility treatment. This method belongs to the group of assisted reproductive techniques and represents a minimally invasive way to increase the chances of conception. Insemination involves the introduction of processed sperm from the male partner directly into the woman’s uterus at the time of ovulation. The procedure can be performed in a natural cycle, but also in a cycle stimulated by hormonal therapy, depending on the individual needs of the patient.
ADVANTAGES OF INSEMINATION
Insemination has numerous advantages compared to other assisted reproduction methods. It is a simple, quick and non-invasive procedure that does not require anesthesia or surgery. Compared to more complex methods such as in vitro fertilization (IVF), insemination is significantly more affordable both in terms of cost and physical burden for the woman. An additional benefit is the possibility of repeating the procedure multiple times, thereby increasing the chance of success.
WHEN IS INSEMINATION RECOMMENDED?
Insemination is suitable for couples with milder forms of infertility or problems with natural conception. The most common indications for this procedure are:
- Milder forms of male infertility:Reduced concentration, motility or morphology of sperm, but with the presence of a sufficient number of healthy spermatozoa for successful processing and use.
- Unexplained (idiopathic) infertility:When, after thorough examinations, the cause of infertility cannot be determined.
- Ovulation disorders: In cases of irregular ovulation or polycystic ovary syndrome (PCOS), insemination can be combined with ovulation stimulation to increase the chances of success.
- Cervical factor infertility:When cervical mucus hinders or prevents the natural passage of sperm through the cervix.
- Semen allergy: In rare cases, when a woman has an allergic reaction to proteins in seminal fluid, injecting processed sperm directly into the uterus avoids contact with cervical mucus.
PREPARATION FOR INSEMINATION
To increase the chances of success, appropriate tests and preparatory procedures must be carried out before insemination. These include:
- Gynecological exam and ultrasound monitoring:Checking the condition of the uterus and ovaries to ensure there are no anatomical or functional obstacles to pregnancy.
- Swabs for infections:Testing for chlamydia, mycoplasma and ureaplasma to rule out infections that could affect the outcome of the procedure.
- Semen analysis:An analysis of the male partner’s semen to assess the number, motility and shape of sperm.
- Tubal patency check (HSG or HyCoSy):Ensuring that the fallopian tubes are not blocked and that sperm can reach the egg.
HOW IS INSEMINATION PERFORMED?
The insemination procedure consists of several steps:
- Ovulation monitoring:Ultrasound exams and measurement of luteinizing hormone (LH) levels determine the exact moment of ovulation. In some cases, ovulation can be triggered with an hCG injection.
- Sperm preparation: The male partner provides a semen sample, which is processed in the laboratory using special methods such as swim-up or density gradient centrifugation, to separate the highest-quality sperm with the greatest motility.
- Insemination: Using a thin catheter, the prepared sperm is inserted directly into the woman’s uterus. The procedure is painless, lasts a few minutes, and does not require anesthesia.
- After the procedure: The woman can resume her usual activities immediately after the procedure. A pregnancy test (β-HCG) is done approximately 14 days after insemination.
CHANCES OF SUCCESS
The success rate of insemination varies depending on various factors, including the woman’s age, cause of infertility, sperm quality and method of stimulation treatment. Generally, the success rate per cycle ranges between 10% and 20%, but it can be higher when insemination is performed in several consecutive cycles or in combination with ovulation stimulation. If, after several attempts, insemination does not result in pregnancy, it is recommended to move on to more complex methods such as IVF.
CONCLUSION
Insemination represents a simple, painless and relatively affordable method of treating infertility. Although it does not always yield results on the first attempt, with proper preparation and an individualized approach, it can be successful in many cases. This procedure allows couples with mild forms of infertility to increase their chances of conception in a natural and less invasive way.
REFERENCES
American Society for Reproductive Medicine. (2022). Intrauterine insemination (IUI). Retrieved from https://www.asrm.org
ESHRE Guidelines Group. (2021). Management of unexplained infertility: Evidence-based recommendations. Human Reproduction, 36(3), 523–540. https://doi.org/10.1093/humrep/deaa365
Ombelet, W., & Dhont, M. (2018). Intrauterine insemination: A first-step procedure in fertility treatment. Reproductive BioMedicine Online, 37(1), 12–17. https://doi.org/10.1016/j.rbmo.2018.04.005
Practice Committee of the American Society for Reproductive Medicine. (2020). Effectiveness and treatment for unexplained infertility. Fertility and Sterility, 114(4), 700–709. https://doi.org/10.1016/j.fertnstert.2020.06.032
Zarek, S. M., & Segars, J. H. (2019). Optimizing natural and assisted conception in women with PCOS. Fertility and Sterility, 112(6), 1021–1030. https://doi.org/10.1016/j.fertnstert.2019.09.002