Insemination: who got it right the first time? Artificial insemination is an assisted reproductive technology. How to behave after insemination

Intrauterine insemination is a reproductive technology in which sperm is taken from a man and placed in a woman's uterus. There is no sexual contact. This method has been practiced in our country since 2003. We will talk about its features and the process itself in this article.

Intrauterine insemination is used to achieve pregnancy, which is certain indications cannot arise. The procedure itself is the artificial insemination of a woman with sperm. There is no classical sexual intercourse.

Insemination can be carried out using either fresh or frozen biomaterial. The sperm is injected directly into the uterine cavity, bypassing the vagina itself and cervical canal.

Intrauterine insemination is performed without anesthesia. It does not have serious negative effects on a woman’s body. A woman's hospitalization is not required for insemination.

Types of intrauterine insemination

Depending on the used biological material May be:

Insemination with husband's sperm.
Insemination with donor sperm.

If intrauterine insemination with donor sperm is used, it is pre-frozen or ready-made frozen material is used. It is stored in special cassettes for about six months. This period allows us to identify some diseases in sperm that were not identified during the test.

If the material is used, the patient's husband must give his written consent to the procedure.

The insemination process itself can:

Accompanied by hormonal stimulation.
Not accompanied by hormonal stimulation (with natural cycle).

Hormone stimulation is not prescribed to young women who have a regular cycle and are ovulating. Hormones increase the number of follicles, but lead to hormonal imbalance and multiple pregnancies. Hormone therapy makes the IUI procedure much more expensive.

Sperm can be injected:

In the vagina.
There are marks in the neck.
Into the uterine cavity.

The last method is the most effective.

Indications

Intrauterine insemination is prescribed to couples of a certain group. It is mainly used when a woman is infertile. For IUI, two participants in the procedure must be examined.

The intrauterine insemination method is used in the following cases:

Insufficient sperm activity in a man. Here, sperm cannot reach the egg and die while still in the vagina. Pathology may have following reasons: serious past infections, heavy loads, unhealthy environment and constant stress.
Erectile dysfunction or ejaculation disorder. The phenomenon can be observed quite often. As a result of this pathology, a man suffers from absolute or temporary impotence. If the man cannot be cured, then intrauterine insemination will give the couple a chance to have a child.
Oncology in a man. If a man has undergone chemotherapy, his sperm quality decreases significantly. Experts advise submitting biological material for freezing before irradiation.
High viscosity of plasma in sperm.
Abnormal phenomena in the development of the penis.
Immunological incompatibility. It is observed in very rare cases. Incompatibility refers to the presence of antibodies in a woman to sperm. The immune system extinguishes viable cells before they reach the egg.
Female vaginismus. Vaginismus refers to contractile actions of the vaginal muscles. It leads to the inability to perform sexual intercourse or to severe pain in a woman. In this case, not only intrauterine insemination, but also the advice of a psychologist can help the couple. A specialist will help identify where the problem is coming from and teach a woman to relax during sexual intercourse.
Lack of ovulation in a woman. In this case, the woman is in long-term infertility. The second partner usually has good sperm counts.
Infertility, the cause of which cannot be determined.
A woman is allergic to sperm.

Insemination is done if a woman does not have a regular sexual partner. Here, of course, biological material from a donor is used. His sperm is also used in cases of impaired sperm motility in the husband, unhealthy ejaculation, and also if geneticists have given the couple an unfavorable prognosis.

Contraindications

IUI has its contraindications:

Complete obstruction of the fallopian tubes. In this case, it will not be possible to physically deliver sperm to the right place.
You cannot get pregnant artificially or naturally if a woman has cancer.
The size of the patient’s uterus is up to 35 mm.
The patient has pathologies of the cervix or cervical canal.
A woman is sick with sexually transmitted infections.
A woman has fibroids or polyps.
The woman has a premenstrual state (here we should talk about temporary contraindications).

How is intrauterine insemination performed?

There are several conditions for the IUI procedure:

The first condition: the woman must be ovulating.
The second condition: the man must have a sufficient amount of sperm. At the same time, sperm must have good and healthy mobility. This condition is assessed using a spermogram.

The procedure is carried out in a natural or hormone-stimulated cycle. However, partners are initially examined to identify health abnormalities.

The woman undergoes the following tests:

Hormone analysis.
Test for rubella. This disease causes a threat to the life of the fetus, various deformities, and pathologies. Therefore, the possibility of rubella must be excluded before pregnancy.
Analysis for determination harmful viruses: ureaplasma, herpes, trichomonas, chlamydia, mycoplasma, .
Analysis to detect cancer cells.
Photo of the fallopian tubes and uterus. The doctor assesses the condition of the organs, in particular the patency of the fallopian tubes.

A man passes:

Analysis for the presence of sexually transmitted infections.
Spermogram procedure. It shows sperm count, consistency, sperm volume, sperm shape and evaluates sperm motility.

Doctors try to correct detected deviations using tests. Next, treatment and re-diagnosis are carried out. Only after this the specialist decides on the need for an IUI procedure. The question of which biomaterial will be used is also immediately resolved: husband or.

Stages of insemination

Intrauterine insemination can be divided into the following stages:

Stimulation of ovulation in a woman (not in all cases).
Carrying out folliculometry and laboratory monitoring of the onset of ovulation.
Collection of biological material (sperm) or defrosting frozen donor material. This stage is carried out during the periovulatory period.
Preparation of sperm for insemination.
The process of introducing sperm itself. This is carried out using a syringe. The sperm is injected with a catheter through the cervical canal into the uterine cavity.

The IUI procedure itself is quick. The woman does not feel pain. The doctor gains access to the uterus using a vaginal speculum. There is no need to dilate the cervix, since the catheter used has a small diameter and easily penetrates through the cervical canal, dilated during the ovulation period. But sometimes there are cases when it is necessary to use expanders.

Visualization with the help of devices of the location of the catheter tip is not necessary. The doctor is guided by his professional feelings. After the tip of the catheter enters the uterine cavity, it presses on the syringe. After the entire amount has been administered, the syringe and catheter are carefully removed. After the procedure, the woman must lie on her back for half an hour. At this time, she may show signs of anaphylaxis and a vasovagal reaction. In this case, the doctor takes emergency measures.

Preparation of biomaterial (sperm)

Due to the fact that spermatozoa bypass the vagina, in which, due to acidic environment often die, even not very fast sperm have the opportunity to participate in the fertilization process. Their high concentration in the uterus significantly increases the chance of conception.

There are no special requirements for sperm collection from a man. But it is advisable to take her to a medical facility to avoid unwanted transportation.

Before sperm are implanted into a woman’s body, they undergo preliminary preparation. This takes about three hours. The doctor selects more viable sperm for further procedure. Sperm is examined for quality indicators, which are specified in WHO standards. After the work has been done, the collected viable material is left alone for 30 minutes. The procedure is necessary. During this time it should naturally liquefy.

Several methods are used to prepare sperm. With any method, there should be one outcome. The seminal plasma should be removed as much as possible from the sperm (this is necessary to prevent adverse reaction). It should not contain immature, dead or poorly motile sperm. In addition, antigenic proteins, bacteria, leukocytes and prostaglandins are removed. The result is a material of excellent quality and high concentration.

There is a special kit for home insemination. The sperm is drawn into a sterile syringe and inserted through a catheter into the vagina. As a result, a great content sperm. This procedure is considered more of a vaginal procedure, therefore the chance of getting pregnant is less than in a clinic. After administration, the woman must maintain a horizontal position for 30 minutes.

In addition to insertion items, the kit includes a pregnancy test. It can be performed on the 11th day after insemination. If the test gives “not pregnant”, then the determination is repeated after 7 days.

Complications

Intrauterine insemination almost always occurs without complications. But there is a probable risk of their occurrence. Complications may be the following:

Infection of the uterus and pelvic organs.
Pain in the lower abdomen.
Vasovagal reaction.
Allergic reaction.

Complications can occur after pregnancy. These include: multiple pregnancy, pregnancy outside the uterus and spontaneous miscarriage.

Efficiency of IUI

The chance of success, according to WHO, is 12%. The effectiveness increases slightly if you perform repeated intrauterine insemination in the same cycle. It is very important to perform IUI very close to the time of ovulation. Doctors are using all possible methods to find out the day of its onset.

The effectiveness is also influenced by the type of infertility, the age of the woman and man, and the parameters of the sperm used. In addition, the condition of the fallopian tubes and endometrium is very important.

The intrauterine insemination procedure can be repeated up to four times. Negative impact It has no effect on a woman’s body. If after many attempts there is no result, then they resort to IVF.

IN at a young age They are usually afraid of getting pregnant. As they get older and start a family, many are very surprised that it turns out that getting pregnant is not as easy as it seemed before. Unfortunately, statistics confirm a high percentage of infertility in our region. However, science does not stand still. There are many procedures that can help couples become parents. One such procedure is insemination.

Artificial insemination or AI is the introduction of high-quality sperm from a husband or donor into the woman’s uterus for the purpose of fertilization.

Donor material is used if a single woman is trying to get pregnant, or if the husband is diagnosed with infertility in a couple. In the second case, he must give written consent.

Insemination and IVF should not be confused. In the first case, conception occurs in the woman’s womb, and in the second, several viable embryos formed under artificial conditions are implanted into her uterus.

Indications for the insemination procedure

Oddly enough, there are many types of procedures. This can be intrauterine insemination, vaginal, intratubal and the like. The most popular intrauterine device, we will talk about it.

Infertility, both female and male, can be caused by a number of reasons, and in people who are absolutely healthy in appearance and leading correct image life. Insemination with sperm is indicated for problems of conception on the part of both women and men:

azoospermia, in other words, too little, or even complete absence motile sperm capable of fertilizing an egg,
absence of ovulation, in this case, additional stimulation is necessary before insemination,
vaginismus, that is, muscle spasm that makes any sexual contact impossible,
immunological incompatibility in a couple, in which the woman develops antibodies to male sperm, interfering with the natural process of fertilization.

There are many other indications for insemination. But you should know that the procedure has a small success rate, about 15% for the first attempt. However, with each subsequent procedure the chances increase, and the cost is significantly lower than that of IVF. It is believed that if after 4 attempts to get pregnant you still don’t succeed, your chances drop significantly.

Preparing for intrauterine insemination

Before insemination, both women and men must undergo a series of examinations.

A man takes a blood test for HIV, hepatitis and other diseases, as well as a spermogram after some abstinence. If the results are not very good, then before the procedure the sperm is subjected to special treatment in order to improve its quality and increase sperm motility.

A woman must undergo a series of examinations to exclude situations where insemination is contraindicated. For example, in case of tubal obstruction or lack of ovulation. In the second case, it is necessary to adjust the course of the procedure, namely stimulation of ovulation.

If, based on the results of all examinations and tests, the results are normal, you can begin insemination.

How does insemination work?

Insemination is carried out only with fresh sperm, which is collected a maximum of 2-3 hours before the start of the procedure.

If it is pre-treated, the chances of success increase, and in case of male infertility, this is the only way the procedure is carried out.

In the absence of stimulation, stimulation is carried out, thereby increasing the chances of success. The woman is placed in a special gynecological chair, where, using a catheter, sperm is gradually introduced into the uterine area.

The consequences of the procedure may be different:

multiple pregnancy,
allergies to medications,
uterine tone,
ovarian hyperstimulation syndrome.

Insemination at home

This is an equivalent replacement for regular sexual intercourse. Using a syringe without a needle, sperm is injected into the vagina. Of course, there is no way to prepare it, as in special medical institutions. But here are some recommendations to increase the chances of a long-awaited pregnancy:

Sperm is suitable for fertilization for a maximum of three hours after production, so it must be introduced as soon as possible.
After administration, lie down for a while with your legs raised up, for example, in the birch tree position.
Need to calculate favorable days for pregnancy using special ovulation tests and regular measurements basal temperature. The girl has regular cycle 28 days long, ovulation occurs around the 14th. This means that favorable days for conception are from the 13th to the 15th.

The difference from insemination in a medical institution is that it is not possible to stimulate ovulation, process sperm efficiently and inject it directly into the area of the uterus. The sperm will end up in the same area as during normal sexual intercourse, and there is no need to try to insert it as deeply as possible, this will only damage the delicate internal organs. Therefore, the chances of getting pregnant using insemination at home are much lower.

Insemination with donor sperm

If a man is given a final and irrevocable diagnosis of infertility that cannot be treated, there is such a solution as insemination with donor sperm. Conducted from written consent spouse.

This is also a great option for single ladies who want to have children. In this case, there will be some increase in the cost of the procedure.

Donor sperm is stored frozen. Once defrosted, it undergoes standard AI preparation.

Pregnancy after insemination

Signs of pregnancy after insemination are the same as usual. The first and most important thing is, of course, a delay in menstruation.

Two weeks after insemination, you can take a pregnancy test and take a blood test for hCG and progesterone. When positive test and an increase in both indicators, pregnancy has occurred! If not, don’t despair - there are three more attempts ahead. If they are not successful, then, most likely, the doctor will then suggest a more expensive procedure - IVF.

Let's sum it up

Artificial insemination is performed to get pregnant by many couples today. And if its effectiveness is much less than that of IVF, the procedure is still very popular due to its relative cheapness and maximum proximity to the natural process of conception.

As a rule, AI is the first step after many unsuccessful attempts to get pregnant. But don't despair if it didn't help. There is always a next step, if only there was money and desire.

The main thing is to remember that thoughts are material! It’s worth dreaming, but you can’t make it a fixed idea. Happiness comes when you least expect it. If something doesn’t work out, under no circumstances should you dwell on it. Perhaps you should switch to work, travel, or, say, repairs. Without giving up trying to conceive a baby. And at the most unexpected moment he will definitely appear!

Video "Artificial insemination"

It would seem that everything turned out the way I wanted: a successful career, happy marriage, arranged life, best friends and pleasant leisure time.

But there is no happiness...

Infertility... A terrible word. Sounds like a sentence. But that's just the sound. Thanks to reproductive methods of treatment, the problem of infertility does not exist today.

Artificial insemination (AI)

is the simplest, most accessible and, in some cases, effective method of assisted reproductive technology. This is a procedure in which pre-treated sperm is injected into the uterus outside of sexual intercourse. What happens next is as usual: sperm move through the fallopian tubes to the egg and fertilize it. A pregnancy obtained in this way is no different from a normal pregnancy.

Indications for AI:

male factor infertility ( bad analysis sperm, sexual disorders);
cervical infertility in women (changes in the properties of uterine mucus, involuntary contractions of the vaginal muscles caused by fear of sexual intercourse);
lack of a partner for a woman.

if you have similar problems Perhaps conducting AI is your path to long-awaited happiness.

Necessary examinations before performing AI

This is how it is with us: if pregnancy occurs naturally, then it doesn’t matter at all who is sick and what. And if you turn to doctors for “long-awaited happiness,” then you must be healthy.I stood on the threshold of the clinic and was preparing to take the first step...

You will have to undergo a full examination for sexually transmitted infections (both partners), have an ultrasound done to exclude possible gynecological diseases, which may be an obstacle to the onset or gestation of pregnancy (for a woman), do a spermogram analysis (for a man).

To prescribe an AI procedure, it is necessary to exclude the presence of diseases in a woman that prevent pregnancy. After all, if menstruation occurs on time, this is not at all a reason to think that you are healthy, and a mature and ovulated follicle does not at all mean that a full-fledged one has matured. good quality egg.

But the most important condition for carrying out AI is the patency of the fallopian tubes, or at least one tube. If you haven't been offered a tubal check, run away from this quack doctor. The lack of information about the fallopian tubes not only sharply reduces the effectiveness of AI, but also increases the risk of ectopic pregnancy.

The examination scheme is simple: they check the functioning of the ovaries (maturation of the eggs), the patency of the tubes (the place where the egg meets the sperm), the condition of the uterine cavity (the ability of the embryo to attach).

The decision on the advisability of insemination will be based, among other things, on sperm quality indicators.

… Full examination in modern reproductive clinic It took me (and my husband) a little over 2 weeks. I didn’t take leave, I just ran to the doctor or the laboratory in the morning, and then to work. I can say that the examination is not a cheap pleasure, but the doctor assured me that such a thorough examination has its advantages. Firstly, the AI procedure is prescribed to me according to my indications and the obstacles to pregnancy will be minimized. Secondly, I will be sure that during the subsequent pregnancy my child will not be threatened by any infection, because carrying out treatment with a child already under the heart is quite dangerous and not always possible. And yet, I realized that I had taken the most important first step towards a long-awaited pregnancy.

Preparing for AI

When all the tests and examination conclusions are ready, the doctor will decide on the advisability of performing AI. If this reproductive method treatment suits you, you proceed next step- preparation for the AI procedure. Preparation for insemination involves determining the date of ovulation, hormonal stimulation of the ovaries (if necessary), monitoring the growth of the endometrium in the uterus, and preparing sperm.

Ovulation - the time when a mature egg leaves the ovary/follicle, occurs approximately in the middle menstrual cycle. The most favorable time conception - a day before ovulation and several hours after, this time is ideal for carrying out AI. Although insemination 2-3 days before ovulation can also lead to pregnancy.

To determine the time of ovulation with an accuracy of at least the day and maturity of the egg, ultrasound monitoring is performed. From the beginning of the menstrual cycle in which AI is supposed to be performed, ultrasound is performed several times, tracking the functioning of the ovaries and the growth of one or more follicles (eggs). Ovulation occurs when the follicle reaches a size of 18-22 mm.

In addition to ultrasound, you can independently determine the time of ovulation using ovulation tests. Such tests, similar to tests for determining pregnancy by urine, are sold in pharmacies and can show those “cherished” days when ovulation occurs.

AI can be carried out either in a natural cycle or with the use of hormonal stimulation of the ovaries, which will lead to the maturation of several follicles/eggs and increases the likelihood of pregnancy. In the second case, starting from the first day of the cycle, the doctor prescribes stimulant drugs.

In addition to controlling the growth and maturation of follicles/ova, important factor for pregnancy to occur is the thickness of the endometrium in the uterus at the time of ovulation. During ultrasound monitoring, the growth of the endometrium is monitored and if the growth is insufficient (by the time of ovulation it should be at least 9 mm), additional hormonal drugs are prescribed to build up the endometrium.

Preparing sperm for AI takes about 2 hours. It takes about an hour to liquefy it, then the sperm must be processed without delay, otherwise its quality will deteriorate. Treated sperm can be stored for several hours without losing its quality. If cryopreserved sperm is used, it will take more time to defrost it.

On the 7th day of the menstrual cycle, I had my first ultrasound. It was already clear then dominant follicle, who stored that same egg.

On the 12th day of the cycle, an ovulation test showed two lines. This means that ovulation will occur within 24 hours. I was happy like crazy, as if I was already pregnant. My beautiful egg will be ready to meet her prince very soon!

On the 13th day of the cycle, in the morning, the doctor confirmed that ovulation was about to occur, the endometrium had grown to 11 mm, and suggested insemination.

I called my husband and asked him to come urgently.

AI procedure itself

The AI procedure itself (sperm injection) takes several minutes. The woman sits comfortably in the gynecological chair. Specially prepared sperm is injected directly into the uterine cavity using a catheter. That's all! The procedure is performed by one person, usually your doctor.

The procedure was painless, I only felt a slight tugging. After injecting the sperm, the doctor left me to lie down for 20-30 minutes. I lay there and imagined the process of conception, the meeting of egg and sperm, fertilization. I dreamed about my future baby, I thought what he would be like, who he would look like and what gender. For some reason I imagined a girl with blond pigtails and plump lips. I tuned in to a positive mood and a positive result and became confident that I would become a mother very soon!

The estimated cost of AI consists of several components:

initial consultation with a doctor - 100-300 UAH.

examination for infections, viruses, hormonal examinations - 1000 UAH.

checking the patency of the fallopian tubes - x-ray (for women) - 300-450 UAH.

spermogram (for men) - 100-250 UAH.

cost of ultrasound monitoring (at least 2-3 ultrasounds required) - 100-150 UAH.

insemination procedure (including sperm preparation) - 1000 UAH.

Thus, the estimated cost of the AI procedure is 2800 - 3450 UAH. This amount can be increased in the case of using donor sperm (approximately 500 UAH) and using medications for ovarian stimulation (the cost is comparable to the cost medical services for insemination - 1000 UAH).

By the way, a higher price for the insemination procedure compared to other clinics does not always mean that this clinic has a better result.

AI success rate and possible reasons for failure

Pregnancy as a result of insemination occurs less frequently than during natural sexual activity in healthy couples, and than during in vitro fertilization (IVF). That is, the probability of pregnancy in one cycle during insemination is less than 30%. Therefore, you should be prepared to carry out at least 3-4 cycles of insemination. However, each subsequent AI will cost less by the amount of the examination and will be approximately 1400 - 1550 UAH.

If pregnancy does not occur after 3-4 cycles of insemination, it is recommended to change the treatment method.

Possible reasons for failure:

1. Insemination was not carried out according to indications; there are obstacles to pregnancy. To avoid failure for this reason, in fact, a full examination is carried out.

2. Insemination was carried out insufficiently qualified or carelessly. Perhaps the ovulation period was not set correctly or there was a delay in sperm preparation, which affected its quality. In this case, you may want to think about changing clinics or doctors.

3. Bad luck. If you have only completed 1-2 cycles of inseminations and are confident in your doctor, most likely you are just out of luck. Talk to your doctor about using ovarian stimulation if it was absent, changing stimulation medications, performing 2-3 inseminations per cycle if only 1 was performed, increasing the time of sexual abstinence for a man before donating sperm (up to 5 days).

On the 22nd day of the cycle, I felt that I was pregnant. Has settled in me new life and has already made itself felt. Before, I would never have believed this, and no one believed me. And I felt it!

With some unbearable effort I restrained myself from taking the test, because it was too early.

I behaved more quietly than usual, as if I was afraid of scaring away my happiness. And I waited every minute.

On the 26th day of the cycle, the test showed the coveted two stripes - one was very pale, but we saw it! I AM PREGNANT!

Tears of happiness...my...husband...

HAPPINNES EXISTS!

P.S. By the way, we are having a girl!

We want to support married couples and single women who have decided to undergo a procedure such as intrauterine insemination (hereinafter referred to as IUI or AI). Unfortunately, not everything in life is always simple and smooth: some people experience loneliness when they have long wanted to find a family, while others experience illness, loss of loved ones, and other misfortunes. There is no need to think that you are the one who is unlucky - everyone experiences some kind of misfortune. And you shouldn’t be embarrassed that you have to go to doctors - we don’t hesitate to see a doctor if, for example, we broke our leg in order to get rid of the pain and be able to walk in the future.

It’s just that artificial insemination of a person, intrauterine insemination, turning to doctors to find a child is less familiar to us, that’s all. This is also less common for the people around us. Methods of artificial insemination (including intrauterine artificial insemination) in Moscow and the regions help more and more married couples every year. Artificial insemination - donor, or with your husband's sperm - will give you the desired result - your child. However, if you are not ready or do not want to face the wariness, skepticism, and even ridicule of others - natural human reactions to something new and unusual - and do not feel confident in convincing people and achieving their understanding of the situation, then you probably should not Tell your loved ones that you have resorted to a procedure such as intrauterine artificial insemination.

Results after insemination – successful pregnancy– will delight both you and your loved ones. Conceiving a child is an intimate, personal matter, and concerns only you. You can answer questions from loved ones or smile mysteriously. The artificial insemination methods used are up to you, your spouse and your doctor.

The oncoming misfortune is sometimes so depressing that complete despondency sets in. But over time, you realize that the problem will not be solved on its own and life will not get better on its own. Artificial insemination in humans - medical method treatment, there is nothing obscene in it. The problem of artificial insemination is largely contrived by people who are uninformed on this issue. If this procedure is indicated for you, artificial insemination - donor or with your husband's sperm - you need to think carefully about everything and act. You need to overcome adversity, not surrender to it. There are always ways to solve a problem. Perhaps it’s not always easy, it’s not always easy to accept something psychologically, you don’t always have enough patience and will. Sometimes you just don't know how to solve a problem, or which way is better.

Artificial insemination. Indications:

couples where not everything is okay on the part of the man (sexual disorders or bad sperm)
single women (if there are no problems “on the female side”)

Many single women really want to have a baby. What to do if there is no suitable partner nearby? Women will learn what artificial insemination is, who became pregnant after artificial insemination, where artificial insemination is performed, how much artificial insemination costs - in Moscow and the regions. Having clarified all the questions, women go to the selected clinic, where they undergo artificial insemination. If intrauterine insemination is successful, after insemination there occurs long-awaited pregnancy. And it doesn’t matter how much artificial insemination costs; the result is a new life, your child is in your arms. I would like to wish single women good luck and understanding and help from loved ones with raising a child.

On men's problems Let's go into more detail. These or other problems in the reproductive sphere now occur in men, including young men, quite often, and, unfortunately, are not always treatable. The problem of artificial insemination for men is quite acute. This is a heavy blow to male pride and simply a human misfortune. This often disrupts the harmony in the couple.

It makes no sense at all to do nothing in this situation, to get away from it - sooner or later the problem will have to be solved, one will have to somehow determine one’s destiny, and procrastination usually leads to the growth of problems.

In this situation, it is important to collect complete information about how modern medicine can help you, where specifically and how successfully. It is also important to visit clinics and doctors in person to get answers to your questions and doubts. If artificial insemination is indicated for you, tests will help you choose the right treatment tactics.

I would like to separately mention that bad sperm is not a diagnosis, it is an analysis. If a man has not been examined and there is no conclusion about the diagnoses, causes of poor sperm and the possibility of treatment, it is too early to make predictions whether pregnancy is possible naturally or whether artificial intrauterine insemination or another ART method is needed.

In case of serious sperm pathologies, if it cannot be corrected, insemination with the husband’s sperm cannot help solve the problem. In these cases, medicine can only help with insemination with donor sperm or IVF/ICSI with husband's sperm.

The role and importance of a man in conception, if you have to resort to artificial methods, not only does not become lower, she becomes much higher and more responsible. Even if donor sperm is used, this is your child, thanks to you a new life is born, and he will be the same as you raise him.

Artificial insemination (AI) is a method of assisted reproduction (along with IVF, IVF/ICSI), in which, as with other methods, some stage of conceiving a child occurs artificially.

General information

Insemination is the artificial introduction of sperm into a woman's genital tract. The entire further process occurs naturally: sperm run from the uterus into the fallopian tubes, where they meet a mature egg released from the ovaries and also entered the fallopian tubes, fertilize it, and then the fertilized egg enters the uterus, where it attaches to the wall of the uterus and gives rise to pregnancy.

Inseminations are carried out near the time of ovulation (the release of a mature egg from the ovary), approximately in the middle of the menstrual cycle.

Previously, the introduction of sperm into the vagina was used, but more successful is the recent introduction of sperm into the uterus - the so-called intrauterine insemination (IUI).

During intrauterine insemination, sperm is pre-processed, making it similar to the composition that sperm acquires in the vagina on the way to the uterus during natural sexual intercourse, and selecting the “squeeze” from the sperm most capable of fertilization. The introduction of unprocessed sperm directly into the uterus is unacceptable.

Artificial insemination. Indications

Inseminations are carried out on single women and are used to achieve pregnancy in spouses in infertile marriages, if the treatment is aimed at achieving natural pregnancy was not successful.

Artificial insemination. Results: Pregnancy as a result of insemination can occur in a woman only when there are no diseases that prevent pregnancy. In case of obstruction/absence of fallopian tubes, endometriosis high degree, in the absence of ovaries or uterus, insemination is not performed.

As a method of assisted reproduction, they are distinguished:

artificial insemination with husband's sperm (AISM)
artificial insemination with donor sperm (AISD)

Artificial insemination with husband's sperm (AISM)

IISM are indicated and can overcome infertility only in those cases when the artificial introduction of sperm bypasses the obstacle(s) due to which pregnancy did not occur, namely:

for sexual disorders, vaginismus, irregular sex life,
with cervical (cervical) factor infertility, when the husband’s sperm die in the wife’s vagina,
with slight deterioration in sperm quality compared to normal,
for infertility unknown origin, when the couple has undergone a full range of examinations, and the cause has not been found, but the use of IVF seems premature, insufficiently justified or too expensive.

In all cases, except the first, it is assumed that the couple has undergone a full infertility examination in accordance with full list examination, and there is a conclusion about the causes of infertility. If a couple is indicated for artificial insemination, tests will help choose the right treatment.

All of the above cases are quite rare and make up only a small percentage of infertility cases.

When inseminating with the husband's sperm, fresh (native) sperm is used, which is donated at the clinic immediately before insemination on the same day, several hours in advance. To carry out insemination, the husband must be examined for at least all sexually transmitted infections.

The child born as a result of such insemination is genetically related to the woman and her husband.

Artificial insemination with donor sperm (AISD)

I believe that before resorting to IVF, it is worth taking the chance of AI with donor sperm (AISD). Why??

It is important to understand that if pregnancy does not occur from insemination with donor sperm, nothing will prevent the use of IVF. If you first go the IVF route and pregnancy does not occur after several attempts, there is a risk that reproductive health and mental condition a woman’s condition will worsen as a result of IVF, and the use of insemination with donor sperm will then turn out to be inappropriate, that is, there will be no other way.

Insemination with donor sperm has advantages relative to IVF/ICSI:

there are no strong hormonal stimulations that could negatively affect the health of the unborn child,
transmission to next generations is excluded male infertility(possible transmission during IVF/ICSI has not been studied by medicine),
There is no risk to the mother's health, unlike the IVF procedure.

IISD are used:

if the quality of the husband’s sperm is poor (as an alternative to IVF, IVF/ICSI) or the woman does not have a sexual partner/husband.

In this case, the sperm of an anonymous donor from the clinic’s donor sperm bank can be used, or the sperm of a donor you bring yourself - this can be your husband’s closest relative (brother, father), a person you know or barely know, but who agrees to act as a donor.

The child born as a result of such insemination will be genetically related to the woman and the donor, but the real father of the child - officially and in fact - becomes the woman's husband, if she has one. Doctors maintain medical confidentiality, and pregnancy after insemination is managed as a normal pregnancy. The donor has no paternity rights or obligations.

More information about donors.

According to the order of the Ministry of Health of the Russian Federation, in order to avoid the transmission of infections medical institutions It is allowed to use only cryopreserved donor sperm that has been frozen and stored in quarantine for at least six months to detect hidden infections.

Since not every man’s sperm can withstand freezing/thawing without seriously deteriorating its quality, only men whose sperm has this property (cryotolerant) are accepted as anonymous donors.

Anonymous donors are examined for all sexually transmitted infections; the absence of mental disorders and congenital deformities.

Other requirements for anonymous donors depend on the clinic: the most stringent requirements are genetic tests on potential heredity, the presence of 2 healthy children.

Carefully choose a clinic where to have artificial insemination! Clinics search for and attract anonymous donors themselves. The number of donors whose sperm makes up a donor sperm bank can be only 2-3 people, or there can be dozens. General information about the donor is provided on appearance, nationality, blood type, presence of children, education and occupation.

When inseminating with the sperm of a donor you bring yourself, as an exception, fresh sperm, not cryopreserved for six months, can also be used. If artificial insemination is carried out in this mode. The cost of the procedure will be lower, the waiting time will be reduced, and the likelihood of pregnancy after artificial insemination will increase.

To carry out insemination, the donor you bring yourself must be screened for at least all sexually transmitted infections.

Where to do artificial insemination. Official registration

Inseminations are carried out in clinics dealing with reproduction problems, in the same place where IVF is carried out (see list on the website). Insemination is carried out by a reproductive specialist (a separate specialization in gynecology) with the participation of an embryologist involved in sperm preparation.

To carry out artificial insemination, an official agreement is signed with the clinic - consent to insemination, with passport data.

If a woman is officially married, then both the wife and husband sign an official consent to insemination both for insemination with her husband’s sperm and for insemination with donor sperm.

When performing insemination with the sperm of a donor you bring yourself, his official consent is also signed. At the same time, his passport details and the passport details of the spouses or single woman for whom he agrees to become a donor are indicated.

Insemination procedure

Before insemination, a woman should be examined for sexually transmitted infections and an ultrasound should be done to exclude possible gynecological diseases that may be an obstacle to the onset or gestation of pregnancy.

Insemination is carried out near the time of ovulation - the release of a mature egg from the ovary, approximately in the middle of the menstrual cycle. Ideally, if in the time interval “one day before ovulation - several hours after”, since this is the most favorable time for conception. Although insemination a day or two or three before ovulation can also lead to pregnancy.

In order to determine the time of ovulation with an accuracy of at least one day, and to make sure that the egg is mature, ultrasound monitoring is performed: from the beginning of the menstrual cycle in which AI is supposed to be performed, ultrasounds are performed several times, tracking the functioning of the ovaries and the growth of one or more follicles (ovules). Follicle growth is usually 2 mm/day and ovulation occurs when the follicle reaches a size of 18-22 mm.

In addition to ultrasound, for precise definition time of ovulation, use ovulation tests (similar to urine pregnancy tests), sold in pharmacies.

AI can be performed using hormonal stimulation of the ovaries. Hormonal stimulation is carried out with the same drugs as for IVF (see the page "pharmacology in IVF" >>>), but usually in significantly smaller doses.

Stimulation can produce multiple follicles/eggs and slightly better quality ones, increasing the likelihood of pregnancy. It should be mentioned that drugs with the active ingredient "clomiphene" (clostil, clostilbegit) are outdated drugs with many side effects and less effectiveness.

If the follicle/s are pre-ovulatory, an ovulation provocateur may be prescribed - human chorionic gonadotropin(hCG).

Two days after ovulation, hormonal support for the second phase of the cycle with the drugs duphaston and utrozhestan can be prescribed, which contributes to the onset and maintenance of pregnancy.

In addition to mature follicles/eggs, an important factor for pregnancy is the thickness of the endometrium in the uterus at the time of ovulation. During ultrasound monitoring, the growth of the endometrium is also monitored, and if the growth is insufficient (at the time of ovulation it should be at least 9 mm), additional hormonal drugs are prescribed to grow the endometrium (estrophem, progynova, divigel).

Inseminations can be carried out without prescribing any medications.

In one menstrual cycle, 1 or 2-3 inseminations can be performed. This depends on whether one or more follicles/eggs mature and when each one ovulates (follicles can ovulate 1-2 days apart) and how accurately the timing of ovulation can be predicted.

In the case of using cryopreserved donor sperm, 2-3 inseminations can be performed at intervals of 24 hours.

When fresh (native) sperm is used, it should be assumed that good sperm quality requires sexual abstinence, ideally 3-5 days. Therefore, insemination is carried out either 1 time - on the day of expected ovulation, or 2 times with an interval of 2-3 days - for example, 2 days before ovulation, and a few hours before or after ovulation. Ultrasound monitoring is carried out until it is determined that ovulation has occurred (!).

Preparing sperm for AI takes about 2 hours: about an hour is spent on the so-called liquefaction, then the sperm must be processed without delay (otherwise its quality deteriorates). Treated sperm can be stored for several hours without losing its quality. If cryopreserved sperm is used, more time is required to defrost the sperm.

The insemination procedure itself (injection of sperm) takes several minutes and is carried out on a gynecological chair.

The sperm is injected through a special catheter directly into the uterus. The procedure is painless, you may only feel a slight stretching. After the procedure, you may feel some tension in the uterus (tone) for several hours. After the injection of sperm, you must remain on the chair in the same position for 15 minutes, then you can get up. A little leakage of fluid is normal.

On the day of insemination, you should limit physical activity and follow the same regimen as on critical days(menstruation). Because insemination directly interferes with the uterus, increasing the risk of infection, greater hygiene and caution must be observed. The mode of life in the following days is without restrictions.

The same doctor, a reproductive specialist, provides consultations, performs ultrasound monitoring, makes all appointments and performs the actual insemination. An embryologist is involved in the storage and preparation of sperm for insemination.

Hormonal support of the second phase of the cycle with utrozhestan and duphaston prevents menstruation from starting, even if pregnancy has not occurred. Therefore, if hormonal support is used, 2 weeks after ovulation you need to take a blood test for pregnancy (blood for hCG).

When negative analysis support is cancelled; if positive, support continues until consultation with a doctor.

Cost of insemination

Artificial insemination. Price. The cost of AI consists of several components: the initial consultation with a doctor, the cost of ultrasound monitoring, the insemination procedure itself, the preparation of sperm for insemination, the cost of donor sperm (if sperm from the clinic’s donor sperm bank is used), the cost of the medications used.

Thus, the cost of insemination depends on the chosen clinic, on whether ovarian stimulation drugs and other drugs are used, and whether a donor sperm bank is used.

In some clinics, when artificial insemination is performed, the price is set as a total price for everything that is performed during the cycle - for ultrasound monitoring and insemination, regardless of whether 1 or 2-3 procedures are required. There are clinics where payment is made for each type of service - separately for ultrasound monitoring, or even for each ultrasound, separately - for each insemination procedure.

Therefore, when determining the cost of insemination in this clinic You should separately ask how much the entire necessary set of services costs.

The cost of donor sperm from a donor sperm bank is paid separately. Medications purchased independently at a clinic or pharmacy, cost modern drugs for stimulation is comparable to the cost of medical services for insemination.

A higher price compared to other clinics for a “kit” or directly for the insemination procedure does not always mean that this clinic has a better result. On average, insemination in clinics in Moscow and St. Petersburg costs several hundred dollars per menstrual cycle.

Artificial insemination. Who got pregnant? Probability of success and possible reasons for failure.

Pregnancy as a result of insemination occurs less frequently than during natural sexual activity in healthy couples, and than during IVF. That is, the probability of pregnancy in one cycle during insemination is less than 30%. Therefore, you should be prepared to carry out at least 3-4 cycles of insemination.

If pregnancy does not occur after 3-4 cycles of insemination, it is recommended to change the treatment method or donor.

This limitation is partly due to the fact that it is undesirable to stimulate the ovaries for more than 3-4 cycles, and partly because there is more effective method- IVF (however more expensive and less harmless to health). However, performing more than 3-4 cycles of insemination without ovarian stimulation, simulating natural sexual activity, may be quite reasonable.

Possible reasons for failure:

a) insemination is not carried out according to indications, there are obstacles to pregnancy,

b) insemination was carried out insufficiently qualified or negligently,

c) bad luck.

More details about each of the reasons:

a) Indications.

If a woman has not undergone fertility testing, it cannot be ruled out that she has diseases that prevent pregnancy. It is also important to understand that a mature and ovulated follicle does not mean that a full-fledged, good-quality egg has matured. If a woman has hormonal disorders, ovarian dysfunction or her age over 35 - possible reason failure may be poor egg quality.

It should be noted separately that AISM occurs when sperm counts decrease. To decide whether insemination is advisable, 2-3 spermograms are necessary, since sperm parameters can vary greatly. When preparing sperm for insemination, the embryologist gives an independent opinion on the quality of the sperm and a prognosis to what extent pregnancy is possible - it is important to know this conclusion in order to make a decision about further treatment if pregnancy does not occur.

b) Professionalism of doctors.

The entire scheme of actions for the insemination cycle is described above. Thus, the reason for failure may be:

delay in sperm preparation,
low quality of biological media used for sperm processing in this clinic,
insufficiently accurately determined time of ovulation and carrying out inseminations not at the optimal time, lack of verification that ovulation has occurred, prescription of an ovulation provocateur when the size of the follicle/s is undergrown or overgrown,
thin (immature) endometrium in the uterus.

If you feel negligence or contradictions in the actions of the doctor, you should think about changing the clinic or doctor.

c) Bad luck.

If you do not find the reasons for failure in reasons a) and b) and have only completed 1-2 cycles of inseminations, most likely you are simply unlucky yet.

You can use ovarian stimulation if it was absent, change stimulation drugs, perform 2-3 inseminations in a cycle, if only 1 was performed, increase the time of sexual abstinence of a man before sperm donation (up to 5 days). The absence of pregnancy for even several cycles of inseminations does not mean that a woman cannot become pregnant during natural sexual activity with a healthy man.

Based on the information collected and the experience of those who have gone through insemination, consultations with many fertility doctors, try to understand whether it is worth resorting to AI in your case and how to do all this. AI may be your chance!

Send us your successful stories! They will give real hope to those who are hesitant, doubtful or afraid of failure!

Among assisted reproductive techniques special place allocated to insemination. It allows you to conceive a child in cases where natural fertilization for some reason becomes impossible. We will tell you in this material how insemination is carried out, to whom it is performed and what its effectiveness is.

Peculiarities

Insemination is the process of insemination. During natural sexual intercourse, natural insemination occurs when sperm enters the woman’s genital tract as a result of her partner’s ejaculation at the moment of orgasm. Next, the sperm have a long way to go - to overcome the vagina with an acidic and rather aggressive environment, to overcome the cervix, the cervical canal. No more than a third of a man’s reproductive cells will reach the uterine cavity.

In the uterus, the environment for sperm is more favorable, but they still have to pass through the fallopian tube, in the ampullary part of which an egg ready for fertilization awaits them. If at some stage difficulties arise, then not a single sperm may reach the egg and then pregnancy will not occur.

In some forms of infertility associated with immune factors, with endocrine disorders, with male factors, with pathologies of the cervix, insemination naturally is difficult. Therefore, artificial insemination can be used. In this case, the sperm of the husband or donor is injected into the woman’s cervix or uterine cavity using special devices, that is, the procedure takes place without sexual intercourse.

The first experience of insemination was carried out in Italy back in the 18th century. Then the British took up the baton. In the 19th century, doctors in many European countries actively used this method of helping with infertility. In the middle of the last century, doctors learned not only to inject sperm closer to the cervix, but began to make intrauterine insertions and even insertions into the mouths of the fallopian tubes.

Insemination belongs to the category of artificial insemination techniques, but has nothing in common with IVF (in vitro fertilization). The main difference is that with in vitro fertilization, the fusion of the sex cells of a man and a woman occurs outside the female body. Eggs and sperm go through this stage in a laboratory Petri dish under the constant supervision of embryologists, and after a few days the embryos are transferred into the uterine cavity.

During insemination, human intervention in the natural process consists only in the fact that the sperm is “helped” to overcome particularly difficult areas - the vagina and the cervical canal of the cervix. Thus, it enters the uterine cavity and fallopian tube. larger number male reproductive cells, and this increases the chances of pregnancy.

Fertilization itself occurs in the natural environment provided by nature - in the wide part of the tube, from where the fertilized egg gradually moves into the uterine cavity. After about 8-9 days, under favorable conditions, implantation of the descended fertilized egg occurs and the development of pregnancy begins.

The differences between insemination and ICSI (introcytoplasmic sperm injection) are the same as from IVF in general. During ICSI, one selected sperm is manually inserted with a thin needle under the membranes of the egg. The whole process takes place outside the female body, in an embryological laboratory.

Quite often, intrauterine insemination is the first method that is prescribed to couples with some forms of infertility. Sometimes treatment ends there, as pregnancy occurs.

If insemination does not give a positive result, the possibility of IVF or IVF + ICSI is considered.

Kinds

Based on the depth of ejaculate injection, vaginal, intracervical and intrauterine insemination are distinguished. Depending on whose germ cells will be used to fertilize a woman, there are two types of insemination:

homologous– insemination, for which the sperm of the husband or the woman’s regular sexual partner is used;
heterological– insemination, for which the sperm of an anonymous or other donor is used.

The procedure with donor sperm is carried out when the sperm of a spouse or permanent partner is considered unsuitable for fertilization due to impaired sperm morphology, a small number of live and active sperm and other severe spermogram abnormalities. Insemination with donor biomaterial is also recommended if a man has severe hereditary pathologies, which can be inherited by the child. A woman who wants a child, but lives alone, without a husband, can also undergo insemination if she wishes.

The procedure with the husband's sperm is carried out if the quality of the ejaculate is good enough for fertilization to occur, but not sufficient for natural conception through sexual intercourse, as well as in case of some female diseases.

Indications

Unlike in vitro fertilization, which could theoretically help a large group of infertile couples with the most for various reasons decreased or absent fertility, intrauterine insemination is indicated for a rather narrow group of patients. These include:

women without a partner;
married couples in which there is a male factor of infertility according to the spermogram;
couples in which the woman has minor pathologies of the reproductive system.

Male factors that may require the use of donor sperm insemination may be due to the absence of testicles at birth or due to injury or surgery. Also, donor material, in agreement with the spouses, is used in the event that a couple has been diagnosed with genetic incompatibility or the man has extremely low sperm quality that cannot be corrected with medication and surgery.

Insemination becomes a chance to become a father for men who, for some reason, cannot perform a full-fledged act, for example, with paralysis of the lower body or spinal cord damage. Intrauterine injection of sperm will help solve the problem of conception for couples in which the man suffers from retrograde ejaculation (sperm enters the urinary tract as a result of disruption of the eruption process).

Donation of sperm followed by its cryopreservation for insemination may be required for men who are undergoing a course of treatment for oncology, for example, a course radiation therapy. Your own reproductive cells may be severely damaged as a result of cancer treatment, but frozen sperm will remain unchanged and can be used for insemination if the couple wishes.

Among female pathologies that prevent pregnancy from occurring naturally, but can be overcome through intrauterine insemination, include cervical or cervical factors of infertility, in which the passage of the partner’s sperm through the genital tract is difficult, with an immune factor of infertility, if produced a large number of antisperm antibodies, as well as for moderate endometriosis and mild forms of menstrual irregularities.

Sometimes it is not possible to identify the true cause of infertility - according to the results of all examinations, both partners are somatically healthy. In this case, intrauterine insemination is also used as an experimental measure.

Insemination is recommended for women with vaginismus, in which the insertion of something into the vagina causes severe spasms, with scarring on the cervix caused by previous operations on the cervix or ruptures during a previous difficult birth.

Contraindications

For most assisted reproductive technologies and techniques, the list of contraindications established by orders of the Ministry of Health is almost identical. As in the case of IVF, a woman who has currently there are spicy ones inflammatory pathologies or worsened chronic diseases. The ban applies to women with disabilities mental health that require regular or periodic use of psychostimulants.

In the presence of oncological diseases, any benign tumors at the time of the procedure, insemination will also be denied. If a woman is diagnosed with malformations of the uterus and tubes, if she suffers from obstruction of the fallopian tubes, if she has congenital anatomical anomalies of the uterus, vagina, tubes and ovaries, insemination is also denied, because pregnancy in these cases can pose a danger to life and health women.

It should be noted that with one tube or with partial obstruction of the fallopian tubes, insemination can be carried out, but only according to individual indicators, that is, the decision on the advisability of the procedure is made taking into account the degree of obstruction and the chances of success.

Infectious diseases of the husband can also cause refusal to perform the insemination procedure, since there is a possibility of infection of the woman at the time of introduction of the husband’s biomaterial. That is why before insemination it is necessary to conduct a thorough examination and undergo a rather impressive list of tests.

Preparation

If the couple was examined by a gynecologist and urologist and these specialists came to the conclusion that insemination is necessary for conception (indications are indicated above), then the woman’s attending physician gives her a referral for tests and examinations. Before insemination, a woman should do general tests urine and blood, biochemical analysis blood tests, tests for sexually transmitted infections, blood tests for HIV, syphilis, blood group and Rh factor.

On the 5-6th day of the menstrual cycle, she should donate blood from a vein for the main hormones responsible for reproductive capabilities (prolactin, FSH, LH, testosterone, estradiol, etc.). A woman must undergo an ultrasound of the pelvic organs, smears from the vagina and scrapings from the cervix. Colposcopy and hysteroscopy are also indicated (if endometriosis is suspected). Tubal patency can be determined diagnostic laparoscopy or other methods.

A man should have a spermogram with mandatory extended testing for antisperm antibodies and different kinds deviations in spermatogenesis. In addition, the man undergoes general blood and urine tests, and undergoes fluorography of organs chest, donates blood for HIV, syphilis, sexually transmitted infections, urethral smear, donates blood for group and Rh factor.

Intrauterine insemination is included in the state support program for NRT (new reproductive technologies), and therefore you can do it either at your own expense or free of charge, under the compulsory medical insurance policy. In the first case, with a doctor’s report and tests, you can go to any clinic that provides a similar service. In the second case, you will have to wait about a month until the documents submitted by the attending physician to the regional Ministry of Health commission are reviewed.

If a couple is allowed to undergo insemination at the expense of government or regional funds, she will be offered a list of clinics and hospitals that can perform the procedure and have the appropriate license to do so. All you have to do is choose one of them and go there with all the tests and documents to complete the quota procedure.

Order of conduct

To undergo intrauterine insemination, a woman does not have to go to the hospital. This procedure is quite simple and quick. It can be done in a natural cycle or with the use of hormonal drugs that should stimulate ovulation in a woman (if there are disturbances in the ovulatory cycle). Whether ovarian stimulation is necessary or not will be decided by a fertility specialist who will receive tests about hormonal background patients.

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In a natural cycle, a woman will not have to take any hormonal drugs, which sometimes cause female body unwanted Negative consequences. She will make her first visit to the doctor after the end of menstruation, donate blood for hormones and will visit the doctor every two days so that follicle maturation is monitored through ultrasound. As soon as the dominant follicle increases to 18-20 mm, an insemination procedure will be prescribed.

Immediately after ovulation, which is perfectly monitored and determined by ultrasound, pre-cleaned and prepared sperm will be introduced into the uterus using a long and thin catheter and a disposable syringe. This procedure is painless, takes no more than five minutes, and does not require anesthesia. For women with increased pain sensitivity, mild local anesthetics can be used.

If a woman has problems with her own ovulation, then the insemination protocol will be very similar to the IVF protocol. First, the woman will receive hormonal drugs that stimulate the maturation of follicles. Up to the 10-12th day of the menstrual cycle, growth will be observed through ultrasound. As soon as the size of the follicle reaches 16-20 mm, the doctor gives the patient a single angle of hCG. This hormone stimulates the maturation of the egg and its release from the follicle approximately 36 hours after the injection.

Immediately after ovulation, sperm will be injected into the uterine cavity through a catheter. During the period of ovulation, the cervical canal opens slightly, which is why a thin catheter can be passed into the uterus without any problems, without resorting to artificial instrumental dilatation of the cervix. This is why the woman does not experience pain.

After stimulating ovulation from the first day, the woman is prescribed progesterone preparations, which help prepare the endometrium of the uterus for the upcoming (possible) implantation of the fertilized egg. For this purpose, drugs such as Duphaston and Utrozhestan are often used. The doctor will tell you in detail how to behave after the procedure.

Before injection, sperm is cleared of seminal fluid and other impurities by settling, washing, and passing through a centrifuge. As a result, only concentrated ejaculate remains. Sperm is freed from immature, defective sperm with poor morphology, from dead and inactive cells. The remaining strong sperm should not live, so they should be injected as quickly as possible. Purified sperm from a husband or donor cannot be frozen, so purification is carried out immediately before injection.

Before donating sperm on the day of insemination, a man is recommended to have sexual abstinence for 3-5 days, nutritious food, and no stress. Alcohol, antibiotics and hormonal drugs are prohibited 2-3 months before insemination. Not worth taking hot bath, visit a bathhouse or sauna. This will help you prepare for the biomaterial in the best possible way.

A woman who has undergone artificial intrauterine insemination is recommended to remain in bed or semi-bed rest for the first two days, not to take hot baths, not to swim, not to go to the bathhouse, and not to sunbathe. You should rest more, get good sleep and eat a balanced diet. Diets won't do any good.

If the doctor prescribes progesterone drugs, they should be taken in a clearly indicated dosage and in compliance with the frequency and schedule. It is unacceptable to skip another tablet or insertion of a suppository.

It is quite difficult, or rather, almost impossible to influence the likelihood of successful fertilization and implantation. These processes are not yet subject to human control. But a calm psychological background, lack of stress, and positive thinking will help increase your chances of success.

If unusual discharge appears after insemination - bloody, greenish, gray or thick yellow, you should immediately inform your doctor.

Don't bother yourself with searching early signs and symptoms of pregnancy - they may not exist. Therefore, doctors recommend going to diagnose pregnancy at the earliest a couple of days before the delay. next menstruation. During this time, you can do a blood test from a vein to determine the plasma concentration of human chorionic gonadotropin hormone - hCG. It is best to start using pregnancy tests that are dipped into a jar of urine at home only on the first day of your pregnancy and later.

A week after the start of the delay, if menstruation does not come, and tests reveal signs of hCG, a confirmatory test should be done ultrasonography, which will accurately establish not only the fact of pregnancy, but also its features - the number of fetuses, the place of attachment of the fertilized egg, the absence of signs of ectopic pregnancy and other pathologies.

Feelings after the procedure

Objectively, the sensations after intrauterine insemination are not much different from the sensations of a woman who had unprotected intercourse during the period of ovulation. In other words, there will not be any special sensations on the days that women so expect and hope for after an artificial infusion of sperm.

On the first day, there may be a slight nagging pain that is almost not noticeable. These are the consequences of inserting a catheter into the uterine cavity.

If at this stage there is a strong pull in the lower abdomen, or a high temperature has risen, you need to call “ Ambulance", infection or air entering the uterine cavity is possible.

Approximately 7-9 days after the injection of sperm, implantation can occur if fertilization has taken place. At the same time, some women note a slight increase in temperature, the appearance aching pain in the lower back and small, light discharge from the genitals of a pink, cream or brownish hue. They are caused by blood entering the vaginal secretion from the damaged endometrium. The functional layer of the uterus is damaged when the fertilized egg implants into it. This phenomenon is called implantation bleeding.

This does not happen to every woman, and therefore you should not rely heavily on such a sign of pregnancy. In addition, implantation is not always successful, and pregnancy, before it has time to begin, can be interrupted for a great variety of reasons, not all of which are known and understood by medicine in general and gynecology in particular.

If pregnancy does begin, from the moment of implantation the level of the hCG hormone will begin to slowly accumulate in the body - it is produced by chorion cells, which ovum“clings” to the wall of the uterus. This does not mean that you will immediately begin to feel sick, as some people think. Toxicosis also does not happen to everyone and usually develops a little later.

Among the earliest signs of pregnancy, even before the delay, are increased breast sensitivity, a short-term but daily increase in body temperature in the afternoon or in the evenings to 37.0-37.5 degrees. A woman may think that she has a cold, since the increase in temperature may well be accompanied by a feeling of nasal congestion and frequent urination, however, without pain (as with cystitis). This is how progesterone acts in the body, which begins to “accompany” pregnancy from its first hours and “protect” the embryo.

There are women who do not have all of these signs even after pregnancy. And there are more sensitive women who intuitively feel that everything in the body now “works” in a new way. Until objective data from blood tests and ultrasounds is available, it is better to stop worrying and relax.

Efficiency

Most gynecologists quite reasonably believe that regular sex life(at least 2-3 sexual intercourse per week) has exactly the same chances of conception as a one-time injection of sperm through a catheter. If sex life is irregular, then the procedure still increases the chances of pregnancy, but only slightly - no more than 11%.

The likelihood of a successful procedure is lower in women over 35 years of age, since their oocytes are already in a state of natural aging, which implies a decrease in the quality of the germ cells. Even if sperm get to such eggs, they sometimes cannot fertilize them, and if intercourse does take place, then there is a high probability that implantation will not occur or the fertilized egg will be rejected.

According to WHO, the percentage of positive results from the first time of intrauterine insemination does not exceed 13%. On the second attempt, the probability of getting pregnant increases slightly - up to 20%; on the third and fourth attempts, the maximum percentage is observed positive results– 25-27%. And then there is no increase in positive dynamics. The probability remains stable at 20-22%.

In gynecology and reproductive medicine, it is believed that after the fourth attempt at artificial insemination, further use of the method is inappropriate - most likely, there are other reasons that prevent pregnancy, the couple needs another examination and, possibly, IVF.

Price

The average cost of an intrauterine insemination procedure in Russia starts from 20 thousand rubles and can reach 60 thousand. The final cost depends on the region, the protocol, and the need to use donor sperm. If ovulation stimulation is planned, the procedure may rise in price by three times the minimum value.

Is the procedure at home possible?

There are special kits for insemination at home. It will be enough for a man and a woman to obtain sperm (through interrupted intercourse or masturbation) and insert it. But such insemination cannot be considered intrauterine. For home administration, only vaginal insemination is possible.

The kit includes a syringe with an extension, which allows you to inject sperm as deep as possible into the vagina so that the concentration of sperm is as high as possible. However, this will not help with cervical factor infertility or low sperm motility.

In addition to the syringe, the kit includes tests with high sensitivity to hCG. They can be used approximately 10 days after ovulation.

Doctors are quite skeptical about such kits, because all the manipulations that the couple is asked to do can be easily carried out during natural sexual intercourse.

Important questions

Many religions frown upon fertilization with donor sperm. In Orthodoxy and Islam, this is considered a violation of the sacrament of marriage, in fact, treason. Before agreeing, think carefully about whether you will then experience moral difficulties. The husband who agrees to inseminate his wife with donor sperm must know that the child will not be his own by genes and blood. And a woman should know that it is impossible to choose a donor; all sperm in cryobanks is stored as anonymous.

But patients will be able to get general information about the donor - age, eye color, height, hair color, occupation, level of education. This will help to at least approximately select a type close to the appearance of the spouse who will have to raise the baby.

Unlike IVF, intrauterine insemination does not make it possible to ensure that the fetus has not inherited genetic diseases that he does not have chromosomal abnormalities, because embryos are not selected, as happens during in vitro fertilization at the stage of preimplantation diagnosis. The insemination procedure also does not allow one to know the sex of the unborn child.

Pregnancy, if it occurs as a result of intrauterine injection of sperm, proceeds without any special features. It is no different from pregnancy that occurs as a result of natural sexual intercourse. A woman will not need to go to appointments more often antenatal clinic, and also pass additional examinations beyond the generally accepted, as happens with women after IVF.

Childbirth can occur either naturally or by caesarean section. A history of insemination is not an indication for cesarean section; it may be prescribed for other reasons and indications.