Insemination procedures for infertility

Treatment Overview

An insemination procedure uses a thin, flexible tube (catheter) to put sperm into the woman's reproductive tract. For some couples with infertility problems, insemination can improve the chances of pregnancy.

Donor sperm are used if the male partner is sterile, has an extremely low sperm count, or carries a risk of genetic disease. A woman planning to conceive without a male partner can also use donor sperm.

Prior to insemination, the sperm usually are washed and concentrated (placing unwashed sperm directly into the uterus can cause severe cramps). Concentration is accomplished by selectively choosing highly active, healthy sperm that are more capable of fertilizing an egg.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is the placing of sperm into a woman's uterus when she is ovulating. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus.

IUI can use sperm from the male partner or a donor. It is often combined with superovulation medication to increase the number of available eggs.

Artificial insemination (AI)

Artificial insemination (AI) is another name for intrauterine insemination but can also refer to placing sperm in a woman's vagina or cervix when she is ovulating. The sperm then travel into the fallopian tubes, where they can fertilize the woman's egg or eggs.

AI can be done with sperm from the male partner or a donor, and can be combined with superovulation.

What To Expect After Treatment

These techniques are done on an outpatient basis and require only a short recovery time. You may experience cramping during the procedure, especially if sperm are inserted into your uterus. You may be advised to avoid strenuous activities for the remainder of the day.

Why It Is Done

Intrauterine insemination or artificial insemination may be done if:

  • Tests have shown no cause for a couple's infertility (unexplained infertility).
  • A man releases semen and sperm into the urinary bladder instead of out the penis (retrograde ejaculation). Sperm are collected, washed, and used for insemination.
  • A man's sperm are absent, low in quantity, or poor in quality. In this case, your doctor may recommend that you try ICSI. ICSI stands for intracytoplasmic sperm injection.
  • There is a problem with a woman's cervix, as from prior surgery, that prevents sperm from traveling through it.
  • A woman does not have a male partner.

How Well It Works

Insemination procedures can improve your chances of becoming pregnant, especially when combined with superovulation treatment.1 Treatment success is strongly influenced by a woman's age (an aging egg supply decreases pregnancy rate, and miscarriage risk increases with age).

Note:

Most of the following success rates are given in terms of pregnancies conceived; they do not reflect the fact that some pregnancies miscarry. In any group of women, live birth rates are lower than early pregnancy rates.

Treating unexplained infertility

  • Superovulated IUI offers a greater chance of pregnancy than does superovulated AI.1
  • Without superovulation, IUI, AI, and well-timed intercourse produce similar pregnancy rates.1

Treating male infertility

  • For mild male infertility, IUI has produced double the pregnancy rate (6.5%) of AI or well-timed intercourse (3%).1
  • Superovulation may only slightly increase the chance of conception when using IUI for mild male infertility.1

Treating endometriosis-related infertility

  • For infertility caused by mild endometriosis, women treated with IUI combined with gonadotropin superovulation had a much higher birth rate than those receiving no treatment.1

Studies have found no benefit to the practice of performing two IUI procedures per cycle for "subfertile" couples (who have not naturally conceived in 1 year but have no severe causes of infertility).2

Risks

Insemination combined with superovulation increases the risk of multiple pregnancy (conceiving more than one fetus).1Multiple pregnancy is high-risk for mother and fetuses. For more information, see the topic Multiple Pregnancy: Twins or More.

Insemination procedures pose a slight risk of infection.

Some women experience severe cramping during insemination.

There is a slight risk of puncturing the uterus during intrauterine insemination.

There is a slight risk of ovarian hyperstimulation syndrome if superovulation is used together with insemination.

What To Think About

Insemination procedures are the simplest and least expensive methods of assisted reproduction. No anesthesia or surgery is needed.

Use of donor sperm

If donor sperm are necessary, you can choose a known or anonymous donor who is willing to provide sperm.

  • Donor sperm from a male who isn't a sex partner (as from a sperm bank, friend, or relative) must remain frozen for at least 6 months before it can be used. This is done so that the donor can be tested twice over 6 months to ensure that he does not have any number of infectious diseases, including the human immunodeficiency virus (HIV).3
  • Frozen sperm are less effective than fresh sperm.
  • A couple may choose to use sperm from a donor who resembles the male partner.

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References

Citations

  1. Al-Inany H (2005). Female infertility, search date April 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  2. Cantineau AEP, et al. (2007). Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples. Cochrane Database of Systematic Reviews (2).
  3. Speroff L, Fritz MA (2005). Male infertility. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1135–1173. Philadelphia: Lippincott Williams and Wilkins.

Last Updated: March 21, 2008

Author: Bets Davis, MFA & Sandy Jocoy, RN

Medical Review: Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

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