ARTIFICIAL INSEMINATION WITH HUSBAND'S SPERM
Artificial insemination is the term used for the placement of sperm in the female reproductive tract by means other than intercourse. Artificial insemination with the husband's sperm can lead to a pregnancy for many infertile couples.
Who is a candidate for artificial insemination?
Artificial insemination is often, but not exclusively, used to treat couples who are infertile because of a male factor. For example, semen abnormalities such as moderately poor sperm count, motility or morphology are often overcome by the use of artificial insemination.
Less commonly, but with good success, artificial insemination is used in cases where the male's sperm are unavailable for contact with the female's reproductive tract. Retrograde ejaculation is one such disorder, and it refers to male ejaculate being released backward into the bladder. This can be found in men with a history of diabetes or trauma to the neck of the bladder. It can also be a side effect of certain medications. When this is the case, sperm may be extracted from a special preparation of urine containing the ejaculate and inserted into the female partner.
Insemination may be used in cases of impotence or severe hypospadias (a urethral abnormality in the man). Some men may store their sperm in a frozen state prior to vasectomy, chemotherapy or testicular surgery. Should they decide to father children, artificial insemination with the thawed sperm may be done. Artificial insemination may also be indicated in certain cases of female infertility as, for example, when there is a cervical disorder that prevents natural conception. It is also used in cases of unexplained infertility (in combination with medication to stimulate the ovaries).
Intrauterine insemination (IUI) is a process by which sperm are placed past the cervix and directly inside the uterus. With natural intercourse, sperm are most concentrated in the cervix and only the most motile ones make their way through the uterus to the fallopian tubes. With IUI, a concentrated suspension of sperm is introduced through the cervix directly into the uterine cavity. This allows large numbers of sperm to reach the fallopian tubes, where fertilization can then occur. This procedure requires that the sperm be "washed" first. That is, the sperm must be separated from the semen (seminal fluid can irritate the uterus, causing severe cramping and pain). Sperm washing is performed under strictly sterile conditions and a variety of safeguards are maintained to insure that semen samples cannot be switched.
The Insemination Procedure
The husband is asked to produce a semen specimen in a clean, sterile container. If the specimen needs to be obtained through intercourse with a condom, a special collection kit may be used. The specimen must be brought to the lab within one hour of production. After the sperm washing procedure is completed, IUI may be done any time within several hours. When the specimen is ready, a speculum is inserted into the vagina and the washed sperm are inserted into the uterus via a small plastic catheter. It is a simple procedure and takes only a few minutes with no or minimal discomfort. When performed during a natural cycle, IUI is timed according to an LH (luteinizing hormone) surge, which precedes ovulation. When used in conjunction with ovulation induction, an injection of hCG (Profasi(r), Novarel(r), Ovidrel(r)) is generally used to trigger release of the egg, which allows optimal timing.
Success rates for artificial insemination are dependent mainly on the specific indication for which it is being used. When the sperm are inherently normal and only physical or psychological barriers to contact with the female partner exist, correctly timed insemination is most often successful, although not always on the first attempt. Where abnormalities of sperm production are present, success depends on the severity of the abnormality involved. With severely depressed counts, ovulation inducing agents are often given to the female partner in order to enhance the per cycle pregnancy rate. With the severest abnormalities, artificial insemination cannot be done and in vitro fertilization with intracytoplasmic sperm injection (ICSI) is required. Obviously, the reproductive potential of the female partner is also crucial.
Prior to beginning a program of artificial insemination, it is important to exclude any female factors that may also be obstructing conception and to discuss realistically the time frame in which pregnancy is expected to occur. There is no increased risk of congenital abnormalities in children born as a result of artificial insemination.