Artificial Insemination Treatment (AI)
What is Artificial Insemination?
Artificial Insemination (AI) refers to a fertility procedure in which sperm is inserted directly into the uterus, in order to improve the chances of conception. It is performed close to the time of ovulation (when the ovary releases an egg).
AI can involve the use of fresh sperm (i.e., from the male partner) or frozen sperm, from the partner or even a donor, and the procedure can be performed during a natural cycle or with artificial hormone stimulation.
How can Artificial Insemination help us?
AI places specially prepared sperm (i.e., washed and concentrated) into the uterus, bypassing the cervix and vagina.
It is considered an easier, cost-effective alternative for couples who prefer to avoid more complex treatments (such as IVF).
The AI procedure is commonly suggested for women diagnosed with infertility, where the fallopian tubes are considered healthy, and more complex treatments are not needed/required.
Who is Artificial Insemination recommended for?The procedure is recommended for couples experiencing the following:
- Problems with intercourse, but potentially normal sperm production.
- Long periods of absence, where normal sperm may be frozen.
- Women with any of the following:
- Unexplained infertility
- Mild to moderate Endometriosis.
- Hostile cervical mucus.
- Ovulatory disorders responsive to fertility medication
- Men with any of the following:
- Mild sperm abnormalities
- Abnormal seminal fluid
- Women over 40 years of age,
- Women with tubal blockage or severe tubal damage,
- Women with severe endometriosis, or
- Men with markedly abnormal semen analysis.
- Is azoospermic (i.e., no sperm is produced),
- Carries a hereditary or infectious disease (e.g., HIV),
- Is unable to produce sperm (e.g., in cases of injury or medical treatment such as chemotherapy).
This procedure can also be used for same sex couples.
An overview of Artificial Insemination – what will happen?
The method of Artificial Insemination most commonly used is called Intra-Uterine Insemination (IUI).
There are currently three IUI treatment options available. Which one is right for your situation will be discussed with you prior to any treatment taking place.
The options are:
Natural Cycle Insemination
Time of insemination follows the woman’s natural menstrual cycle. It may be used for couples who are unable to have natural intercourse for fertilisation, including same sex couples. It is not a successful method for couples where the male is experiencing poor sperm quality.
Induced Cycle Insemination
Clomiphene Citrate Ovulation Induction
In order maximise the insemination opportunity, medication is used to stimulate the ovaries and cause or regulate ovulation (i.e., release of eggs). The use of this medication in combination with IUI has been shown to increase pregnancy rates over Natural Cycle IUI.
Follicle Stimulating Hormone (FSH) Ovulation Induction
Ovarian stimulation is stronger with this option and it has been shown to increase pregnancy rates over Natural Cycle IUI and Clomiphene Citrate IUI. However, regular monitoring is required to minimize complications relating to overstimulation of the ovaries.
The most recent studies have suggested that the most successful pregnancy results are achieved using Induced Cycle IUI.
IUI involves preparing or ‘washing’ the sperm. The technique of sperm preparation involves separation of the seminal plasma from the actual sperm cells, followed by concentration of the sperm that appear to be stronger and healthier (i.e., they are more uniform in their shape, size and motility).
The specially selected sperm are then gently inserted into the uterine cavity using a speculum (to open the vagina and expose the cervix) and a disposable catheter (to bypass the cervix and place the sperm into the uterus).
The procedure itself is not painful - in fact, it is described by many women as similar to a Pap smear. There may be some mild discomfort, but normal daily activities can be resumed immediately after the procedure. The whole procedure takes just a few minutes. Partners are more than welcome to attend the insemination procedure.
What if Artificial Insemination doesn’t work for us?
If the AI / IUI procedure is unsuccessful after three to six cycles (i.e., cycles where artificial insemination is performed), your fertility treatment will be reviewed. Some options could include the addition of fertility drugs, or hormone tablets to enhance fertility.
However, it is recommended that after three unsuccessful attempts, consideration should be given to an In Vitro Fertilisation (IVF) cycle. The potential improvement in fertility that this type of treatment may offer will depend upon the analysis of the semen, and will be discussed with you prior to further options being offered. We understand that this is an emotional and stressful time for our patients. Please be assured that risk/benefit issues will be discussed with you by your specialist prior to any treatment taking place, and you should be prepared to ask as many questions as you need to feel comfortable with proceeding.
Many couples are hesitant to consider IVF due to cost restraints, and hence favour an AI as a first option. Careful consideration should be given to both options. The difference in cost for undergoing a number of AI treatments compared with one cycle of IVF may well be offset by the comparative potential pregnancy success rates. It may therefore be worth considering IVF as a first option, depending on individual circumstances. These decisions can be discussed prior to any final decisions being taken.
What are the Potential Risks of Artificial Insemination?
Infection is a rare but important risk occurring in fewer than 1 in 500 cases. It may be more common in women with a history of previous pelvic infection, who may be given antibiotics in order to minimise this risk.
Sometimes, there is an unexpected excessive response from your ovaries to low dose FSH injections. Some women who over-respond may develop ‘Ovarian Hyperstimulation Syndrome (OHSS). Symptoms include severe discomfort, nausea, vomiting, abdominal distension (swelling) and dehydration. It is important that the clinic is notified immediately if any of these symptoms occur during your treatment, as hospitalisation may be required.
When ovarian stimulation has been undertaken, multiple pregnancy may occur (up to 10% of women). If there are too many follicles seen on ultrasound prior to the IUI procedure, the risk of multiple pregnancy may be too high and the procedure may be cancelled.
In a small number of cases (about 2%), it is not possible to place the catheter into position through the cervix and the sperm cannot be inserted into the uterine cavity.