Artificial insemination

| Artificial insemination is an assisted reproductive technique in which the encounter between the sperm and the egg is facilitated.

In a normal sexual relationship, the sperm are deposited in the woman's vagina, they must cross the cervix and go up through it until they reach the fallopian tubes. Then they must travel through the tubes until they reach the ovum and fertilize it. In artificial insemination, the sperm are deposited inside the uterus, as close to the tubes as possible to facilitate their journey.

First of all, a visit should be made with the reproduction specialist who, after the pertinent study, will indicate the best treatment in each case. Depending on the case, conguyal artificial insemination (IAC) may be indicated, that is, with the partner's semen, or artificial insemination with donor semen (IAD).

The IAC is indicated in the cases of:

• Slight alteration in the quality or quantity of sperm in the seminogram study.
• Alterations in the cervix.
• Some patients with ovulation disorders.
• Sterility of unknown origin.
• Urological pathology: in some cases of retrograde ejaculation, or impotences due to spinal cord injuries, sperm can be recovered for insemination.
• Oncological patients: when an oncological treatment must be carried out on the male that may cause subsequent sterility, semen samples can be frozen for later use.

The IAD is indicated in the cases of:

• Azoospermia: Inability of the testes to produce sperm.
• Hereditary diseases.
• Women without a male partner.

In both IAC and IAD, treatment consists of three phases: ovulation induction, sample preparation, and insemination.

Ovulation induction is usually done with gonadotropins injected subcutaneously. Treatment usually lasts between 5 and 12 days and medical controls are carried out to assess the number and growth rate of the follicles and the advisability of adjusting the medication regimen. The first control is usually carried out between 4 and 6 days after the start of treatment, it consists of a vaginal ultrasound and the date of the next control is usually set. In some cases it is also necessary to perform blood tests at these visits. The number of controls to be carried out depends a lot on each patient, but 3-4 are usually required for each cycle. When at least one follicle is mature, the administration of another injected hormone (HCG) is indicated to trigger ovulation between 36 and 42 hours after its administration.

On the day of insemination, a semen sample collected following some very simple guidelines should be brought to the laboratory:

• Sexual abstinence for 3-5 days prior to collection.
• Sample delivery no later than one hour after collection.
• Obtaining the sample by masturbation and collecting it in a sterile container.
• Collect all the ejaculate.
• Notify if you are taking any medication or have had a recent episode of fever.

In some cases where it is not possible to obtain it on the same day as insemination, it can be frozen unless the quality of the sample contraindicates it.

The sample obtained is processed in the laboratory, generally with a gradient technique, which separates the seminal plasma, cell debris, dead, immobile or slow sperm from sperm with greater mobility and fertilization capacity, which are concentrated in a volume small. Prostaglandins are also removed from the semen to avoid subsequent uterine contractions that, in addition to being painful, would impede the success of the technique.

Insemination is a simple technique that is performed in the same office. The patient lies on the table in a gynecological position, a vaginal speculum is placed as in an annual check-up, and a fine cannula is inserted through the cervix into the interior. The seminal sample is injected through the cannula and the patient rests for a few minutes afterwards.

In the case of a donor insemination, the process is the same as the conjugal one, but the semen sample is obtained from a semen bank. The donor candidates undergo various tests to minimize the risk of diseases communicable to the offspring, and are selected according to the physical characteristics of race, size, eye color ...

The first day after insemination, immersion baths and sexual intercourse should be avoided and after 24 hours a normal life can be carried out. Small blood loss and slight abdominal pain may appear for the first few days. Sometimes a treatment with progesterone ovules is recommended the first days after insemination.

The success rate is between 15-20% for each cycle. 90% of women who become pregnant with artificial insemination do so in the first four cycles, so after four cycles it is recommended to change the technique if it has not been successful.

The risks of artificial insemination are multiple pregnancy, which occurs in 10-15% of cases, and ovarian hyperstimulation syndrome, which occurs in 1% of patients. Subsequent pregnancy has a risk of miscarriage and ectopic pregnancy similar to a spontaneous pregnancy, and the risks to the mother and fetus are the same as in a normal pregnancy.