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Artificial Insemination

Artificial insemination (or Intrauterine insemination (IUI)) is a technique that can help treat certain kinds of infertility in both men and women. It’s a popular infertility treatment for men who have low sperm counts, or when doctors cannot determine the reason a couple is infertile.

In this procedure, sperm are “washed” by centrifugation and then injected directly into the uterus. This makes the trip shorter for the sperm and bypasses any possible cervical mucus obstructions. Ideally, it makes pregnancy possible where it wasn't before.

Though the pregnancy rates for women undergoing artificial insemination may not be as high as they are for some more advanced techniques, this technique has a key advantage: It's a simple procedure with few side effects. For those reasons, it may be recommended for some couples as an initial form of treatment for infertility.

If you are undergoing artificial insemination, your doctor will use ovulation kits, ultrasound, or HCG injections to make sure you are ovulating when you undergo artificial insemination.  In some cases, your doctor will place you on fertility drugs, such as clomiphene (Clomid), Letrozole (Fermara) or FSH injections to induce superovulation (ovulation of multiple eggs) before you undergo artificial insemination.

When you are ovulating, your partner will be asked to produce a semen sample. The doctor will suggest that your partner abstain from sex for two to five days in advance to ensure a higher sperm count. If you live close to the clinic, your partner may be able to collect the semen at home by masturbating. Otherwise, the clinic will provide a private room for this purpose. The sperm must be "washed" in a laboratory within one hour of ejaculation.

The process of "washing" the sperm enhances the chance of fertilization and removes chemicals in the semen that may cause discomfort for the woman. It consists of liquefying the semen at room temperature for 30 minutes. Then, semen is layered over a harmless chemical solution and it is centrifuged to collect the best sperm.

The sperm are then suspended in culture medium and placed in a thin catheter to be introduced through the vagina and cervix into the uterus. Artificial insemination is a short, relatively painless procedure that many women describe as being similar to a Pap smear. Some women have cramping during the procedure and light bleeding afterward. Immediately after the procedure, your doctor will probably have you lie down for about 15 to 45 minutes to give the sperm a chance to get to work. After that, you can resume your usual activities. Two days later, you start vaginal progesterone inserts supplementation.

Success rates for artificial insemination vary. Factors that lessen your chance of success include:

  • Advanced female reproductive age (older than 35)
  • Poor egg quality
  • Poor sperm quality
  • Severe endometriosis
  • Severe damage to fallopian tubes (usually from chronic infection)
  • Blockage of fallopian tubes (IUI will usually not work in this case)

In Vitro Fertilization procedure (IVF)

This procedure consists of harvesting eggs (oocytes) directly from ovarian follicles with a needle introduced through the vaginal wall under direct ultrasound guidance.  This is an office-based outpatient minimally invasive procedure under anesthesia. First, the ovaries are stimulated with FSH hormone injections in order to induce multiple egg development. At the same time the eggs are harvested, the male provides his semen specimen and the eggs and the sperm are combined in the Petri dish to allow for sperm-egg interaction resulting in fertilization. Alternatively, a direct Intra-Cytoplasmic Sperm Injection (ICSI) can be performed. Embryos are cultured in an incubator and 3 or 5 days later, one or two embryos are placed into the uterine cavity using a plastic catheter. If more than 1-2 embryos are developed, the remaining ones are frozen (cryopreserved) in liquid nitrogen for long term storage for later use.

IVF is performed if the Fallopian tubes are removed (salpingectomy) or blocked permanently. Also, if the sperm concentration is very low or all other infertility treatment options have been exhausted then IVF becomes the last available approach.

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