Among the assisted reproductive technologies for infertility, artificial insemination is a simple, economical and non-surgical treatment, which mainly focuses on male factors, such as oligo-, oligo- and malformed spermatozoa, semen non-liquefaction or poor liquefaction, sexual dysfunction that prevents normal sexual intercourse, retrograde ejaculation, non-ejaculation, etc. In addition, artificial insemination by donor sperm can also be used for patients with azoospermia, and female vaginal and cervical abnormalities where semen cannot enter the reproductive tract normally, as well as immune infertility. In addition, artificial insemination can be used to assist pregnancy in cases of vaginal or cervical abnormalities of the female partner and immune infertility.
The artificial insemination technique can be divided into artificial insemination with husband sperm (AIH) and artificial insemination by donor sperm (AID) according to the source of semen. The so-called artificial insemination by husband means collecting the husband’s semen, washing and separating it, and slowly injecting the washed semen into the wife’s internal reproductive organs with the help of artificial insemination tubes through the operation of a doctor to achieve the purpose of conception; while artificial insemination by donor means the use of sperm from the national sperm bank for the purpose of fertility when the husband has serious male infertility problems that have not been treated by various methods and his spouse has normal fertility. Artificial insemination with donor semen is performed using sperm from the national sperm bank for fertility purposes.
Artificial insemination has been used in clinical practice for two hundred years. At the beginning, it was mainly used for anatomical abnormalities such as severe hypospadias, retrograde ejaculation, impotence and premature ejaculation, etc. In recent decades, it has been used for patients with reduced semen volume, sperm count less than 20 million/ml, low sperm motility, less than 50% of motile sperm and semen non-liquefaction. With the accelerated pace of modern life, environmental pollution, high male work pressure, socializing and other factors, the occurrence of male infertility has become more prominent. There are already many infertile couples who have obtained pregnancy through artificial insemination techniques.
A. Artificial insemination is not applicable to all infertility patients.
The necessary conditions for artificial insemination are: first, the female’s fallopian tubes are usually on at least one side and function well; second, the female has normal ovulation function; third, the male must have a certain number of sperm in his semen. We must emphasize that the main purpose of artificial insemination is to allow the concentration of sperm entering the female internal genitalia to reach or approach the level of a normal couple during natural intercourse, while by washing the sperm, the antigens on the surface of the sperm can be removed to facilitate conception.
In the artificial insemination technique, the female factor does not change much and the male factor improves significantly, so its pregnancy rate is comparable to the natural conception rate of a normal couple, about 20% per cycle.
Second, the medical procedure for couples who need artificial insemination is roughly as follows.
1. First of all, you should choose a regular medical institution qualified for artificial insemination for consultation.
In accordance with the management specifications of the Ministry of Health on assisted reproductive technology, medical institutions engaged in artificial insemination of husband sperm must be evaluated and recorded by the Department of Health, and institutions engaged in artificial insemination of donor sperm and human sperm banks must be evaluated and approved by the expert group of the Ministry of Health, therefore, it is necessary to choose a regular medical institution qualified for artificial insemination for consultation.
2, followed by the exclusion of infectious and genetic diseases that are not conducive to the implementation of artificial insemination techniques and pregnancy.
Both men and women should undergo relevant infertility examinations to determine whether they need to implement artificial insemination techniques and to exclude contraindications, such as acute genitourinary infections or sexually transmitted diseases in one of the men and women or serious hereditary diseases or psychosomatic diseases, one of the men and women is in the period of radiation and toxic substances, one of the men and women has drug addiction and other bad habits. If the female partner has obstructed or dysfunctional fallopian tubes, she should choose in vitro fertilization-embryo transfer technique instead of artificial insemination to facilitate pregnancy.
3. Thirdly, it is necessary to clinically monitor the female partner’s ovulation period and implement artificial insemination during the ovulation period.
The determination of the female partner’s ovulation time is the key step for the success of IUI. Generally, you can use urine LH test paper and ultrasound to monitor the growth of follicles from the tenth day of the woman’s menstruation. The doctor will determine that ovulation is about to occur by referring to the vaginal ultrasound of the woman (including changes in the endometrium, follicle size, etc.) and the cervical mucus condition, and artificial insemination can be performed around the time of ovulation. Ovulation is the best time to send the male partner’s carefully selected “quality sperm” into the female partner’s uterus.
4, the implementation of artificial insemination technology can not violate the relevant national fertility policy.
It is important to emphasize that, according to the Ministry of Health, the implementation of assisted reproductive technology must be in possession of identity cards, marriage certificates, birth certificates, after reviewing the original copy retained for the record. Can not violate the national family planning policy and the relevant reproductive laws and regulations.
5, artificial insemination technology should be followed up on time.
Generally speaking, 15-20 days after the implementation of artificial insemination still no menstrual flow, should promptly return to the hospital, has determined whether pregnancy, and further post-pregnancy follow-up, including the pregnancy site, the number of pregnant fetuses, whether the need to strengthen luteal support, etc., to ensure the continuation of pregnancy. If there is no pregnancy, it is recommended to follow up after the onset of menstruation and the next treatment plan has been formulated.
III. Some issues related to artificial insemination technique.
There is no difference between pregnancy after artificial insemination and natural pregnancy, and there is no difference in the comparison of fetal birth defect rate. Related pregnancy complications such as miscarriage, ectopic pregnancy, pregnancy-related diseases, and mode of delivery are not different from natural pregnancy.
In addition, it is worth mentioning that many women think that IUI is “painful”, but in fact, the process of IUI is not an invasive operation. It only requires the exposure of the cervix with a vaginal speculum and the gentle delivery of washed good sperm into the uterus with a small diameter insemination tube, which does not cause pain or other discomfort. Unnecessary and excessive mental anxiety may lead to ovulation disorders in women and reduced sperm viability and difficulties in sperm retrieval in men, thus making IUIs fail.
Therefore, in addition to listening to the doctor during the consultation, the patient couple needs to adjust their mindset, try to relax and get enough rest, which is the primary prerequisite for conceiving a healthy baby. However, informal medical institutions do not have the relevant technology for washing semen, and directly injecting semen into the uterus without washing can have more serious adverse consequences.
Artificial insemination is a relatively simple assisted reproduction technique that costs about $1,000 on average, and many infertile couples have benefited from this technique to become pregnant. However, IUI is not recommended to be performed an unlimited number of times for infertility treatment. Studies have found that when conception does not occur after 4-6 cycles of continuous effective IUI techniques, other factors causing infertility, such as pelvic adhesions, tubal factors, etc., should be taken into consideration and the factors associated with infertility should be re-evaluated and, if necessary, in vitro fertilization-embryo transfer techniques should be performed to help conception.
If the patient also has ovulation disorders, ovulation promotion should be performed at the appropriate time after the doctor’s examination and then IUI should be performed when the follicles are mature and ready to ovulate. The pregnancy rate with IUI after ovulation promotion is slightly higher, around 20-25%, but one should be alert to the occurrence of ovarian hyperstimulation syndrome and multiple pregnancies.