ARTIFICIAL INSEMINATION

Artificial insemination consists of inserting into the uterus a sample of semen which has previously been prepared in a laboratory to concentrate and capacitate the sperm to give it a greater chance of starting a pregnancy. By placing them inside the womb, we avoid the worst barriers the sperm are faced with, such as the cervix and the womb itself, making their encounter with the egg easier.

Before the insemination is made, the woman will have to be given medication which will improve ovulation. This medication is the same substance which in normal conditions leads to ovulation. By taking it in greater quantities than are spontaneously produced, we ensure on the one hand that ovulation will occur, and if it is possible we increase the number of follicles and, therefore, the number of eggs which are produced that month. This will improve the probabilities of pregnancy though very strict limits are always applied to minimise the risk of a multiple pregnancy. With this aim, every few days, on specific days, the patient must visit the clinic so that ultrasound scans may be carried out. These enable us to control the number of follicles which are developing, as well as to know which the optimum day will be for making the insemination.

Once the ultrasound scan shows that everything is ready, the insemination is made. This procedure is no more unpleasant than a typical gynaecological examination. It consists of introducing a thin tube measuring a few millimetres through the cervix in order to place the semen inside the uterus. Nor does it require the patient to rest more than for the first few minutes after insemination.

Artificial insemination is the simplest assisted reproduction technique we have and the most suitable when we have found small irregularities in male infertility tests. For example, it is the technique which we recommend when small or moderate problems are found in the seminogram. We can equally use artificial insemination if the patient has only one working Fallopian tube.

Another typical sign for artificial insemination is when the cervix will not make the necessary changes during ovulation to all the sperm to pass. In this case, this technique allows us to skip this barrier, placing the sperm directly inside the uterus. Equally, when the problem lies in an ovulation defect in the woman, the fact that ovarian stimulation is required makes artificial insemination the ideal solution.

Finally, there are couples in whom, after undergoing infertility tests, we find no anomaly to explain why they are not getting pregnant. This is what we call infertility of an unknown origin. In such cases, artificial insemination, in view of its simplicity, becomes the first therapeutic step we can offer the patient.

The next question which comes to us is, "What chance of pregnancy do we have with this technique?" Pregnancy rates with artificial insemination lie in the region of 18%-20%. This rate may seem somewhat low, but they are not really if we take into account the fact that the probability of spontaneous pregnancy in a couple without the slightest problem is 25% each time they try for pregnancy. Furthermore, with this technique, it is possible, if one cycle is not successful, to try again and start a new cycle immediately after the period. After four attempts, about two thirds of couples are expecting.

Usually each couple attempts four artificial insemination cycles. The reason for not trying more than this if a pregnancy does not appear is that experience tells us that the probability of success in the fifth or an even later cycle is minimal, as in the majority of cases there is some other problem which justifies another more complex technique being used such as in vitro fertilisation.