Everything large quantity married couples in last years need assisted reproductive technology. A few decades ago, with some problems, women and men remained childless. Now medicine is developing at a very fast pace. So if you can't for a long time to become pregnant, it is worth using a method such as insemination. Who succeeded the first time, the presented article will tell you. You will learn about the procedure and how it is carried out, and you will also be able to read the reviews of patients who have passed this stage.

Assisted intrauterine insemination

Artificial insemination is the process of introducing into a cavity reproductive organ a woman's sperm from her partner. This moment- the only thing that happens artificially. After that, all processes are carried out naturally.

Insemination can be done with the husband's or a donor's sperm. The material is taken fresh or frozen. modern medicine and the experience of doctors allow a couple to conceive a child even in the most seemingly hopeless situations.

Indications for the operation

The insemination procedure is indicated for couples who cannot conceive a child on their own within a year, while both partners do not have any pathologies. Usually in this case they talk about infertility. of unknown origin. Also indications for insemination will be such situations:

• decrease in sperm quality or sperm motility in a man;
• erectile dysfunction;
• irregular sex life or sexual disorders;
• cervical factor of infertility (production of antisperm cells in the partner's cervical canal);
• age factor (both men and women);
• anatomical features of the structure of the genital organs;
• the impossibility of sexual intercourse without protection (with HIV infection in a woman);
• the desire to conceive a child without a husband, and so on.

Insemination with sperm is usually carried out in private clinics dealing with assisted reproductive technologies. The procedure requires some preparation and has several stages. Let's consider them.

Exploratory survey

Artificial insemination involves the diagnosis of both partners. A man must pass a spermogram so that specialists can reasonably assess the condition of sperm. If unsatisfactory results are obtained during the procedure, additional manipulations will be applied. Also, the partner is examined for the presence of sexual infections, takes a blood test and fluorography.

The woman is to big diagnostics than a man. The patient undergoes ultrasound diagnostics, tests to determine genital tract infections, and provides fluorography. Also expectant mother it is necessary to investigate the hormonal background, to determine the ovular reserve. Depending on the results obtained, further tactics of working with the couple are chosen.

Initial stage: stimulation or natural cycle?

Before insemination, some women are prescribed hormonal drugs. You need to take them in a strictly prescribed dose.

The doctor indicates the days when the medicine is administered. It can be in the form of tablets or injections. Hormonal ovarian stimulation is needed for a woman with ovulation disorders, as well as for those patients who have a reduced ovarian reserve. A decrease in the number of eggs can be an individual feature or a consequence of ovarian resections. Also, a decrease is observed in women approaching 40 years.

Both during stimulation and natural cycle, the patient is prescribed folliculometry. The woman regularly visits a specialist ultrasound diagnostics, which measures the follicles. Attention is also drawn to the state of the endometrium. If the mucous layer grows poorly, then the patient is prescribed additional medications.

Important point

When it is found that the follicle has reached the appropriate size, it is time to act. Depending on when ovulation occurs, insemination is prescribed in a few days or a couple of hours. Much depends on the condition of the sperm. If fresh material is used, then its introduction can occur no more than once every 3-5 days. Therefore, the couple is offered two options:

• insemination 3 days before ovulation and a few hours after it;
• the introduction of the material once directly during the rupture of the follicle.

Which of the methods is better and more efficient has not yet been determined. Much depends on the health of the partners and the indications for insemination. Those who succeeded the first time with a single injection are not advised to decide on a double one. And vice versa. The situation is different with frozen sperm or donor material.

Another variant

Insemination by a donor always involves pre-freezing of the material. Such sperm after thawing can be introduced in several portions. Efficiency this method slightly higher than fertilization with fresh material.

You can also freeze sperm in your partner married couple. You don't have to be a donor to do this. You need to discuss this issue with a reproductive specialist. In time, its quality improves, only the best, fastest and healthiest spermatozoa are selected. Pathological cells are removed from the material. As a result of the manipulation, a so-called concentrate is obtained.

Material introduction process

This procedure takes no more than half an hour. The woman is located in the usual position. V cervical canal A thin catheter is inserted through the vagina. A syringe with the collected material is fixed at the other end of the tube. The contents of the injection are delivered to the uterus. After that, the catheter is removed, and the patient is recommended to lie down for another 15 minutes.

On the day of insemination, a woman is forbidden to strain and lift heavy objects. Rest recommended. There are no restrictions for the next day. However, personal hygiene must be observed, since after insemination there is a risk of infection.

On the first and second days from the transfer of the material, a woman may experience pulling pain in the lower abdomen. Doctors do not advise taking medications. If the pain seems unbearable to you, then you need to seek medical help. Also, some patients may have minor bloody issues. They are associated with a small and the possibility of trauma to the mucous membrane. Allocations pass independently and do not require the use of additional drugs.

Pregnancy diagnostics

After insemination, pregnancy should occur within a few hours. After this time, the egg becomes incapacitated. But at this moment, the woman still cannot find out about her new position. Some patients are prescribed hormonal support. Preparations are always needed in a cycle with stimulation and sometimes in a natural one.

The test after insemination will show correct result after 10-14 days. If a woman was stimulated and an injection of chorionic gonadotropin was given, then positive test she can see immediately after the procedure. However, he does not talk about the onset of pregnancy. The reagent on the strip only shows the presence of hCG in the body.

Ultrasound can most accurately confirm or refute pregnancy. But this may not be earlier than 3-4 weeks after the procedure. Some modern devices allow you to get the result after 2 weeks.

Insemination: who succeeded the first time?

There are statistics of couples who performed such manipulation. The chance of pregnancy ranges from 2 to 30 percent. Whereas in the natural cycle, without assisted reproductive methods, in healthy spouses it is 60%.

A favorable outcome on the first attempt usually occurs under the following conditions:

• the age of both partners is in the range from 20 to 30 years;
• the woman does not have any hormonal diseases;
• in history, the man and woman do not have genital tract infections;
• partners lead healthy lifestyle life and prefer proper nutrition;
• duration failed attempts to conceive a child is less than five years old;
• no previous ovarian stimulation or gynecological surgery.

Despite these parameters, success can be in other cases.

One of the modern assisted reproductive techniques is intrauterine insemination. This is the name of the artificial (outside intercourse) introduction of sperm into the uterine cavity to increase the likelihood of pregnancy. Despite a fairly long history and ease of implementation, this method firmly occupies its niche in the treatment certain types. To increase the effectiveness of the procedure, it is necessary to carefully approach the definition of indications and the preliminary examination of partners.

History reference

Initially, artificial insemination with the introduction of sperm into the vagina was used to impregnate a dog in 1780 by the Italian Lazaro Spalazzi. Published information about obtaining normal and viable offspring inspired the Scottish surgeon John Hunter practicing in London in 1790. On his recommendation, a man suffering from hypospadias collected sperm, which was inserted into the vagina of his wife. This was the first documented successful attempt at insemination resulting in the woman's pregnancy.

Since the second half of the 19th century, artificial insemination has been widely used for the treatment of infertility in many European countries. Initially, native sperm was injected into the woman's posterior vaginal fornix. Subsequently, techniques were developed with irrigation of the cervix, intracervical administration and the use of a special cervical cap.

In the 1960s techniques have been developed to extract enriched and purified portions of sperm. This gave impetus to further development reproductive technologies. To increase the likelihood of conception, spermatozoa began to be injected directly into the uterine cavity and even into the mouth. fallopian tubes. The method of intraperitoneal insemination was also used, when a portion of the prepared sperm was placed directly to the ovary using a puncture of the Douglas space.

Even the subsequent introduction of complex invasive and extracorporeal reproductive technologies has not led to the loss of the relevance of artificial insemination. Currently, intrauterine sperm injection is mainly used, and often this technique becomes the first and successful way to help infertile couples.

Indications for intrauterine insemination

Artificial intrauterine insemination can only be used in a certain group of infertile couples. Determination of indications and contraindications with a prognosis of the effectiveness of the procedure is carried out after examination of both sexual partners. But in some cases the estimate reproductive health required for women only. This happens if you want to get pregnant out of wedlock or if a man has insurmountable obstacles to spermatogenesis (lack of both testicles for some reason).

In the Russian Federation, when deciding on the advisability of insemination with the husband's or donor's sperm, they rely on the Order of the Ministry of Health of the Russian Federation No. 67 dated February 26, 2003. Allocate testimony from the woman and from her sexual partner (husband).

Intrauterine insemination frozen donor sperm is used when the husband has hereditary diseases with an unfavorable medical and genetic prognosis and for sexual and ejaculatory disorders, if they are not amenable to therapy. The indication is also the absence of a permanent sexual partner in a woman.

Intrauterine insemination with the husband's sperm (native, pre-prepared or cryopreserved) is performed with cervical infertility factor, vaginismus, infertility of unknown origin, ovulatory dysfunction, mild degree. The male factor is moderate ejaculatory-sexual disorders and the presence of subfertile sperm.

Like other auxiliary methods, insemination is not carried out in the presence of active inflammatory process, infectious disease or malignant tumor any localization. The reason for refusal may also be some mental and somatic diseases if they are a contraindication to pregnancy. You can not use insemination and in the presence of pronounced malformations and pathology of the uterus, preventing the bearing of a child.

Methodology

For the implementation of intrauterine insemination, the woman does not need to be hospitalized. Depending on the type of infertility, the procedure is carried out in a woman's natural or stimulated cycle. The protocol for hormonal stimulation of hyperovulation is determined by the doctor and is most often similar to that in preparation for.

Preliminary conduct a thorough survey of partners to identify the most probable cause infertility. Attempts are necessarily made to treat and correct the identified deviations with repeated monitoring of the results. Only then can a decision be made on the need for insemination with an assessment of the need to use donor frozen sperm.

There are several stages of the procedure:

• use of the hyperovulation stimulation protocol in a woman (if necessary);
• and laboratory monitoring of the onset of natural or stimulated ovulation;
• collection of sperm from a sexual partner or defrosting of cryopreserved sperm of a donor (or husband) is carried out during the periovulatory period;
• preparation of sperm for insemination;
• introduction of the received portion of the material through the cervical canal into the uterus using a syringe with a thin catheter attached.

The intrauterine insemination procedure itself is short and painless. To facilitate access and provide visual control, the doctor usually uses vaginal mirrors. The cervix usually does not require additional expansion, the small diameter of the catheter allows you to easily pass it through the cervical canal, which is ajar during ovulation. However, small diameter cervical dilators are sometimes required. Semi-rigid or flexible memory catheters are currently used for insemination.

Intrauterine injection of sperm is carried out without using any means of visualizing the position of the catheter tip. During the procedure, the doctor focuses on his feelings when passing through the cervical canal and pressing the syringe plunger. Upon completion of the introduction of the entire portion of the prepared sperm, the catheter is carefully removed. After intrauterine insemination, it is advisable for a woman to lie on her back for 30 minutes. At the same time, the doctor necessarily monitors the appearance of signs of a pronounced vasovagal reaction and anaphylaxis, if necessary, providing emergency assistance.

Semen preparation

Intrauterine insemination is a simple, painless and non-invasive way to improve the chances of fertilization of an ovulating egg. At the same time, spermatozoa do not have to survive in acidic and not always favorable environment vagina and independently penetrate through the cervical canal of the cervix. Therefore, even insufficiently active male germ cells get the opportunity to participate in fertilization. And a high concentration of spermatozoa artificially created in the uterine cavity significantly increases the likelihood of conception.

When performing intrauterine insemination, the sperm of a woman's sexual partner or frozen donor biological material is used. The choice depends on the quality of the ejaculate, the presence of contraindications to the use of the husband's biomaterial (for example, in the presence of severe genetic abnormalities) and other criteria. There are no special requirements for the collection of native sperm. But it is desirable to receive ejaculate in medical institution for the fastest and most gentle transportation to the laboratory.

Sperm intended for insemination undergoes a short preliminary preparation. It usually lasts no more than 3 hours. Preparation is necessary for the selection of viable spermatozoa and obtaining the most purified material before introducing it into the uterine cavity. Sperm taken from a sexual partner or donor is examined in accordance with WHO standards to clarify the quantity and quality of spermatozoa, assess the prospects for its use for insemination (we wrote about the main method of semen analysis in our article ""). After that, the native ejaculate is left for 30 minutes to naturally liquefy, and the thawed sample can be immediately processed.

One of the following methods can be used to prepare sperm:

• floating, based on the active movement of mobile and viable spermatozoa on the surface of the washing medium;
• washing with drugs to increase sperm motility (pentoxifyllines, methylxanthines);
• centrifugation of the diluted sperm sample to create a density gradient;
• filtration of the washed and centrifuged portion of the ejaculate through glass fiber.

The choice of material preparation method depends on the content of morphologically normal and mature germ cells, as well as on the class of their mobility. In any case, the semen processing technique used for intrauterine insemination should provide the maximum complete removal seminal plasma. This is necessary to prevent the development anaphylactic shock and others adverse reactions from the woman's body. Together with the seminal plasma, antigenic proteins (proteins) and prostaglandins are removed.

It is also important to free the ejaculate from dead, immature and immobile spermatozoa, leukocytes, bacteria and impurities. epithelial cells. Competent pre-treatment provides sperm with protection from the resulting oxygen free radicals and maintains the stability of the genetic material of the cells. As a result of processing, the specialist receives a sample with the maximum concentration of spermatozoa suitable for fertilization. It is non-storable and must be used the same day.

artificial insemination at home

Sometimes intrauterine insemination is performed at home, in which case the couple uses a special kit and native fresh ejaculate. But at the same time, sperm is not injected into the uterine cavity in order to avoid infection and the development of anaphylaxis. Therefore, this procedure is actually vaginal. The kit for intrauterine insemination at home most often includes urinary tests for, FSH and hCG levels, a syringe and an extension cord for it, a vaginal speculum, and disposable gloves. Sperm is drawn into a syringe and injected deep into the vagina through an extension cord. This allows you to create high concentration spermatozoa near the cervix.

After the procedure, the woman must remain in a horizontal position with a raised pelvis for at least 30 minutes to avoid semen leakage. Orgasm increases the likelihood of pregnancy, because it helps to reduce the walls of the vagina and changes the patency of the cervical canal.

The kit also includes highly sensitive pregnancy tests. They allow already on the 11th day after insemination to detect a specific increase in the level of hCG in the urine. At negative result and delayed menstruation, the test is repeated after 5-7 days.

Method efficiency

According to the European Society for Human Reproduction and Embryology, the prognosis of pregnancy after a single intrauterine insemination is up to 12%. Wherein repeated procedure in the same cycle only slightly increases the likelihood of conception. Most of all, the effectiveness of insemination is affected by the time of its implementation, it is desirable to carry out the procedure as close to the time of ovulation as possible. Depending on the individual features the periovulatory period begins already on the 12th day of the ovarian- menstrual cycle or falls on the 14th - 16th day. Therefore, it is very important to determine the time of expected ovulation as accurately as possible.

To plan the date of insemination, the results of transvaginal ultrasound monitoring of follicle maturation and dynamic monitoring of the level of luteinizing hormone in the urine are used. The same studies allow you to choose the time for the injection of preparations based on chorionic gonadotropin, the main trigger of ovulation during the stimulating protocol. Ovulation usually occurs 40 to 45 hours after the peak urinary luteinizing hormone levels. It is during this period that it is desirable to carry out intrauterine insemination.

The success of the procedure is affected by the type of infertility, the parameters of the sperm used during insemination, and the age of the partners. The condition of the fallopian tubes, the thickness and functional usefulness of the endometrium in the current cycle are also important. For a preliminary forecast of insemination, sometimes on the day of the procedure, a woman undergoes a three-dimensional ultrasound with the determination of the volume of the endometrium. A volume of 2 ml or more is considered sufficient for implantation of the fetal egg.

The stronger the fertility of the sperm used for artificial insemination, the higher the chance of a successful pregnancy. The most important parameters are the mobility of spermatozoa with the possibility of their purposeful movement, the correctness of the morphological structure and the maturity of germ cells.

Insemination is indicated for mild to moderate male factor infertility, when no more than 30% of abnormal or sedentary spermatozoa(according to WHO standards). To assess the prospects of using sperm for intrauterine administration analyze the sample obtained after processing. And most important indicator at the same time is total motile sperm.

Risks and possible complications

Intrauterine insemination is a minimally invasive reproductive technique. In the vast majority of cases, it does not cause a woman any obvious discomfort and passes without complications. However, the risk of developing various adverse events still exists.

TO possible complications this procedure includes:

• pain in the lower abdomen immediately after the introduction of the prepared sperm, which is most often associated with the reaction of the cervix to the endocervical advancement of the catheter and to mechanical irritation of the tissues;
• vasovagal reaction varying degrees severity - this condition is associated with a reflex reaction to manipulations with the cervix, while there is an expansion of peripheral vessels, a decrease in heart rate and a decrease in blood pressure;
• general allergic reaction on the compounds contained in the washing media, most often benzylpenicillin and bovine serum albumin serve as an allergen;
• ovarian hyperstimulation syndrome, if insemination was carried out against the background of superovulation provocation;
• infection of the uterine cavity and pelvic organs(probability less than 0.2%), which is associated with the introduction of a catheter or the use of cervical dilators.

Separately, there are complications associated with pregnancy after insemination. These include multiple pregnancies (when using a protocol with hyperovulation stimulation), and spontaneous abortion in the early stages.

Intrauterine insemination may not give a positive result in the first reproductive cycle. The procedure can be repeated up to 4 times, it will not affect the woman's body negative impact and will not cause serious complications. If the method is ineffective, the issue of IVF is decided.

Insemination the process of entering the male seminal fluid is called ( sperm) in the female reproductive tract. Other favorable conditions after insemination, one of the male germ cells ( sperm) will merge with the female reproductive cell ( ovum), that is, the process of fertilization will occur. In the future, an embryo will begin to develop from a fertilized egg ( fetus).

If the described process occurs during natural intercourse, we are talking about natural ( natural) insemination. At the same time, artificial insemination can be used to develop pregnancy.
In this case, the pre-obtained male seminal fluid introduced into the female genital tract artificially ( using special tools and techniques), which can also lead to artificial insemination eggs and pregnancy. Sexual intimacy ( sexual contact) is excluded.

How is artificial insemination different from IVF and ICSI?

Artificial insemination and IVF ( in vitro fertilization) are two absolutely different procedures performed in order to achieve pregnancy. The essence of artificial insemination has been described previously ( male seminal fluid is injected into the female genital tract, which fertilizes the egg in the woman's body).

During in vitro fertilization, the process of fusion of male and female germ cells occurs outside the body of the expectant mother. Pre-obtained eggs are placed in a test tube, where optimal conditions are created to support their vital activity. Then pre-obtained male germ cells are added to the same test tube ( spermatozoa). Across certain time one of the sperm enters the egg and fertilizes it. After that, the fertilized egg is injected into the uterine cavity and attached to its walls. Further pregnancy develops as usual.

One of the varieties in vitro fertilization is an intracytoplasmic sperm injection procedure ( ICSI). Its essence lies in the fact that a pre-selected and prepared sperm is injected directly into the female germ cell, which increases the chances of their successful fusion. If fertilization is successful, the fertilized egg is also placed in the uterine cavity, after which a normal pregnancy begins to develop.

Is it possible to choose the sex of a child with artificial insemination?

It is impossible to choose or predetermine the sex of a child with artificial insemination. The fact is that the sex of the unborn child is determined only when the male and female germ cells merge. The first sex cells in the developing embryo begin to appear at the fifth week of pregnancy, while the external and internal genital organs are laid only at the 7th week of intrauterine development. Since artificial insemination only controls the process of introducing seminal fluid into the mother's body, and not the process of fusion of germ cells, the doctor cannot predict or determine which sperm will fertilize the egg. That is why it is impossible to somehow influence the sex of the unborn child with this procedure.

Indications for artificial insemination with husband's sperm ( homologous insemination) or donor ( heterologous insemination)

The need for artificial insemination may be due to various diseases of a man or woman, as well as the desire of patients. Depending on whose seminal fluid ( sperm) will be introduced into the genitals of a woman, homologous and heterologous insemination is isolated.

The homologous method is spoken of in cases where the seminal fluid of the husband or the woman's permanent sexual partner is used during the procedure.
If the woman does not have a permanent sexual partner, and also if his sperm cannot be used for fertilization ( due to various diseases or anomalies), donor sperm can be injected into the uterine cavity. In this case, we are talking about heterologous insemination.

It is worth noting that regardless of whose seminal fluid is used for fertilization, the technique for performing the procedure does not change.

Testimony from a woman infertility)

The procedure can be performed both if the woman has diseases that make natural insemination impossible, and under other circumstances.

Indications for artificial insemination by a woman are:

• Vaginismus. This is a disease of a woman in which the penetration of something into the vagina causes severe spasm (reduction) muscles, which is accompanied by severe pain. Pain can occur both during sexual intercourse and when using hygienic tampons. It is extremely difficult or even impossible for such women to conceive a child naturally, as a result of which they may resort to artificial insemination. During the procedure, a woman can be put into a medical sleep, as a result of which she will not experience any pain.
• Endocervicitis. This is an inflammatory disease in which the mucous membrane of the cervical canal is affected. The cause of the pathology can be various infections, injuries, hormonal disorders, non-compliance with personal hygiene rules, and so on. As a result of the development of the inflammatory process, a woman may experience pain during intercourse. Moreover, it can impede the passage of spermatozoa into the uterine cavity, as a result of which the likelihood of pregnancy with natural insemination will be significantly reduced.
• Immunological incompatibility of the couple. The essence of this pathology lies in the fact that the body of a particular woman ( that is, her the immune system, which normally provides protection against the invasion of foreign bacteria, viruses and other agents) begins to produce antibodies against the sperm of her sexual partner ( husband). At the same time, during natural insemination, spermatozoa will die before they can reach the egg and fertilize it.
• Operations in the region of the cervix. After surgery, scars may remain on the cervix, which can prevent the passage of sperm.
• Anomalies in the development and / or location of the female genital organs. As a result improper development there may be violations of the shape and location of the uterus, cervix and / or fallopian tubes. All this can impede the process of sperm entering the egg, thereby leading to infertility.
• With a lack of estrogen. V normal conditions cervical mucus is located in the cervical region, which prevents the penetration of infectious agents, as well as spermatozoa ( during natural intercourse) into the uterine cavity. during ovulation ( when the egg matures, that is, it becomes ready for fertilization and moves into the fallopian tube) stands out a large number of estrogen ( female sex hormones). Estrogens change the properties of cervical mucus, making it less thick and more stretchable, which makes it easier for sperm to pass into the uterine cavity. With a lack of estrogen, the mucus will remain thick all the time, as a result of which the spermatozoa will not be able to reach the egg and fertilize it.
• Unexplained infertility. If, after a full examination of a woman and her sexual partner, it is not possible to identify the cause of infertility, the doctor may also advise resorting to artificial insemination. For some couples, this may lead to pregnancy, while others may require more effective methods ( e.g. in vitro fertilization).
• Lack of a permanent sexual partner. If a woman is living on her own but wants to have a baby, she can also have an artificial insemination procedure in which her egg is fertilized with the sperm of another man ( donor).

Is artificial insemination indicated for obstruction of the fallopian tubes or with one passable tube?

With this pathology, there is a complete or partial overlap of the lumen of the fallopian tubes, in which normally spermatozoa meet with the egg and fertilize it. The cause of the development of the disease can be frequent infectious and inflammatory processes in the uterine cavity, operations on abdominal cavity (after them, adhesions may form, which can compress the fallopian tubes from the outside), abdominal tumors ( can also compress the fallopian tubes) etc.

With complete obstruction of both fallopian tubes, it is not advisable to perform artificial insemination, since the injected spermatozoa will not be able to reach the egg and fertilize it. In this case, it is recommended to treat the obstruction or perform the in vitro fertilization procedure.

At the same time, it should be noted that partial obstruction, as well as obstruction of only one tube, is not a contraindication for artificial insemination. With partial obstruction of both tubes, spermatozoa introduced into the uterine cavity or the tube itself can reach the egg and fertilize it. Also, the process of fertilization can occur with one passable pipe if at the time of the procedure it is in it that a mature egg is found.

Indications for insemination with husband's sperm

Before treating an infertile couple, both sexual partners should be examined, since the cause of infertility can be not only diseases of a woman, but also diseases of a man.

Indications for artificial insemination by the husband are:

• Inability to ejaculate ejaculation) in the vagina. The cause of this condition may be violations of the functions of the male genital organs. Also given state may be seen in damage spinal cord men, when the whole is paralyzed Bottom part body ( including genitals).
• Retrograde ejaculation. With this pathology, the process of normal ejaculation is disrupted, as a result of which the sperm enters the urinary tract men. Insemination and fertilization do not occur, since the seminal fluid does not enter the female genital tract.
• Deformities of the male genital organs. In the presence of anatomical anomalies in the development of the penis, sexual intercourse may not be possible, as a result of which the couple may also resort to artificial insemination. Similar conditions can also occur after traumatic lesions of the penis.
• Oligospermia. Normally, during intercourse, a man releases at least 2 ml of seminal fluid. It is believed that with a smaller amount of sperm, it will not be enough for the spermatozoa to penetrate the cervical mucus and reach the egg.
• Oligozoospermia. With this pathology, the number of spermatozoa in the sperm of a man is reduced. Most of them die on the way to the egg, as a result of which the probability of fertilization decreases.
• Asthenozoospermia. With this pathology, sperm motility decreases, as a result of which they also cannot reach the egg. The problem will be solved by intrauterine or intratubal insemination.
• Performing chemotherapy/radiotherapy. If the patient has been diagnosed neoplastic disease, before starting treatment, he can donate his sperm to a special storage. In the future, it can be used for artificial insemination.

Indications for insemination with donor sperm

If, during the examination of an infertile couple, the husband's sperm was found unsuitable for fertilization, donor sperm can be used for artificial insemination.

Artificial insemination with donor sperm is indicated:

• With azoospermia in a husband. With this pathology, there are no spermatozoa in the seminal fluid of a man ( male sex cells), as a result of which the fertilization of the egg is impossible. It is worth noting that in the so-called obstructive form of azoospermia, the cause of the disease is a mechanical obstacle that forms in the way of semen excretion. In this case, the husband's sperm, obtained using special techniques, can be used.
• With necrospermia in a husband. With this pathology, there are no live spermatozoa in the male seminal fluid that could fertilize the egg.
• In the absence of a permanent sexual partner. If a single woman wishes to have a child, she can also resort to artificial insemination with donor sperm.
• If the husband has genetic diseases. In this case, there is a high risk that these diseases can be transmitted to the unborn child.

How many times can you do insemination and what are the chances of getting pregnant while doing this?

You can perform artificial insemination an unlimited number of times, provided that the wife has no contraindications for this procedure. The number of inseminations performed does not affect the condition of the female genital organs or her health. The likelihood of pregnancy in this case depends on several factors that should be considered before performing the procedure.

The success of artificial insemination is determined by:

• The quality of the preliminary examination. Before performing the procedure, it is extremely important to conduct a full examination of the couple and identify the cause of infertility. If you miss this moment and carry out the insemination of the husband’s sperm to a woman who, for example, has a complete tubal obstruction, there will be no effect. At the same time, when using low-quality male sperm the procedure will also be ineffective.
• Cause of infertility. If the cause of infertility is partial obstruction of the fallopian tubes, pregnancy can occur only after 2-3 inseminations. At the same time, if a man's sperm quality is poor, the chance of pregnancy also decreases.
• The number of attempts. It has been scientifically proven that the probability of pregnancy at the first insemination is about 25%, while at the 3rd attempt - more than 50%.

It is worth noting that if pregnancy does not occur after the first insemination, there is nothing to worry about. It is necessary to perform the procedure at least 1 - 2 more times before talking about its inefficiency.

Contraindications to artificial insemination

Despite the relative simplicity and safety of the procedure, there are a number of contraindications, in the presence of which it is prohibited to perform it.

Artificial insemination is contraindicated:

• In the presence of inflammatory diseases genital tract. Performing the procedure when there is an infection in the vagina, cervix, or uterus itself can make the procedure extremely painful. It also increases the risk of spreading the infection and developing severe complications. The likelihood of pregnancy in this case is reduced. That is why insemination should be performed only in the absence of these diseases.

• In the presence of ovarian tumors. During pregnancy, the ovaries produce sex hormones that maintain the pregnancy. With ovarian tumors, their hormone-producing function can be disrupted, which can cause complications during gestation.
• If there are contraindications to pregnancy or childbirth. This list includes many pathologies, from diseases of the uterus, cardiovascular, respiratory and other body systems to mental disorders women under which she will not be able to endure or give birth to a child.
• With akinospermia in a husband. The essence of this pathology is that the male germ cells are completely devoid of mobility. Such spermatozoa will not be able to reach the egg and fertilize it, as a result of which it makes no sense to perform artificial insemination with such seminal fluid. In this case, it is recommended to resort to in vitro fertilization, which is highly likely to lead to pregnancy.
• In the presence of infectious diseases at the husband. In this case, the risk of infection of the woman during the procedure remains.

Is artificial insemination possible with endometriosis?

With this pathology, endometrial cells ( mucous membrane of the uterus) spread outside the organ, penetrating the cervix and other tissues. This can disrupt the process of sperm advancement, thereby leading to infertility.

Carrying out artificial insemination can contribute to the onset of pregnancy, but does not guarantee its successful development and outcome. The fact is that with endometriosis, the strength of the uterine wall can be violated. In this case, during the growth and development of the fetus, it can break, which will lead to the death of the fetus or even the mother. That is why, in the presence of endometriosis, you should first conduct a full diagnosis, evaluate all possible risks and execute necessary treatment, and only then proceed to artificial insemination.

Is insemination performed for polycystic ovaries?

This pathology is characterized by metabolic disorders, hormonal disorders and the defeat of many internal organs, including the ovaries. The process of maturation of the egg in polycystic ovaries is disturbed, as a result of which the woman experiences anovulation ( lack of ovulation, that is, during the menstrual cycle, the egg does not enter the uterus and cannot be fertilized). Perform artificial insemination husband's or donor's sperm) does not make sense.

Is artificial insemination performed for uterine fibroids?

uterine fibroids are benign tumor, which develops from the muscle layer of the organ. In some cases, it can reach a significant size, thereby blocking the entrance to the vagina or fallopian tubes and making the process of conception impossible ( sperm cannot reach the egg). Performing artificial insemination can help solve this problem, but it is worth remembering that the presence of fibroids is dangerous for a pregnant woman. The fact is that during the growth of the fetus there is a thickening and stretching of the normal muscle layer of the uterus. At the same time, the tumor can also increase, squeezing the growing fetus and leading to various violations its development. Moreover, if the tumor is located in the cervical region, it can become an obstacle to the fetus during childbirth, as a result of which doctors will have to perform a caesarean section ( removal of the baby from the uterus during surgery). That is why it is recommended to treat the fibroids first before planning the procedure ( if possible), and then perform artificial insemination.

Do they do artificial insemination after 40 years?

Artificial insemination can be performed at any age, if there are no contraindications for this. At the same time, it is important to note that during the procedure, women over 40 years of age significantly reduce the likelihood of success. So, for example, with artificial insemination of women under the age of 40, pregnancy can occur in 25-50% of cases, while after 40 years the probability of a successful outcome of the procedure does not exceed 5-15%. This is due to a violation of the functions of the female genital organs, as well as a violation hormonal background women, as a result of which the processes of fertilization and development of the egg are disrupted.

Is it possible to perform insemination with teratozoospermia?

It is impossible to perform insemination with the sperm of a man suffering from teratozoospermia. The essence of this pathology lies in the fact that the structure of most male germ cells ( spermatozoa) is broken. Under normal conditions, each spermatozoon has a strictly defined structure. Its main components are the tail and head. The tail is a long and thin part that provides sperm motility. It is thanks to the tail that he can move in the genital tract of a woman and reach the egg, as well as merge with it. The head region contains genetic information that is delivered to the egg during fertilization. If the head or tail of the spermatozoa is damaged, they will not be able to reach the female germ cell and fertilize it, as a result of which it is impractical to inseminate with the seminal fluid of such a man.

Preparing women and men for artificial insemination

Preparation for the procedure includes a full examination of both sexual partners and treatment of diseases that could create difficulties during the procedure itself or in a subsequent pregnancy.

Before planning artificial insemination, consultation is necessary:

• therapist- to detect diseases of internal organs.
• Gynecologist ( for women) - in order to identify diseases of the female reproductive system.
• Andrologist ( for men) - in order to identify diseases or disorders of the male reproductive system.

• Urologist ( for women and for men) - to detect diseases genitourinary system, including infectious ones.
• Mammologist ( for women) - a specialist who is engaged in the identification and treatment of diseases of the mammary glands.
• Endocrinologist- doctor who treats endocrine glands (his consultation is needed in violation of the production of certain hormones).

If during the examination of the patient ( female patients) any disease is detected, an additional consultation of the relevant specialist may be required ( for example, a cardiologist for heart diseases, an oncologist for uterine fibroids or other tumors, and so on).

Tests before insemination

Before the procedure, it is necessary to pass a number of tests, which will assess general state female body and exclude the presence of a number of dangerous diseases.

For artificial insemination, you must pass:

• General blood analysis. Allows you to determine the concentration of erythrocytes ( red blood cells) and hemoglobin. If a woman has anemia ( anemia, characterized by a decrease in the number of red blood cells and hemoglobin) should first identify and eliminate its cause, and only after that carry out insemination. Also, a general blood test allows you to identify possible active infectious and inflammatory processes in a woman's body ( this will be indicated by an increase in the concentration of leukocytes - cells of the immune system).
• General urine analysis. This study allows you to detect the presence of infection of the genitourinary system. Also, the presence of blood in the urine may indicate more serious kidney disease, which can adversely affect the course of pregnancy.
• Blood chemistry. This analysis allows you to evaluate functional state liver, kidneys, pancreas, heart and many other organs. In case of a pronounced violation of their functions, the procedure is contraindicated, since terrible complications can develop during a subsequent pregnancy.
• Analysis for STIs ( sexually transmitted infections). These infections include HIV AIDS virus), gonorrhea, syphilis, chlamydia, and so on. Their presence in the future mother jeopardizes the development of pregnancy and the health of the fetus, as a result of which they should be cured before insemination ( if possible).
• Tests for sex hormones. A study of the sex hormones of a man and a woman is carried out to identify a possible cause of infertility. Moreover, an assessment of the functioning of the female reproductive system is necessary in order to determine whether a woman will be able to bear a child in the event of pregnancy. The fact is that the course of pregnancy, as well as the process of childbirth, are controlled various hormones. If their excretion is impaired, this can lead to the development of complications during pregnancy or childbirth ( until the death of the fetus).
• Rh factor analysis.

It would seem that everything turned out the way I wanted: a successful career, a happy marriage, an arranged life, best friends and pleasant leisure.

But no happiness...

Infertility... A terrible word. Sounds like a judgment. But that's just the sound. Thanks to reproductive methods of treatment, the problem of infertility does not exist today.

Artificial insemination (AI)

is the simplest, most accessible, and in some cases effective method assisted reproductive technologies. This is a procedure in which pre-treated semen is injected into the uterine cavity outside of intercourse. What happens next is as usual: the spermatozoa move through the fallopian tubes to the egg and fertilize it. A pregnancy obtained in this way is no different from a normal pregnancy.

Indications for AI:

• male factor of infertility (poor semen analysis, sexual disorders);
• cervical infertility in women (changes in the properties of uterine mucus, involuntary contractions of the muscles of the vagina caused by fear of sexual intercourse);
• woman's lack of a partner.

if you have similar problems, perhaps, it is the conduct of AI that is your path to long-awaited happiness.

Necessary examinations before conducting AI

It’s so customary with us that if pregnancy occurs naturally, then it doesn’t matter at all - who is sick and what. And if you turn to doctors for “long-awaited happiness”, then you must be healthy.I stood on the threshold of the clinic and prepared to take the first step...

You will have to undergo a full examination for sexually transmitted infections (both partners), do an ultrasound to rule out possible gynecological diseases that may be an obstacle to the onset or gestation of pregnancy (for a woman), do a semen analysis (for a man).

To prescribe an AI procedure, it is necessary to exclude the presence of diseases in a woman that prevent pregnancy. After all, if menstruation comes on time, this is not at all a reason to think that you are healthy, and a mature and covulating follicle does not mean at all that a full-fledged one has matured, good quality egg.

But the most important condition for AI is the patency of the fallopian tubes, or at least one tube. If you were not offered to check the patency of the tubes, run away from this quack doctor. The lack of information about the fallopian tubes not only dramatically reduces the effectiveness of AI, but also increases the risk of ectopic pregnancy.

The examination scheme is simple: they check the work of the ovaries (the maturation of eggs), the patency of the tubes (the place where the egg meets the sperm), the condition of the uterine cavity (the ability to attach to the embryo).

The decision on the advisability of insemination will be based, among other things, on indicators of sperm quality.

… Full examination in modern reproductive clinic It took me (and my husband) a little over 2 weeks. I didn’t take a vacation, I just ran in the morning to the doctor or to the laboratory, and then to work. I can say that the examination is not cheap, but the doctor assured me that such a thorough examination has its advantages. Firstly, the AI ​​procedure is assigned to me according to the indications and the obstacles to pregnancy will be minimized. Secondly, I will be sure that during the onset of pregnancy, no infection will threaten my child, because it is quite dangerous and not always possible to carry out treatment with a child under the heart. And yet, I realized that I took the most important first step towards a long-awaited pregnancy.

Preparing for AI

When all the analyzes and examination conclusions are ready, the doctor will decide on the advisability of conducting AI. If this reproductive method of treatment suits you, you proceed to next step- preparation for the AI ​​procedure. Preparation for insemination consists in determining the date of ovulation, hormonal stimulation of the ovaries (if necessary), monitoring the growth of the endometrium in the uterus, and preparing sperm.

Ovulation - the time when a mature egg is released from the ovary / follicle, occurs approximately in the middle of the menstrual cycle. Most auspicious time conception - a day before ovulation and a few hours after, this time is ideal for AI. Although insemination 2-3 days before ovulation can also lead to pregnancy.

To determine the time of ovulation with an accuracy of at least a day and the maturity of the egg, ultrasound monitoring is performed. From the beginning of the menstrual cycle, in which AI is supposed to be performed, ultrasound is done several times, tracking the work of the ovaries and the growth of one or more follicles (eggs). Ovulation occurs when the follicle reaches a size of 18-22 mm.

In addition to ultrasound, you can determine the time of ovulation yourself with ovulation tests. Such tests, similar to tests for determining pregnancy by urine, are sold in pharmacies and are able to show those “cherished” days when ovulation occurs.

AI can be carried out both in a natural cycle and with the use of hormonal stimulation of the ovaries, which will lead to the maturation of several follicles / eggs and increase the likelihood of pregnancy. In the second case, starting from the first day of the cycle, the doctor prescribes stimulant drugs.

In addition to controlling the growth and maturation of follicles / eggs, an important factor for the onset of pregnancy is the thickness of the endometrium in the uterus at the time of ovulation. During ultrasound monitoring, the growth of the endometrium is monitored and, if the growth is insufficient (by the time of ovulation, it must be at least 9 mm), additional hormonal preparations are prescribed to build up the endometrium.

Preparing sperm for AI takes about 2 hours. It takes about an hour to liquefy it, then the sperm must be processed without delay, otherwise its quality deteriorates. Processed semen can be stored for several hours without losing its quality. If cryopreserved sperm is used, then more time is required to thaw it.

On the 7th day of my menstrual cycle, I had my first ultrasound. Even then it was clear dominant follicle, which stored the same egg.

On the 12th day of the cycle, the ovulation test showed two strips. This means that ovulation will occur within a day. I rejoiced like crazy, as if I was already pregnant. My beautiful egg will soon be ready to meet her prince!

On the 13th day of the cycle, in the morning, the doctor confirmed that ovulation is about to happen, the endometrium has grown to 11 mm, and suggested insemination.

I called my husband and asked him to come immediately.

AI procedure itself

The AI ​​procedure itself (sperm injection) takes a few minutes. The woman is comfortably located in the gynecological chair. Specially prepared sperm is poured directly into the uterine cavity using a catheter. That's actually all! The procedure is performed by one person, usually your doctor.

The procedure is painless, I felt only a slight sipping. After the sperm infusion, the doctor left me to lie down for 20-30 minutes. I lay and imagined the process of conception, the meeting of the egg and sperm, fertilization. I dreamed about my future baby, thought about what it would be, who it looked like and what gender. For some reason, she introduced a girl with blond pigtails and plump lips. I am in a positive mood and positive result and became confident that very soon I will become a mother!

The estimated cost of AI consists of several components:

initial consultation with a doctor - 100-300 UAH.

screening for infections, viruses, hormonal examinations- 1000 UAH

checking the patency of the fallopian tubes - X-ray (for women) - 300-450 UAH.

spermogram (for men) - 100-250 UAH.

the cost of ultrasound monitoring (at least 2-3 ultrasounds are required) - 100-150 UAH.

insemination procedure (including sperm preparation) - 1000 UAH.

Thus, the estimated cost of the AI ​​procedure is 2800 - 3450 UAH. This amount can be increased in case of using donor sperm (approximately UAH 500) and using medicines for ovarian stimulation (the cost is comparable to the cost medical services for insemination - 1000 UAH).

By the way, a higher price for the insemination procedure compared to other clinics does not always mean that this clinic has a better result.

Probability of AI success and possible reasons for failure

Pregnancy as a result of insemination occurs less frequently than during natural sexual activity in healthy couples, and than during in vitro fertilization (IVF). That is, the probability of pregnancy in one cycle during insemination is less than 30%. Therefore, you should tune in to at least 3-4 cycles of insemination. However, each subsequent AI will cost less by the amount of the examination and will be approximately UAH 1400 - 1550.

If pregnancy does not occur after 3-4 cycles of insemination, it is recommended to change the method of treatment.

Possible reasons for failure:

1. Insemination was not carried out according to indications, there are obstacles to pregnancy. To avoid failure for this reason, in fact, a complete examination is carried out.

2. Insemination was carried out insufficiently qualified or negligently. Perhaps the ovulation period was set incorrectly or there was a delay in the preparation of sperm, which affected its quality. In this case, you may consider changing clinics or doctors.

3. Bad luck. If you have only had 1-2 insemination cycles and are confident in your doctor, most likely you are just out of luck. Talk to your doctor about using ovarian stimulation if it was not available, changing stimulation medications, doing 2-3 inseminations per cycle if only 1 was done, increasing the time a man has sexual abstinence before donating sperm (up to 5 days).

On the 22nd day of the cycle, I felt that I was pregnant. Has settled in me new life and has already made itself known. Before, I would never have believed in such a thing, and no one believed me either. And I felt!

With some unbearable efforts, I restrained myself so as not to take a test, because it was still too early.

I was quieter than usual, as if I was afraid to frighten away my happiness. And I waited every minute.

On the 26th day of the cycle, the test showed the coveted two strips - one was very pale, but we saw it! I AM PREGNANT!

Tears of happiness...my...husband...

HAPPINNES EXISTS!

P.S. By the way, we have a girl!

Artificial insemination is one of the ways to help infertile couples to become parents. It is considered a type of IVF, but the main difference is how the insemination procedure takes place. In this case, fertilization is carried out inside the female body, and is more simple and accessible than.

Types of procedure

Artificial insemination can be done with the sperm of a spouse or a donor. The use of donor biomaterial is usually carried out due to the low quality of the partner's male seminal fluid, genetic pathologies, or is used by single women who want to find the joy of motherhood.

This is done in several ways:

1. intracervical, the introduction of sperm into the cervix. V Lately rarely used, due to low efficiency;
2. intrauterine, delivery of male germ cells into the uterine cavity. It is this method that is the most effective and most often used in practice;
3. vaginal - the introduction of sperm into the vagina, next to the cervix.

The latter method is often referred to as "home insemination". Despite the fact that medical workers the effectiveness of the procedure is in doubt, and they do not understand why insemination is done at home, some women managed to achieve a positive result.

How to do it yourself:

• choose the right date - either directly at the time of ovulation, or 2-3 days before it;
• using a sterile syringe without a needle to introduce sperm into the vagina;
• spermatozoa are able to maintain mobility while on outdoors, no more than 3 hours. Therefore, it is important to have time to introduce them into the vagina during this time, and it is desirable to use the biomaterial after the first ejaculation, as the most viable;
• after the procedure, it is recommended to lie down with your legs raised up, or stand in the “birch” position.

For those who decide to this method fertilization, you need to know that during the procedure, which is carried out in laboratory conditions, sperm pass special treatment and components that stimulate conception are introduced into it.

Artificial insemination occurs by the method of delivering male germ cells to a woman's body.

To carry out the procedure at home, you can purchase a special kit designed for this purpose. When self-transfer of seminal fluid into the vagina, you should not try to penetrate deep into the cervix, otherwise you can cause injury and infection.

The procedure is carried out either using hormonal drugs, to stimulate ovulation, or in the natural cycle.