A Look at Artificial Insemination

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Artificial insemination (AI) is the least complex of the assisted reproductive technologies (ART) and is often tried as a first treatment in uncomplicated cases of infertility.

Artificial insemination involves preparing and delivering sperm so that a highly concentrated amount of active, motile sperm are placed directly into the cervix -- called intra-cervical insemination or into the uterus -- called intrauterine insemination (IUI). The standard procedure practiced in most clinics is IUI.

IUI can be done with sperm from the male partner or a sperm donor, and is often combined with ovulation induction by hormone therapy. It is a useful treatment for women with open fallopian tubes and a normal uterine cavity and in cases where the man has unexplained infertility.

The Procedure

The IUI procedure involves monitoring of the woman’s cycle with an ovulation predictor kit and/or pelvic ultrasounds to determine ovulation. Fertility drugs may also be taken in advance to increase the number of eggs released (super ovulation). At the time of ovulation, the man produces semen specimens that are prepared in the laboratory utilizing specialized enhancing solutions.

The semen specimen must be prepared or washed prior to being injected into the uterus. Unwashed semen has chemicals that can cause extremely painful uterine cramping. The sperm are then placed in the uterus. IUI is performed in the office, without anesthesia, using a thin flexible tube (catheter) that is passed through the cervix and into the uterus.

After the IUI, the woman lies quietly for 20 to 30 minutes. Studies have shown that there is a significantly higher pregnancy rate in those women who lay quietly for at least 10 minutes after sperm were injected compared with those who got up immediately.

Success Rates

Success rates for IUI are based on the age of the woman, quality of sperm and the reason for infertility. A review of 45 studies reported that in unexplained infertility cases, the per-cycle pregnancy rates were 4 percent for intrauterine insemination (IUI) alone and 8 percent to 17 percent per cycle for IUI combined with super-ovulation.

Depending on diagnosis, physicians commonly suggest IUI as a reasonable first option for many women under age 40. It is less expensive and poses less risk for multiple births than the more advanced assisted reproductive technologies, such as in vitro fertilization (IVF). Although IVF procedures are more effective per cycle, couples tend to be able to afford more IUI cycles, so the pregnancy rates over time are very similar.

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