Various types of intrauterine insemination
Intrauterine insemination may be performed with either partner’s sperm (homologous) or sperm from a donor (heterologous). It can be performed during a natural cycle (without the use of medication), or following the use of hormone protocols to stimulate ovulation in cases of women with anovulation (polycystic ovary syndrome), or controlled ovarian stimulation.
Couples screening
Woman:
- Hormonal profile and ovulation testing (testosterone, DEHA-S, androstenedione, FSH, LH, E2, Testo, DHEA-S, Prolactin, 17-OH progesterone or PRG, TSH, T3, T4 and AMH, depending on medical history).
- Ultrasound screening of the uterus and ovaries
- Hysterosalpingography (HSG) to investigate the morphology and the patency of the fallopian tubes and the uterus.
Man:
- Sperm analysis test (spermogramme)
- Screening for infectious diseases (Hepatitis B and C, syphilis and HIV)
When is intrauterine insemination indicated?
- Mild quantitative and qualitative sperm abnormalities and presence of anti-sperm antibodies
- Unexplained infertility
- Heterologous use of sperm (single-parent family, azoospermia of the partner)
- Disorders of the cervical mucus in quantity and quality
- Anatomical abnormalities of the cervical canal
- Sexual dysfunction, retrogradeejaculation
Basic prerequisites for intrauterine insemination:
- Women aged 35 or younger with good egg quality
- Open fallopian tubes
- Mild abnormalities in sperm concentration, motility and morphology
What is the procedure of intrauterine insemination?
Intrauterine insemination is the injection of sperm, submitted to special processing to increase concentration and motility, directly into the woman’s endometrial cavity. This technique bypasses the barrier of the cervix, so more and better-quality sperm reach the fallopian tubes in anticipation of the egg, thus increasing the chances for successful insemination of the egg and pregnancy.
When do we administer hormone treatment?
Women with a regular menstrual cycle and established ovulation are usually not administered hormone stimulation, but her follicles are monitored in frequent intervals by transvaginal ultrasound and measurements of oestradiol in the blood. When the follicle reaches 18 mm in size (gross diameter) with an appropriate oestradiol value, we usually administer chorionic gonadotropin injection (β-ΗCG) and proceed with semen injection in the following 24 hours, since sperm can wait for 72-90 hours inside the fallopian tube for the egg to be released from the follicle. In cases of irregular menstrual cycle or known anovulation, we use specific hormone treatment to stimulate ovulation, such as clomiphene citrate or, gonadotrophins in small doses (75-150 iu daily), for controlled ovarian stimulation and multiple ovulation. Obviously, the process is monitored with frequent transvaginal ultrasounds and measuring oestradiol in the blood.
Sperm processing
Semen is collected via masturbation on the date of the intrauterine insemination, and is submitted to special processing to improve sperm concentration and motility, and to eliminate any potential toxic substances, such as prostaglandins, which can adversely affect the outcome. The sample is first centrifuged and processed to density gradient separation (Percoll), in order to select the best sperm in terms of viability and motility. Next, the processed sperm is concentrated in a small quantity of culture media with a high protein content that is necessary to activate the sperm. Finally, using a thin, sterilised catheter the sperm is injected through the cervical canal into the endometrial cavity.
What is the percentage of pregnancy achieved with intrauterine insemination?
The success rate in homologous or heterologous sperm injection is 10-15%. In general, the percentage is higher in cases of mild infertility, with the use of hormone preparations and in women under 35 years old. The use of clomiphene citrate and gonadotrophins increases the chances for ectopic pregnancy, due to the multiple ovulations.