The article presents basic information about artificial insemination and advice on choosing a clinic.
The term "artificial insemination" has nowadays become a commonly used expression and has become a part of everyday life. But not so long ago it was perceived as a complete mysticism and sounded like "conception in a test tube". In 1978, the first child, Louise Brown, was born with the help of "in vitro conception". Since then, more than 200,000 people have been born through this technology in the United States alone.
The term artificial insemination (AI) means the fusion of an egg and a sperm outside the female body, the cultivation of this already fertilized egg under appropriate conditions up to a certain stage and its insertion into the uterus. There is another similar term - artificial insemination. The difference between these methods is that in artificial insemination sperm is placed in the uterus, bypassing the vagina and cervix, and the further process of fertilization proceeds as in natural conditions.
In what cases is artificial insemination used?
Artificial insemination is never the first step in the treatment of infertility. On the contrary, this method is always used as a last resort when all possible treatments (medical, surgical and artificial insemination) have failed. Most often artificial insemination is used for the following diseases and conditions.
- Endometriosis
-Uterine tubal obstruction or pronounced uterine deformity.
-Ovulation disorders
-Insufficient quality or quantity of spermatozoa
-Immunologic disorders leading to the destruction of spermatozoa or ova
-Unexplained infertility*
How does it happen?
If pregnancy does not occur naturally, or as a result of medication, surgery or artificial insemination, the couple is referred to a clinic specializing in artificial insemination. At the initial consultation in such a clinic, the history of the disease, the methods of treatment, concomitant diseases, heredity and bad habits of the partners are clarified. Here the couple also clarifies all the questions they are interested in - the chances of a positive result, the cost of the procedure and so on. The couple is offered to undergo an examination - some blood tests and ultrasound to determine the structure of the ovaries and the number of follicles**. After the interview, examination and examination, the method and scheme of IUI is determined.
The process of direct fusion of sperm and egg is preceded by the administration of drugs that promote the maturation of several eggs in the follicles and the retrieval of these eggs. In a natural healthy cycle, i.e. without the use of medication, there is usually only one egg maturation. For the process of AI, several eggs are needed, because after their fusion with sperm, several embryos are selected and with the best characteristics. Part of them - 1 or 2-3 is planted in the uterus, and part can be frozen. In this regard, the patient is prescribed fairly intensive drugs that cause superovulation, ie simultaneous maturation of several eggs. The administration of these drugs usually begins two weeks before the egg retrieval procedure. In addition, the growth of the follicles in which the eggs mature is monitored by ultrasound. Once the follicle has reached a certain size, a drug is administered to promote its final maturation, and after 24-48 hours the egg retrieval procedure is carried out. In this case, the woman is laid on a gynecological chair and intravenously administered anesthetic and briefly disabling drugs. A long hollow needle is inserted into the abdominal cavity through the vagina, which under the control of an ultrasound sensor is introduced into the ovarian follicles. With the help of this needle, the fluid contained in the follicles together with the ovum is sucked out and placed in a special container. At the same time, the sperm of the spouse is obtained in the next room and also placed in a container. Using certain criteria, specialists select the best eggs and the best sperm, mix them and place them in an incubator, where fertilization (Photo 1.) and maturation of the fertilized egg takes place. In the incubator for three days, the fertilized egg as a result of intensive division turns into a multicellular organism - blastocyst (Photo 2.). With the help of a special catheter through the vagina and cervical canal such an embryo is introduced into the uterine cavity. In the future there will be a process of implantation (introduction) of the blastocyst into the mucous membrane of the uterine cavity (Photo 3.) In those cases where there may be hereditary diseases, embryo replantation is performed on the fifth day after geneticists select healthy embryos.
In cases when sperm motility is insufficient, the method of intracytoplasmic (intracellular) sperm injection (ICSI) is used - a special pipette is used to puncture the egg and inject a sperm into the cell.
Unused embryos that meet the characteristics of healthy embryos can be frozen at the couple's request in case the pregnancy does not occur. Storing the embryo will allow the woman not only not to undergo repeated ovulation stimulation, but also to save the money associated with this procedure. A number of centers have a bank of donor sperm and eggs obtained from healthy volunteers. These donor eggs and spermatozoa are used in cases where it is not possible to obtain one's own for some reason - absence or severe pathology of sperm, absence of ovaries, etc. The donor sperm and spermatozoa are used in cases where it is not possible to obtain one's own eggs and spermatozoa.
The procedure of inserting the embryo into the uterine cavity is painless, does not require anesthesia and, according to women, resembles taking a swab. After this procedure, the woman is offered to rest for 2-3 hours, after which she goes home. For two weeks, the patient takes medications that will promote the implantation of the embryo in the mucous membrane of the uterine cavity. After two weeks, a urine or blood test is performed to confirm pregnancy. If pregnancy has occurred, the woman is prescribed medications for the further development of the embryo and its carrying.
How to choose a clinic?
One of the most important questions that arise before the couple is the choice of clinic. If in ordinary cases about doctors and clinics patients willingly share their impressions, then about visiting the center of artificial insemination couple and their devoted relatives, for obvious reasons, keep silent. A couple who have been referred to an IUI procedure under the state program does not have to choose a clinic, as it is determined by a commission of the Ministry of Health. The others have to choose and decide for themselves. The first source of information is a gynecologist who has treated infertility and who will recommend this or that institution. The second source is the internet and patient reviews. It should be remembered that on Internet forums you can not always find objective information about the center. Negative reviews can leave both mentally unhealthy persons and competitors. It is advisable to study several clinics, or better yet, visit them and get a consultation.
Western literature sometimes contains articles about all sorts of misunderstandings related to IUI - erroneous embryo transfer to another woman, utilization of frozen embryos in violation of ethical and legal norms, etc. In order not to fall into one of these stories, it is necessary to make sure that the clinic has proper control and strictly observes ethical standards. And remember, if the staff of the center did not have time to explain everything to you in detail during the consultation, they will not have time to communicate with you and explain the whole process of artificial insemination.
What is the success rate of artificial insemination?
The result of IUI depends on many factors, including the type of infertility, the age of the woman, her weight, her bad habits and, of course, the skill and experience of the clinic staff. Unfortunately, in Ukraine there are no accurate statistics on the results of IUI. In the United States, the percentage of pregnancy is on average 20-30%. However, not all cases of pregnancy end in childbirth, there may be miscarriages at early or late terms. As a result, only 22-23% of all women who undergo IUI end up delivering a live fetus.
One of the major factors determining successful outcome is the age of the woman. For example, a woman under 35 years of age has a chance of a favorable outcome in 39% of cases, while a woman over 40 years of age has a chance of a favorable outcome in only 11.5% of cases. Excess or lack of weight, smoking, alcohol abuse - these are factors that significantly reduce the likelihood of pregnancy and carrying.
Medical technology is constantly evolving and the incidence of pregnancy using IUI is slowly but steadily increasing.
The method of infertility treatment, which recently was perceived as a "miracle of miracles", has firmly entered medical practice. It will allow many couples to realize one of their purposes in life and feel the incomparable happiness of motherhood and parenthood.
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* - unexplained type of infertility - infertility, the causes of which, as a result of a complete and comprehensive examination, could not be established
** - follicles are small 0.5-2.0 cm cystic formations in the ovaries, filled with clear fluid, in which the egg matures.