The procedure of artificial insemination

The desire to have a child is a natural and profoundly strong human instinct. However, approximately one in eight families dreaming of parenthood faces the challenge of infertility. It can be physically and emotionally draining. Nevertheless, it is important not to lose hope, as science and medicine have made significant advancements and offer various diagnostic and treatment options.One such method is artificial insemination, which is a common and accessible form of assisted reproductive technology.
What is artificial insemination?Artificial insemination (AI) is a set of procedures used to assist individuals or couples unable to conceive a child naturally. It involves the introduction of sperm into the woman's cervix during ovulation. This process helps ultimately increase the chances of conception and the birth of a child.
Reasons to Employ AIArtificial insemination is primarily employed by couples trying to conceive for at least one year without success through natural means. Typically, couples undergo medical examinations to assess fertility before considering AI. These include blood tests, ultrasound examinations, ovarian reserve checks, hormone level checks, partner sperm analyses, and other relevant assessments. After these evaluations, they may seek assistance from reproductive specialists.
The main reasons for turning to artificial insemination procedures include the following:● Male or female infertility: When sperm and egg cells are unable to create an embryo for various reasons. This also includes cases of "unexplained infertility" where medical indicators are normal, but the fertilization process does not occur.● Sperm quality issues: When the quantity or quality of sperm is insufficient for fertilization.● Ovulation problems: When a woman's ovaries do not release an egg or the process occurs irregularly.● Endometrium disorders: When there are issues with the inner lining of the uterus. If a woman has tissue abnormalities, inflammation, or developed polyps, it hinders the process of conception and pregnancy.● Blockage of the fallopian tubes: When the tubes connecting the ovaries and the uterus are obstructed and impede the movement of egg cells.● Uterine problems: Abnormal shapes, structures, sizes, tumors, secondary deformations, endometriosis, and other conditions can be present occasionally.● Additional treatments: Chemotherapy or radiation therapy undergone by any of the partners may significantly affect the reproductive systems of both.● Genetic disorders: Artificial insemination can benefit couples who do not wish to pass on genetic pathologies to their children.
These are just some common reasons, as each case is individual, just like every unique human organism.
Preparation for AI proceduresA couple must first undergo a set of diagnostics to understand the source of infertility issues. Once the ultimate cause is determined, the doctor can assess whether the method of artificial insemination is suitable for the specific case.
The diagnostics encompass various tests approved by the Ministry of Health of Ukraine Order No. 787, dated September 9, 2013. For women, mandatory tests include both clinical and hormonal examinations, such as:● Blood analysis: general as well as for syphilis, HIV, hepatitis B and C, toxoplasmosis, chlamydia, cytomegalovirus, and rubella, as well as clotting checks and more.● Hormonal analysis to assess the regulation of the reproductive system.● General gynecological examination.● Evaluation of egg cells since the procedure's success depends on the quantity and quality of oocytes.● Cytological examination of cervical smears.● Ultrasonographic examination of the pelvic organs, and so on.
Additional tests may be required if necessary, including endometrial biopsy and assessment of the patency of the reproductive tract, which involves ultrasonographic examination, hysterosalpingography or laparoscopy, colposcopy, and others.
Men also need to undergo preparation consisting of several stages, including:●  Blood tests to determine blood type and Rh factor, as well as screening for syphilis, HIV, hepatitis B and C.● Semen analysis (spermogram) to assess the quality and quantity of sperm in a male.● Chest X-ray (fluoroscopy) to examine the lungs.
This completes the list of mandatory tests. However, depending on specific indications in the medical history, extra tests may be necessary, such as hormone blood tests or consultations with an andrologist, among others. Certain diets and lifestyle changes may also be recommended to ensure maximum sperm quality.
Types of artificial insemination:● Intracervical Insemination (ICI)● Intrauterine Insemination (IUI)● In Vitro Fertilization (IVF)
After a thorough medical examination and preparation, artificial insemination begins. The specific procedure and its components depend on the chosen method:
Intracervical Insemination (ICI): This is a straightforward method that simulates natural sexual intercourse. It involves introducing sperm into the cervix, allowing fertilization (the fusion of sperm and egg) to occur naturally within the woman's body. A syringe specially designed for ICI is filled with unwashed diluted sperm from a donor or the intended father. The doctor then inserts it into the vagina and slowly releases the sperm near the cervix. After the procedure, it is recommended that the woman lie on her back for approximately 30 minutes.
Intrauterine Insemination (IUI):According to the recommendations of the Ministry of Health of Ukraine, if four or more attempts of ICI have been unsuccessful, it is advisable to consider intrauterine insemination (IUI). At the beginning of the process, the prospective mother may be prescribed fertility medications to enhance the chances of conception. Alternatively, the procedure can be carried out within the natural menstrual cycle. On the day of insemination, the prospective father provides a semen sample, which is then separated from the seminal fluid in the laboratory. If the male has been diagnosed with infertility or genetic disorders, donor sperm may be used. After preparation, the sperm is introduced into the patient's uterus using a thin, flexible catheter. Since the sperm is directly placed into the uterine cavity, it has a shorter distance to travel to reach the egg, increasing the probability of successful fertilization compared to natural sexual intercourse.
What is IVF, and how does it stand out?In vitro fertilization (IVF) is considered the most effective form of assisted reproductive technology. Since 1978, over 8 million children have been born with the help of IVF.The procedure can be performed using the eggs and sperm of the couple seeking treatment or with the help of eggs or oocytes obtained from a known or anonymous donor. The main difference between IVF and the methods mentioned above is that during IVF, the fertilization of the egg occurs outside the woman's body, in a laboratory. Then, the resulting embryo is implanted into the mother's uterus.IVF is a complex process consisting of multiple procedures, with an average duration of three weeks for one cycle. Sometimes this process is divided into separate stages, which extends the timeline. It is used to preserve or enhance reproductive function, prevent genetic disorders, and facilitate the conception of a child.
The stages of in vitro fertilization (IVF) include:● Ovulation stimulation: The doctor may prescribe contraceptive pills or estrogen before kicking off the IVF procedure. This is done to suppress the development of ovarian cysts and regulate the menstrual cycle. Ovarian stimulation may also involve hormone injections to stimulate the development of a larger number of eggs.● Follicle puncture: Once it is determined that the ovaries have produced a sufficient number of mature eggs, the doctor retrieves several eggs from the woman's ovaries. This is a relatively quick and simple procedure that takes about 30 minutes.● Fertilization of eggs with sperm: The retrieved eggs are then mixed with sperm from the partner or a donor in the laboratory, resulting in fertilization. Once the cells form an embryo, it is ready for implantation. ● Embryo culture: The embryos are cultured and monitored in laboratory conditions to ensure their development and viability.● Embryo transfer: At the appropriate time, the doctor uses specialized equipment to transfer the embryo into the mother's uterus for implantation.
Before starting IVF, the doctor may prescribe birth control pills or estrogen. This is used to stop the development of ovarian cysts and control the menstrual cycle. As for ovarian stimulation, an injection of hormones can be used to help stimulate the development of more eggs.All this takes place under the supervision of reproduction doctors who have experience in artificial insemination and have an understanding of the dosage and expediency of certain methods. At the same time, the condition of the endometrium is monitored using ultrasound and other diagnostic methods. Once it has been determined that the ovaries will produce enough mature eggs, doctors will remove a few of them from the woman's ovaries.It is a small and simple procedure that takes up to 30 minutes. Then, in laboratory conditions, the obtained eggs are mixed with the partner's or donor's sperm, resulting in fertilization. When the cells form an embryo, it is time for implantation. The doctor, using special equipment, implants the embryo into the uterus.
When is it clear if artificial insemination worked?Various factors shape the time it takes to determine the success of artificial insemination. Typically, a pregnancy test is conducted approximately two weeks after the procedure. This includes a blood test to measure the level of human chorionic gonadotropin (hCG) and may be accompanied by additional ultrasound examinations.
The main factors impacting the overall success of artificial insemination success are:● The woman's age;● The causes of infertility;● Sperm quality;● The condition of the endometrium on the day of fertilization;● The chosen method of AI;● The quality of medical care, and so on.
As for the method of intrauterine insemination (IUI), scientists provide the following statistics on average success rates:● 18.9% for women up to 26 years old;● 13.9% for women aged 26 to 30;● 12.4% for women aged 31-35;● 11.1% for women aged 36-40;● 4.7% for women aged 41-45;● 0.5% for women 45 years and older.
It is worth noting that these statistics can also vary depending on the type of infertility. For instance, couples with unexplained infertility have the highest success rate. In the case of tubal infertility, the likelihood of conceiving a child does not exceed 5%. So each case is highly individual.As for the IVF method, the chances are quite high if a couple under 35 seeks medical help and uses their eggs and sperm. In such cases, 46% of procedures result in pregnancy. For couples aged 35-38, this success rate drops to 22%.As a rule, it is recommended to perform a series of inseminations rather than a single attempt until pregnancy occurs. On average, it takes 3 or 4 attempts. The procedure has a cumulative success rate, meaning the chances of success increase with multiple attempts.
Is artificial insemination legal in Ukraine?Yes, artificial insemination is permitted in Ukraine and is regulated at the national level. Our country has one of the most progressive legislations regarding reproductive medicine in Eastern Europe. Today, hundreds of couples face the problem of infertility, and there is a general trend of deteriorating reproductive health in the population. According to the Ukrainian Association of Reproductive Medicine (UARM), as of 2018, over 1 million cases of infertility were recorded. For many couples, AI is the only opportunity to have their children. Each year, approximately 15,000-18,000 procedures of in vitro fertilization (IVF) or other types of artificial insemination are performed in Ukraine, which accounts for about 357 procedures per 1 million population.
According to the order of the Ministry of Health "On Approval of the Procedure for the Application of Assisted Reproductive Technologies in Ukraine," the creation of an embryo through artificial insemination with donor sperm, egg, or embryo is allowed to support the reproductive health of individuals who have difficulties conceiving naturally. The law also regulates issues related to the storage, transportation, and use of sperm, eggs, and embryos. It establishes clear requirements and indications for using the services and defines the organizational and legal framework, procedures, and conditions for conducting such medical efforts.