Artificial insemination techniques represent an improvement over the natural fertilisation process. The procedure involves insertion of spermatozoa - either from the patient's partner or a donor - into the uterine cavity of the patient, who has previously undergone ovarian stimulation.
The percentage of pregnancy outcomes per insemination cycle is approximately 15%. It should be taken into account that pregnancies obtained through artificial insemination carry the same risk of miscarriage and ectopic pregnancy as spontaneous pregnancies do, with the same probability of genetic abnormalities and malformations.
Artificial insemination is indicated in women with permeable fallopian tubes and an adequate ovarian reserve. The determining male factor is a mobile sperm count (MSC) of more than 3 million.
Artificial insemination consists of a number of steps. These are as follows:
The aim of this procedure is to obtain 2 to 3 suitable follicles for fertilisation. Hormonal stimulation can be carried out with or without prior inhibition of the body's own hormones. Medication dose and treatment duration are determined in accordance with the patient's needs and characteristics. In some cases, one or two cycles of contraceptives are all that is needed to prepare the patient for stimulation.
Hormones to induce ovulation and maturation of oocytes are used once the stopping phase is over, or between the second and third day after the start of the patient's menstrual cycle.
During the ovulation induction phase, patients are closely monitored to assess their individual response and to adjust the dose as required to avoid ovarian hyperstimulation. That is why patients are tested three times per week by way of vaginal ultrasounds.
Once oocyte stimulation and maturation has occurred, medication is given to induce ovulation, which normally takes place after 34 to 36 hours. To increase the chance of success, ovulation is synchronised with the moment insemination is to take place.
Semen is prepared in the laboratory; semen samples can be obtained at home or at the laboratory facilities. Sexual abstinence is recommended 3 to 5 days prior to the estimated retrieval date, which is normally scheduled on the same day insemination is to take place. Samples are to be placed in a sterile and closed container in a vertical position. It is important that the sample does not undergo sudden temperature changes; nor should any condoms, creams or lubricants be used in its retrieval. Semen is to be brought to the laboratory within one hour of being collected and delivered to the centre avoiding contamination of any kind. Insemination is performed after the semen sample has been prepared in the laboratory.
Insemination is the insertion of semen into the woman's uterine cavity. This procedure is performed at the doctor's office. The prepared sample is introduced through the cervix. This step of the process, which takes 10 minutes, does not require special preparation. After a 10-minute rest period, the patient is discharged.
It is recommended that in the days that follow patients should avoid strenuous activity. Starting on the day of insemination, pharmacological treatment is started and is continued for at least 15 days, until the pregnancy test is taken.
If the pregnancy test is positive, the first transvaginal ultrasound check is carried out three weeks later to determine adherence of the gestational sac, embryonic vitality and number. If the pregnancy test is negative, the patient will be given an appointment for an ultrasound test and a new artificial insemination cycle is scheduled. No more than 3 or 4 cycles are recommended.