Insemination

WHAT is artificial insemination?

Insemination is any process, excluding sexual intercourse, in which sperm is deposited in the female genital tract. This includes squirting sperm into the vagina, the cervical canal, or directly into the uterus.

Pregnancy rates are highest if insemination is directly into the uterus but this is also the most expensive, and most "medicalized" option since the sperm must be properly prepared (washed) prior to insemination which must be performed by a health care worker.

Washed sperm is sperm that is prepared in the lab to remove all the components of semen other than sperm and seminal fluid. The advantage of semen that has been prepared in this way is that it can be inseminated directly into the uterus. Unwashed sperm cannot be placed in the uterine cavity since the white blood cells and debris normally found in semen are irritating.

Intracervical insemination can be done to avoid the extra expense of "washing" the sperm. In addition, an intracervical insemination is appropriate if it is technically difficult to get the catheter through the cervical opening and into the uterus. This can happen if the uterus is tipped or the cervical opening is small.

WHY this procedure is done

There are many circumstances in which artificial insemination is utilized to achieve pregnancy. Insemination using a husband's sperm is often recommended to increase the chance of pregnancy if a couple is having fertility issues. Donor sperm is used if the husband or male partner has no sperm. Donor insemination is also utilized if there is no male partner. Single women and lesbian couples often take advantage of this option.

WHAT you should do to prepare

Getting pregnant is essentially all about timing; if the egg and the sperm aren’t in the same place at the same time, it is not going to happen. At your appointment prior to insemination your doctor will discuss how to track ovulation (the release of an egg) with an ovulation predictor kit or ultrasound. Once you have determined when you are going to ovulate, you need to contact the sperm bank and make an appointment at the same time. Your insemination appointment in our office should be 45 minutes after your andrology lab appointment. No other preparation is needed.

WHAT to expect during the procedure

An insemination is very similar to a Pap smear. After you are brought to the examination room you will be asked to undress from the waist down. A speculum is placed in the vagina and a thin flexible catheter is threaded though the cervical canal and into the uterine cavity where the sperm is deposited. The majority of women feel nothing other than the speculum, but some report mild cramping. The insemination takes only a minute.

WHAT to expect after the procedure

Immediately after the insemination, the exam table will be tilted so you are lying with your hips higher than your head. This is done to facilitate any sperm deposited in the cervix or vagina to enter the uterus. Generally, you stay in this position for about ten minutes. A medical assistant will come in and return the exam table to a normal position. Do not get down yourself. You will be elevated high off the ground. You should then go about your normal activities. There are no restrictions on exercise, travel or intercourse. Some women note mild cramping or are aware of increased vaginal discharge. Slight spotting is not unusual or a cause for concern.

FAQS

How do I obtain donor sperm?
Your doctor can recommend banks that we routinely work with. You can also start by going to the American Association of Tissue Banks website, www.aatb.org/aatbac.htm. Since 2002, The American Society of Reproductive Medicine released specific criteria regarding sperm quality, and recommended comprehensive genetic and medical screening of potential donors. Banks listed with The American Association of Tissue Banks website adhere to recommended guidelines, and obtain and keep appropriate medical records so you can be sure that what you are getting has been properly screened, properly prepared, and is of good quality.

In addition, every bank has varying degrees of information about the donor. While all provide race, height, weight, coloring, education and religion, some will let you know if the donor prefers Mozart to Hip Hop, sailing to Latin Dance. Some even provide baby pictures, audio interviews, personality profiles, SAT scores, and essays. There is no limit to the amount of information you can get.

What if I want to use sperm from a known donor?
Insemination using sperm from an anonymous donor has the advantage of avoiding potential paternity issues with a biological father who suddenly decides he wants to be "involved." In addition, you get a maximum amount of genetic, medical, and personal information about the person who will be the biological father of your child. Having said that, many women choose to use a known donor. It is important that you consult with a lawyer regarding relinquishment of paternity prior to insemination. Once you have identified the donor, he can donate sperm at any time by contacting the sperm lab. The sperm will be frozen and on the day of insemination thawed, washed and prepared for insemination. If the donor is out of town, arrangements can be made for him to deposit to a bank, which will then send the sperm to our sperm lab. The andrology lab will help you with any necessary arrangements.

What if they are backed up in the sperm lab or my husband takes a long time to produce the specimen and I miss my appointment time?
Not to worry. We understand that things don't always go on schedule and we will perform your insemination whenever you arrive. It may be with a different physician or PA than you were originally scheduled with, but it will get done. If it is late in the day, and you are running late, please call to ensure that someone will be available when you arrive.

How can I be sure I am getting the right sperm if a number of women are getting inseminated on the same day?
When you leave the andrology lab they will hand your sperm to you in a sealed envelope. You will hold on to your envelope until you are in the exam room. No one will take it from you until you are in the exam room. If someone asks to take your sperm to "get it ready", you should decline. Once in the exam room the syringe will be attached to the catheter prior to insemination. The sperm will never leave your sight.

Once I get the specimen from the lab, how long until the sperm is not as good?
There is no loss of motility for hours.

What if I am ovulating on the weekend?
If we are "controlling your cycle" by inducing ovulation with Clomiphene, we will try and schedule ovulation Monday through Friday. If your insemination is on the weekend, we have arrangements with a fertility clinic that can perform the insemination.

How successful is insemination?
Success rates are dependent on multiple factors including your age, baseline fertility, and sperm quality. Keep in mind that even couples having intercourse often have difficulty conceiving, particularly if the woman is older. Insemination is no different, but because of the costs involved, there should be an effort with every cycle to maximize the chances of conception by monitoring ovulation to ensure the timing is correct.

Intrauterine inseminations have the highest pregnancy rates. With this process, the highest concentration of sperm gets to the egg since nothing is "lost" in the vagina.

While pregnancy rates are a little lower for intracervical inseminations than intrauterine insemination, they are significantly higher than with vaginal inseminations or intercourse.

Will my insurance cover insemination costs?
Every policy is different. Many insurance companies do not cover insemination costs unless there has been one year of "documented" infertility. Any fees not covered by insurance will be an out of pocket obligation so please check prior to embarking on a treatment cycle.

Should my bladder by empty prior to insemination?
Most women are more comfortable having a speculum inserted if they have an empty bladder. In some cases, a full or partially full bladder will push the uterus into a position that makes it easier to slide the catheter into the uterus. We recommend a slightly full bladder. In other words, no need to empty completely, but you should be comfortable.

Can my husband, partner or a friend be in the room with me during an insemination?
Absolutely. Many women choose to have someone accompany them. If your partner/husband would like to participate by pushing the plunger to inject the sperm once we have placed the catheter in the uterus, they are welcome to do so.

View a segment from In the Loop with iVillage where Dr. Streicher discusses artificial insemination.