What is artificial insemination?
The term artificial insemination covers a range of treatments for infertility. Basically, reproductive physicians help assisted reproduction somewhat so that the egg and sperm can more easily find each other and successfully fuse.
Artificial insemination: methods
The following three methods of artificial insemination are available:
- Sperm transfer (insemination, intrauterine insemination, IUI)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
Except for sperm transfer, artificial insemination takes place outside the female body. Thus, sperm and egg must first be removed from the body and prepared accordingly.
Further information
You can find out more about the procedure and the advantages and disadvantages of the individual methods in the articles Insemination, IUI, IVF and ICSI.
Cycle monitoring
What is the procedure of artificial insemination?
The procedure of artificial insemination depends on the organic causes of infertility. Only after an exact diagnosis can the doctor decide which procedure is most suitable.
Even though each reproduction technique is slightly different in detail, the following steps can be distinguished in all of them:
Obtaining sperm cells.
In order to help fertilization, doctors need sperm cells. The collection or extraction can be done in different ways. Which one is chosen in each individual case is decided by the individual case. Basically possible are:
- masturbation
- Surgical extraction from the testicle (TESE, testicular sperm extraction)
- surgical extraction from the epididymis (MESA, microsurgical epididymal sperm aspiration)
To learn how sperm extraction from the testicles or epididymis works, see the article TESE and MESA.
Hormonal stimulation treatment
Important stimulation protocols are the short protocol and the long protocol:
Short protocol
The short protocol lasts about four weeks. Starting on the second or third day of the cycle, the patient injects herself with the stimulating hormone (FSH or hMG = human menopausal gonadotropin) daily under the skin. She can also ask her partner to give her the ready injection. From about the sixth day of the stimulation cycle, the hormone GnRH (gonadotropin-releasing hormone) is also administered. It prevents spontaneous ovulation (“downregulation”).
If the doctor determines at the check-up about ten days after the start of treatment that the follicles have matured well, he gives the woman the hormone hCG (human chorionic gonadotropin). It triggers ovulation. After 36 hours – just before ovulation – the follicles are then removed by puncture.
Long protocol
Hormonal stimulation can also be performed with tablets or with a combination of injections and tablets, depending on the protocol.
Oocyte collection (more precisely: follicle puncture)
The following options exist for retrieving the oocytes or follicles:
- Retrieval of mature oocytes (follicle puncture after hormone treatment)
- Removal of immature oocytes (IVM, in vitro maturation)
Further information
To learn how immature eggs can be used in artificial insemination, see the article In Vitro Maturation.
Embryo transfer
After artificial insemination outside the body (ICSI, IVF), insertion of the fertilized eggs into the uterus (transfer) is the most important step on the way to pregnancy. If this happens within three days after fertilization, it is called embryo transfer.
At what time the transfer should best be done varies from individual to individual.
Blastocyst transfer
If more eggs are available, it may make sense to wait a little longer. Due to the development of new nutrient solutions, the eggs can now continue to grow outside the female body for up to six days.
If the cells divide after fertilization, blastomeres are formed from the eggs within the first three days, which then reach the blastocyst stage on about the fifth day. Only 30 to 50 percent of all fertilized cells make it to this stage. If the transfer occurs five to six days after fertilization, it is called blastocyst transfer.
For whom is artificial insemination suitable?
Artificial insemination helps couples with a fertility disorder (male and/or female) and lesbian couples to have a child. Artificial insemination also offers cancer patients prior to chemotherapy or radiotherapy the chance of having a child later.
Artificial insemination: prerequisite
Artificial insemination is best regulated in Europe for married heterosexual couples. In addition to a committed partnership, a couple must meet other requirements, such as:
- clear medical indication
- Compulsory counseling for artificial insemination (assisted reproductive technology, ART)
- HIV test
- Rubella and chickenpox vaccination
- Recommended: Tests for toxoplasmosis, chlamydia, hepatitis.
Artificial insemination: lesbian couples
Artificial insemination: single women
For anonymous sperm donation in Germany, Austria and Switzerland, a steady partnership, at best with a marriage certificate, is mandatory. Women without a partner have hardly any chance of artificial insemination – single women who want to have children will have a hard time finding a doctor or a sperm bank for artificial insemination in this country. Reason are legal grey areas. For single women from Germany, Austria and Switzerland, countries such as Denmark, where anonymous sperm donation is permitted, are therefore attractive. Or they try a so-called self or home insemination.
Artificial insemination: chances of success
Artificial insemination is not successful for all couples. Sometimes it is a rocky road with failed attempts, setbacks, psychological and physical stress. Some couples eventually hold their desired child in their arms, while for others artificial insemination reaches its limits.
Artificial insemination works best for women up to 35, after which the pregnancy rate drops rapidly and approaches zero for women over 45. The reason for this is the quality of the eggs, which decreases with age. The older the woman, the higher the risk of miscarriage and malformation. If the trend toward starting a family late in life continues and egg donation remains prohibited, freezing a woman’s own eggs and sperm at a young age (social freezing) could become more important.
More information
Read more about egg freezing at a young age and why the method has not yet become established in some countries in the article Social Freezing.
Artificial insemination: chances by method
Guidelines: Artificial insemination in Germany, Austria and Switzerland
If pregnancy does not occur after several fertilization attempts, this is depressing for the couple and difficult to accept. However, there are also limits to medicine – physical, methodological and legal. Not everything that is technically possible is permitted in Germany, Austria and Switzerland.
Advantages and disadvantages of artificial insemination
Various risks and complications exist with artificial insemination. Thus, the following problems may occur:
- hyperstimulation syndrome
- bacterial infection
- injury to bladder, intestine, blood vessels due to puncture
- Multiple pregnancies: couples must be clear – in artificial insemination twins are rare, because usually two embryos are inserted. In addition, twins often result in premature births and cesarean deliveries.
- slightly increased rate of miscarriage (mostly due to the older age of the women)
- psychological stress
Despite all the risks and complications, artificial insemination naturally offers a great advantage – the chance to fulfill the longed-for desire to have a child despite fertility problems, cancer or a homosexual partnership.
