Insemination - types and techniques of implementation. Possible complications after the procedure. Where do they make it?

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How is the insemination procedure performed?

Insemination is carried out in a specially equipped room of a clinic or hospital. The procedure is performed on an outpatient basis, that is, the woman comes to the doctor directly on the day of insemination, and after its completion goes home.

On what day of the natural cycle is insemination done?

To procedure artificial insemination turned out to be most effective, the doctor first studies the patient’s menstrual cycle, calculating the time of expected ovulation ( that is, the release of a mature egg, ready for fertilization, into the fallopian tube).
Once released from the ovary, the egg can be fertilized within about 24 hours. At this time, artificial insemination is prescribed.

On average, ovulation occurs on the 14th day of the menstrual cycle, but in some cases it can occur earlier or later. However, it is impossible to predict the exact time of ovulation, and a woman cannot subjectively feel this. That is why, to maximize the effectiveness of artificial insemination, doctors use a number of diagnostic tests to calculate the moment of ovulation.

To determine the time of ovulation, use:

• Ultrasound of ovarian follicles. Under normal conditions, during each menstrual cycle, one main follicle is formed in one of the ovaries - a sac of fluid in which the egg develops. This follicle is visible using ( Ultrasound) ultrasound examination already on the 8th – 10th day of the cycle. Once a given follicle has been identified, it is recommended to perform an ultrasound every day. If the follicle was visible the day before, but during the next procedure it cannot be determined, this indicates that ovulation has occurred.
• Determination of the level of luteinizing hormone ( LH) in blood. This hormone is secreted by a special gland ( pituitary gland) and is involved in the regulation of the menstrual cycle. An increase in the level of this hormone in the middle of the cycle indicates that ovulation will occur within the next 24 to 48 hours.
• Measuring basal body temperature. During the period of ovulation, body temperature increases by approximately 0.5 - 1 degree, which is due to hormonal changes occurring in a woman’s body. However, to notice such a temperature jump, a woman must regularly ( within a few months) keep a graph of basal temperature, measuring it twice a day ( morning and evening, at the same time).
• Examination of cervical mucus. Under normal conditions, the mucus found in the cervical area is relatively dense, cloudy, and poorly extensible. During ovulation, under the influence of female sex hormones, it liquefies, becomes transparent and more viscous, which is used by doctors for diagnostic purposes.
• Subjective feelings of a woman. During ovulation, a woman may experience nagging pain in the lower abdomen, as well as increased sexual desire, which, together with other signs, can be used for diagnostic purposes.

Stimulation of ovulation ( ovaries) before insemination

The essence of this procedure is that before insemination, a woman is prescribed hormonal drugs that stimulate the growth and development of the follicle, egg maturation and ovulation. The need for this procedure arises in cases where it is impossible to perform insemination in the usual way ( for example, if a woman does not have a regular menstrual cycle).

To stimulate ovulation before insemination, a woman is most often prescribed recombinant follicle-stimulating hormone ( FSH). This is an analogue of the natural hormone produced by the pituitary gland during the first half of the menstrual cycle. Under its influence, follicles in the ovaries are activated and develop. The FSH drug should be used for 8 to 10 days ( more precise instructions can be given by the attending physician after a full examination, determining the regularity and other features of the menstrual cycle in a particular woman), after which ovulation should occur.

The danger of using this method is that when too high doses of FSH are prescribed, the so-called ovarian hyperstimulation syndrome may develop, when instead of one follicle, several mature at once. In this case, during ovulation, 2 or more eggs may enter the fallopian tube, which can be fertilized during the artificial insemination procedure. The outcome of this phenomenon can be multiple pregnancy.

Types and techniques of artificial insemination ( intracervical, intrauterine, vaginal)

To date, several techniques have been developed that allow the introduction of male seminal fluid ( sperm) into the female genital tract. However, to understand the mechanism of their action, it is necessary to know how insemination occurs under natural conditions.

With natural insemination ( occurring during sexual intercourse) a man's sperm is ejaculated into a woman's vagina. Then the sperm ( During one sexual act, about 200 million are ejected), having mobility, begin to move towards the uterus. They must first pass through the cervix, a narrow canal that separates the uterus from the vagina. A woman’s cervix contains special mucus that has protective properties. Passing through this mucus, most of the sperm die. The surviving sperm enter the uterine cavity and then travel to the fallopian tubes. One of these pipes contains a mature ( ready for fertilization) egg ( female reproductive cell). One of the sperm penetrates her wall earlier than the others and fertilizes her, resulting in pregnancy. The remaining sperm die.

Artificial insemination can be:

• Intracervical ( vaginal). This is the simplest form of the procedure, which is as similar as possible to natural sexual intercourse. No special preparation is required before performing it ( Naturally, before any insemination you should refrain from smoking, drinking alcohol, drugs, and so on). Insemination can be carried out with either fresh, unpurified seminal fluid ( in this case it must be used no later than 3 hours after receipt), and frozen sperm ( from a sperm bank). The essence of the procedure is as follows. In the morning on the appointed day, a woman comes to the clinic, goes into a specially equipped room and lies down in a gynecological chair or on a special table. Special dilating speculum is inserted into her vagina, making it easier to access the cervix. Next, the doctor collects sperm into a special ( with blunt tip) syringe, inserts it into the vagina and brings the tip as close as possible to the entrance to the cervix. After this, the doctor presses on the syringe plunger, as a result of which the sperm is squeezed out of it onto the mucous membrane of the cervix. The syringe and speculum are removed, and the woman must remain in the gynecological chair lying on her back for 60 to 90 minutes. This will prevent the leakage of seminal fluid and will also facilitate the penetration of sperm into the uterus and fallopian tubes. One and a half to two hours after the procedure, the woman can go home.
• Intrauterine. This procedure is considered more effective than intracervical insemination. Its essence lies in the fact that after installing speculum in the vagina, sperm is drawn into a special syringe, to which a long and thin catheter is attached ( a tube). This catheter is inserted through the cervix into the uterine cavity, after which the sperm is squeezed into it. When performing this procedure, it is recommended to use specially prepared and purified sperm. The introduction of fresh seminal fluid into the uterine cavity can cause contraction of the uterine muscles ( which will reduce the likelihood of fertilization) or even cause severe allergic reactions.
• In-pipe. The essence of the procedure is that pre-prepared sperm are injected directly into the fallopian tubes in which the egg should be located. It is worth noting that, according to the results of recent studies, the effectiveness of this procedure does not exceed that of conventional intrauterine insemination.
• Intrauterine intraperitoneal. With this procedure, a certain amount of previously obtained and processed ( purified) male sperm is mixed with several milliliters of a special liquid, after which the resulting mixture ( about 10 ml) is inserted into the uterine cavity under slight pressure. As a result, the solution containing sperm will penetrate the fallopian tubes, pass through them and enter the abdominal cavity. Thus, the probability of fertilization of an egg, which may be located in the path of the injected solution, significantly increases. This procedure is indicated for unknown causes of infertility, as well as for ineffective intracervical or intrauterine insemination. In terms of execution technique, it is no different from the previously described procedures.

Does insemination hurt?

Artificial insemination is an absolutely painless procedure. Some women may experience discomfort when inserting speculum into the vagina, but there will be no pain. At the same time, it is worth noting that with vaginismus, a woman reacts painfully to any procedures involving the insertion of any instruments into the vagina. Such patients are usually prescribed special sedatives, and if necessary, they can be put into superficial medicated sleep. In this state, they will not feel pain and will not remember anything about the procedure.

Is it possible to perform artificial insemination at home?

At home, you can perform the procedure of artificial intracervical ( vaginal) insemination, which is similar in mechanism of action and effectiveness to natural insemination. Performing other variants of the procedure requires the use of purified sperm, as well as intrauterine insertion of foreign objects, and therefore they should only be carried out by an experienced specialist in a clinic setting.

Preparation includes calculating the day of expected ovulation ( the techniques have been described previously). When ovulation has occurred, you should proceed directly to the procedure itself.

To carry out artificial insemination at home you will need:

• Disposable sterile syringe ( for 10 ml) – can be purchased at any pharmacy.
• Sterile container for collecting semen– for example, a container for taking tests, which can also be purchased at a pharmacy.
• Sterile disposable vaginal dilator- can be bought at the pharmacy, but the procedure can be performed without it.

It is recommended to perform the procedure in a place protected from sunlight ( best at night), as they can damage sperm. After the donor ejaculates semen into a sterile container, it should be left in a warm, dark place for 15 to 20 minutes to allow it to become more fluid. After this, you should draw the sperm into a syringe and insert its tip into the vagina. If a woman uses vaginal dilators, the syringe should be inserted under visual control ( you can use a mirror for this). It should be brought as close to the cervix as possible, but try not to touch it. If a vaginal dilator is not used, the syringe should be inserted into the vagina 3–8 cm ( depending on the anatomical features of the woman). After inserting the syringe, gently press the plunger so that the seminal fluid moves to the surface of the mucous membrane of the cervix.

After the sperm is injected, the syringe and dilator are removed, and the woman is advised to remain in the “lying on her back” position for the next one and a half to two hours. Some experts recommend placing a small cushion under the buttocks so that the pelvis is raised above the bed. In their opinion, this promotes the movement of sperm to the fallopian tubes and increases the likelihood of pregnancy.

Why are utrozhestan and duphaston prescribed after insemination?

These drugs are prescribed to ensure the normal development of the fertilized egg after the procedure. The active component of both drugs is the hormone progesterone or its analogue. Under normal conditions, this hormone is secreted in a woman’s body in the second phase of the menstrual cycle ( it is produced by the so-called corpus luteum, which forms at the site of a mature and ruptured follicle after ovulation). Its main function is to prepare the female body for implantation and development of a fertilized egg.

If during the period after ovulation the concentration of this hormone in a woman’s blood is reduced ( which can be observed in some diseases of the ovaries, as well as in patients over 40 years of age), this can disrupt the process of attachment of a fertilized egg to the wall of the uterus, resulting in pregnancy not occurring. It is in such cases that patients are prescribed utrogestan or duphaston. They prepare the lining of the uterus for egg implantation and also support fetal development throughout pregnancy.

How to behave after insemination ( do's and don'ts)?

Immediately after the procedure, the woman should lie on her back for at least an hour, which is necessary for normal penetration of sperm into the uterus and fallopian tubes. In the future, she should follow a number of rules and recommendations that will help increase the effectiveness of the procedure and reduce the risk of complications.

Is it possible to take a bath after artificial insemination?

Immediately after performing intracervical insemination ( including at home) taking a bath is not recommended, as this may reduce the effectiveness of the procedure. The fact is that with this technique, part of the sperm is located in the vagina.
If during the first hours after the end of the procedure the woman takes a bath, water ( together with the soaps, gels or other substances it contains) can enter the vagina and destroy some sperm, which will reduce the likelihood of pregnancy. That is why it is recommended to bathe in the bathroom no earlier than 6 to 10 hours after insemination. At the same time, it is worth noting that a light shower under clean water ( without using hygiene products) will not affect the outcome of the procedure in any way.

When performing intrauterine or other types of insemination, the patient is allowed to take a bath immediately after returning home. The fact is that in these cases, seminal fluid is introduced directly into the uterine cavity or into the fallopian tubes, which are normally reliably separated from the environment by the cervix. Even if the woman takes a bath immediately after finishing the procedure ( that is, after lying in the gynecological chair for the prescribed one and a half to two hours), water or any other substances will not be able to penetrate the uterine cavity and in any way affect the fertilization of the egg.

Is it possible to swim and sunbathe after insemination?

A woman is allowed to swim in a river, lake, sea or other body of water no earlier than 24 hours after the procedure. Firstly, this is due to the risk of water entering the vagina and destroying the sperm there. Secondly, during the artificial insemination procedure, the vaginal mucosa may be slightly injured by objects inserted into it ( dilators, syringe). In this case, its protective properties will be significantly reduced, as a result of which infection can occur when swimming in polluted waters.

There are no special instructions regarding tanning. If a woman has no other contraindications, she can sunbathe in the sun or visit a solarium immediately after the procedure, which will not affect its effectiveness.

Is it possible to have sex after artificial insemination?

Having sex after artificial insemination is not prohibited, since sexual contact will in no way affect the process of sperm advancement and egg fertilization. Moreover, if the cause of a couple's infertility has not been reliably identified before the procedure, regular sexual intercourse may increase the likelihood of pregnancy. That is why there is no need to limit or somehow change your sex life after performing this procedure.

How many hours after insemination does fertilization occur?

Fertilization of the egg does not occur immediately after the insemination procedure, but only 2 to 6 hours after it. This is due to the fact that sperm need time to reach the egg, penetrate its wall and connect its genetic apparatus with it. Under normal conditions ( with natural insemination) the sperm must travel from the cervix to the fallopian tubes, which on average is about 20 cm. This can take him from 4 to 6 hours. Since intracervical insemination is as similar as possible to natural insemination, with this type of procedure the time until fertilization is approximately the same.

In intrauterine insemination, male reproductive cells are introduced directly into the uterine cavity. They do not waste time passing through the mucous barrier in the cervix, as a result of which fertilization can occur earlier with this type of procedure ( after 3 – 4 hours). If intratubal insemination is performed ( when sperm are injected directly into the fallopian tubes), the egg located there can be fertilized within a couple of hours.

Signs of pregnancy after artificial insemination

The first signs of pregnancy can be detected no earlier than a few days after the procedure. The fact is that immediately after fertilization, the egg moves into the uterine cavity, attaches to its wall and begins to actively increase in size there, that is, to grow. This entire process takes several days, during which the fertilized egg remains too small to be detected by any means.

It is worth noting that after artificial insemination, pregnancy proceeds in exactly the same way as during natural conception. Therefore, the signs of pregnancy will be the same.

Pregnancy may be indicated by:

• change in appetite;
• taste disturbances;
• impaired sense of smell;
• increased fatigue;
• increased irritability;
• tearfulness;
• abdominal enlargement;
• engorgement of the mammary glands;
• absence of menstruation.

The most reliable of all these signs is the absence of menstrual bleeding for 2 or more weeks after ovulation ( that is, after performing the procedure). All other symptoms are associated with hormonal changes in the female body during pregnancy, but can also be observed in a number of other conditions.

On what day after insemination should I take a pregnancy test and donate blood for hCG?

After fertilization, the egg enters the uterine cavity and attaches to its wall, whereupon the embryo begins to develop. From about 8 days after fertilization, embryonic tissue begins to produce a special substance - human chorionic gonadotropin ( hCG). This substance enters the mother’s blood and is also excreted in her urine. It is on determining the concentration of this substance in a woman’s biological fluids that most early pregnancy tests are based.

Despite the fact that hCG begins to be produced approximately 6–8 days after fertilization of the egg, its diagnostically significant concentrations are observed only by the 12th day of pregnancy. It is from this period that hCG can be detected in urine ( For this purpose, standard express tests are used, which can be purchased at any pharmacy.) or in a woman's blood ( To do this, you need to donate blood to a laboratory for analysis.).

Why is an ultrasound performed after insemination?

A few weeks after the procedure, the woman should undergo an ultrasound examination of the pelvic organs.

The purpose of performing an ultrasound after insemination is:

• Confirmation of pregnancy. If the fertilized egg attaches to the wall of the uterus and begins to develop, after a few weeks the embryo will reach a significant size, as a result of which it can be detected during an ultrasound examination.
• Identify possible complications. One of the dangerous complications of insemination can be ectopic pregnancy. The essence of this pathology is that the egg fertilized by the sperm attaches not to the wall of the uterus, but to the mucous membrane of the fallopian tube or even begins to develop in the abdominal cavity. Lab tests ( determination of hCG in the blood or urine of a woman) will indicate that pregnancy is developing. At the same time, the prognosis in this case is unfavorable. With an ectopic pregnancy, the embryo dies in 100% of cases. Moreover, if this condition is not detected in a timely manner, it can lead to the development of complications ( for example, to rupture of the fallopian tube, to bleeding, and so on), which would endanger the woman's life. That is why, during an ultrasound examination, the doctor not only detects the presence of an embryo in the uterine cavity, but also carefully examines other parts of the reproductive system for the purpose of early diagnosis of ectopic pregnancy.

Can twins be born after insemination?

After artificial insemination, as after natural fertilization, one, two, three ( or even more) child. The mechanism for the development of this phenomenon is that during the procedure several mature eggs can be fertilized at once. The likelihood of this increases significantly when insemination is performed after ovarian stimulation, during which ( in the ovaries) several follicles can develop at once, from which several mature eggs, ready for fertilization, can be released simultaneously.

Much less often, multiple pregnancies develop when one egg is fertilized by one sperm. In this case, at the initial stages of development, the future embryo is divided into 2 parts, after which each of them develops as a separate fetus. It is worth noting that the probability of such a development of events is the same with both artificial and natural insemination.

Complications and consequences after artificial insemination

The procedure for performing insemination is relatively simple and safe, as a result of which the list of complications associated with it is quite small.

Artificial insemination may be accompanied by:

• Genital tract infection. This complication can develop if during the procedure the doctor used unsterile instruments or did not comply with hygiene standards. At the same time, the cause of the development of infection may be a woman’s failure to comply with personal hygiene rules immediately before or after the procedure. It is important to remember that any infection is much easier to cure at the initial stage of development. That's why if you experience pain, burning or redness in the genital area, you should immediately consult your doctor.

• Allergic reactions. May occur during intrauterine or intratubal insemination, when poorly prepared ( poorly cleaned) seminal fluid. Allergies can manifest as restlessness, blotchy skin, muscle tremors, a significant drop in blood pressure, or even loss of consciousness. Extremely severe allergic reactions require immediate medical attention as they pose a danger to the patient's life.
• A drop in blood pressure. The cause of the development of this complication may be careless, rough manipulation of the cervix during intrauterine insemination. The mechanism for the development of this phenomenon is the irritation of special nerve fibers of the so-called autonomic nervous system, which is accompanied by a reflex dilation of blood vessels, a slowdown in the heartbeat and a decrease in blood pressure. If this complication develops, the woman is strictly forbidden to get up, as this will cause blood to flow out of the brain and she will lose consciousness. The patient is prescribed strict bed rest for several hours, drinking plenty of fluids, and, if necessary, intravenous fluids and medications to normalize blood pressure.
• Multiple pregnancy. As mentioned earlier, the risk of developing multiple pregnancies increases when insemination is performed after hormonal stimulation of the ovaries.
• Ectopic pregnancy. The essence of this phenomenon is described above.

Nagging pain in the abdomen

During the first hours after intrauterine insemination, a woman may complain of nagging pain in the lower abdomen. The cause of this phenomenon may be irritation of the uterus caused by the introduction of poorly purified sperm into it. In this case, a strong contraction of the uterine muscles occurs, which is accompanied by a disruption of microcirculation in them and the appearance of a characteristic pain syndrome. A few hours after the end of the procedure, the pain goes away on its own, without requiring any treatment. At the same time, it is worth noting that strong contraction of the uterine muscles can disrupt the process of moving sperm to the egg, thereby reducing the likelihood of pregnancy.

Chest pain ( nipples hurt)

Breast pain may appear several weeks after insemination and is most often a sign of a developing pregnancy. The cause of the pain syndrome is a change in the mammary glands under the influence of progesterone and other hormones, the concentration of which in a woman’s blood increases during pregnancy. In addition to painful sensations in the nipple area, slight white discharge may appear, which is also completely normal during pregnancy.

Temperature

During the first 2–3 days after insemination, a woman’s body temperature can rise to 37–37.5 degrees, which is absolutely normal. An increase in temperature by 0.5 - 1 degree is observed during ovulation and is associated with hormonal changes occurring in the female body.

At the same time, it is worth noting that an increase in temperature to 38 degrees or higher, which occurs during the first or second day after insemination, may indicate the development of complications. One of the common reasons for an increase in temperature may be the development of an infection acquired during the procedure ( for example, if the doctor or patient fails to comply with hygiene standards). The development of infection is accompanied by activation of the immune system and the release of many biologically active substances into the blood, which determine the increase in temperature 12–24 hours after infection. The temperature can reach extremely high values ​​( up to 39 – 40 degrees or more).

Another reason for the increase in temperature may be an allergic reaction associated with the introduction of poorly purified seminal fluid into the uterus. Unlike infectious complications, with an allergic reaction the body temperature rises almost immediately ( within the first minutes or hours after the procedure) and rarely exceeds 39 degrees.

Regardless of the cause, an increase in temperature over 38 degrees is a reason to consult a doctor. It is not recommended to take antipyretic drugs on your own, as this can distort the clinical picture of the disease and complicate the diagnosis.

Will I get my period after insemination?

The presence or absence of menstruation after insemination depends on whether sperm can reach the egg and fertilize it. The fact is that under normal conditions, certain changes occur in a woman’s uterus during the menstrual cycle. During the first phase of the menstrual cycle, its mucous membrane is relatively thin. After the egg matures and leaves the follicle, the concentration of the hormone progesterone increases in the woman’s blood. Under its influence, certain changes are observed in the mucous membrane of the uterus - it thickens, the number of blood vessels and glands in it increases. In this way, it prepares for the implantation of a fertilized egg. If implantation does not occur within a certain time, the concentration of progesterone decreases, as a result of which the superficial part of the uterine mucosa dies and is released through the woman’s genital tract. The resulting bleeding is associated with damage to small blood vessels and is usually moderate in nature.

Considering the above, it follows that if menstruation appeared after insemination, conception did not occur. At the same time, the absence of menstruation may indicate a developing pregnancy.

Brown bloody discharge ( bleeding)

Under normal conditions, no vaginal discharge should be observed after insemination. If in the first hours after the procedure a woman experiences slight white discharge, this indicates that the seminal fluid injected into her ( a certain part of it) leaked out. In this case, the likelihood of pregnancy is significantly reduced, since most of the sperm will not reach the fallopian tubes.

The appearance of brown bloody) discharge, accompanied by moderate pain in the lower abdomen, can be observed 12 to 14 days after insemination. In this case, we will be talking about menstrual bleeding, which normally begins 2 weeks after ovulation ( if the egg was not fertilized). At the same time, we can say with confidence that the attempt at conception failed.

This bleeding does not require any treatment and usually stops on its own after 3 to 5 days, after which the next menstrual cycle begins.

Why is the pregnancy test negative after insemination?

If, 2–3 weeks after insemination, a pregnancy test and a blood test for human chorionic gonadotropin show a negative result, this indicates that fertilization of the egg did not occur, that is, pregnancy did not occur. It is important to remember that successful fertilization on the first attempt is observed only in half of the cases, while other women need 2 or more attempts to achieve a positive result. That is why, after a single negative result, you should not despair, but you should try again during the next ovulation. This increases the chances of successful fertilization.

Where ( in which clinic) is it possible to do artificial insemination in the Russian Federation?

In the Russian Federation, prices for artificial insemination vary widely ( from 3 – 5 to 60 or more thousand rubles). The cost of the procedure will be determined by its type ( intracervical insemination will be the cheapest, while other techniques will be somewhat more expensive), source of sperm ( insemination with donor sperm will be much more expensive than with the sperm of a husband or regular sexual partner) and other factors.

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Every year the problem of infertility, both female and male, becomes more pressing. Not all married couples can get pregnant “on the spot”, which is associated with an increase in morbidity, environmental deterioration, and the frantic pace of life. Artificial insemination is one way out of this situation. Despite its low effectiveness (from 15 to 20 to 30% of pregnancies after the procedure), it has a number of advantages, an important one of which is its low price (compared to IVF).

Artificial insemination: what is it, types

Intrauterine insemination or artificial insemination is the procedure of introducing sperm (from a husband or a donor) into a woman's genital tract to achieve pregnancy. This medical procedure refers to assisted reproductive technologies and is carried out in a clinic; after completion of the procedure, the woman goes home. Artificial insemination began to be used about 200 years ago; in Russia, the AI ​​method was first used by Shorokhova in 25 of the last century. This technology began to be used more widely in the 1950s and 1960s.

Options for conducting AI

The artificial insemination method includes 2 options:

Homologous technique

In this case, artificial insemination is carried out with the husband's sperm. To perform the procedure, both freshly obtained sperm, immediately before its injection, and cryopreserved sperm are used. Cryopreservation of the husband's sperm is carried out before the man's sterilization, before starting a course of treatment with cytostatics and on the eve of irradiation.

Heterologous technique

Artificial insemination is performed with donor sperm for absolute and relative medical reasons. Mixing the sperm of the donor and the spouse is not allowed, since the chances of fertilization of the egg with the husband's sperm will not increase, and the quality of the donor sperm will deteriorate. Before carrying out AI with donor sperm, a test is performed to test the penetration of the husband's and donor's sperm into the cervical mucus. If significant differences are identified in the penetration abilities of the husband's and donor's sperm, the issue of AI is resolved in favor of the donor.

According to the technique of performing the procedure, artificial insemination is divided into:

Intracervical (subspecies – vaginal)

This is the simplest procedure and is performed without any special technical difficulties. In its technique, intracervical AI is as close as possible to natural sexual intercourse. No special preparation is required before the manipulation. Artificial insemination is carried out with freshly obtained purified sperm (no later than three hours before the procedure) and with cryopreserved sperm. The essence of the vaginal method is to introduce sperm into the woman’s vagina, and the intracervical (intracervical) method is as close as possible to the cervix.

Intrauterine

This method of introducing sperm is more effective compared to intracervical insemination. The technical essence is the introduction of specially prepared and purified sperm into the uterine cavity through the cervical canal. If fresh and unpurified seminal fluid is introduced into the uterus, it may contract or develop an allergic reaction, which will not only significantly reduce the chances of fertilization, but also pose a threat to the patient’s life.

In-line

Before the procedure, sperm undergo special preparation. Then the seminal fluid is injected into the fallopian tube from which ovulation occurred. It has been proven that the effectiveness of intratubal insemination is no higher than intrauterine insemination.

Intrauterine intraperitoneal

A certain amount of processed sperm is combined with several milliliters of a special liquid that increases sperm motility. Then the resulting solution (approximately 10 ml) is injected into the uterine cavity under pressure. As a result, sperm with liquid will almost immediately enter the tubes and from there into the abdominal cavity. The chances of fertilization of an egg currently located in the abdominal cavity are much higher than during natural sexual intercourse. This AI method is used for unknown causes of infertility and in cases of failure of intracervical and intrauterine insemination.

Preparing for AI

Before insemination, the woman (recipient), the man (husband or donor) and the sperm itself are prepared. The married couple must undergo a full examination, and if any diseases are detected, they must be treated (for example, sexually transmitted infections). Also, spouses must follow all the recommendations for the pregnancy planning period (within six months). These include: giving up bad habits, maintaining a healthy lifestyle, stimulating the immune system, rational nutrition, taking vitamins, etc.

Specialist consultations

Both spouses need to visit the following doctors:

• therapist – identification of chronic somatic pathology and its correction;
• gynecologist (women) – identifying gynecological diseases;
• andrologist (men) – determination of dysfunctions in the male reproductive system;
• urologist – exclusion of pathology of the urogenital system;
• mammologist (women) – detection of breast diseases;
• endocrinologist – exclusion of endocrine disorders.

According to indications, additional consultations with related specialists (cardiologist, oncologist, ENT doctor and others) are prescribed.

Analyzes and instrumental diagnostic methods

On the eve of the AI, the married couple is prescribed tests and instrumental diagnostic methods:

• general blood and urine tests to exclude anemia, inflammation, allergic reactions, infections and other pathologies of the urogenital system;
• blood biochemistry (women) – assess the condition of the liver and kidneys, pancreas and heart, exclude metabolic disorders;
• coagulogram (women);
• examination for STIs – identify and treat hidden sexually transmitted infections (chlamydia, ureaplasmosis, cytomegalovirus and herpetic infections and others);
• gonorrhea smears (men and women);
• blood for viral hepatitis, syphilis and HIV infection;
• blood for hormones (women) - sex hormones, prolactin, FSH, LH, thyroid and adrenal hormones;
• blood group and Rh factor (exclude isoserological incompatibility of spouses);
• spermogram (men) – the number of live sperm and their activity, the volume of seminal fluid, its thickness and color are assessed;
• Ultrasound (women) – gynecological area, kidneys, thyroid gland, mammary glands;
• fluorography, ECG.

Sperm preparation

Before performing AI, it is necessary to prepare the sperm. For this purpose, it is processed - seminal plasma is separated from active sperm. This prevents proteins and prostaglandins from seminal fluid from entering the uterine cavity (which can provoke uterine spasms and an allergic reaction). In addition, seminal plasma contains factors that reduce the fertilizing ability of male germ cells. Also, sperm preparation includes the rapid and high-quality removal of not only seminal plasma, but also dead sperm, epithelial cells, leukocytes and various microorganisms. Today, several options for sperm preparation are used:

• Sperm floating method

The essence of the method is the spontaneous movement of motile sperm in the washing solution. The floating of male germ cells from the seminal fluid avoids the centrifugation method, during which the sperm may be damaged by reactive oxygen species. But this method is only suitable for ejaculate with a high concentration of active sperm. The duration of the procedure is 2 hours.

• Washing sperm

The simplest technique. It is based on the removal of the liquid part of the ejaculate, which somewhat improves sperm motility. The resulting ejaculate is suspended in a washing solution containing antibiotics and dietary supplements in a centrifuge tube. The seminal fluid is then centrifuged, causing the cells to pellet out and the excess solution to be drained off. The resulting precipitate is washed again and centrifuged. Then the solution is drained and the precipitate is washed a third time and centrifuged. The duration of sperm purification is about 1 hour.

• Sperm centrifugation

Sperm washing, which removes the liquid part of the seminal fluid and separates active sperm from “garbage” (leukocytes, microbes, dead epithelial cells and sperm). Centrifugation is repeated twice, the resulting sediment is again diluted in a washing medium and used for intrauterine insemination. The duration of the procedure is 1 hour.

• Sperm filtration through fiberglass

This option for sperm purification includes washing the ejaculate, centrifugation, repeated washing and placing the resulting sediment on glass fibers. The solution of the washed sediment is filtered, and the resulting filtrate is collected for AI.

Timing for AI

On what day is it advisable to carry out AI? The timing of insemination is determined by calculating the day of ovulation. The success of the procedure depends on accurately determining the date of ovulation. Not so long ago, intrauterine insemination was carried out after examination for 2 - 3 cycles and performing functional diagnostic tests, measuring basal temperature and determining the concentration of progesterone in the blood in the middle of the second phase of the cycle. Using these studies, the estimated date of ovulation was calculated.

Today, the optimal day for the insemination procedure is calculated using the following methods:

• Determination of the urinary LH peak level

When the concentration of LH in the urine reaches its peak, ovulation occurs after 40–45 hours. In this regard, the AI ​​is planned for the next day.

• Ultrasound monitoring of follicle growth

Follicles are detected by ultrasound when they reach 2–3 mm in diameter. Rupture of the main follicle and release of the egg occurs when the follicle size is 15 – 24 mm. The procedure is performed when the size of the dominant follicle reaches 18 mm or more and the thickness of the endometrium is 10 mm.

• Introduction of the ovulation factor - hCG.

The administration of choriogonin stimulates ovulation and is advisable when the size of the dominant follicle is 17–21 mm. Insemination is carried out after 24 – 36 hours.

On the eve of the AI ​​procedure

It is necessary to begin preparing for the expected date of the AI ​​5–7 days in advance. Men should avoid visiting the sauna and bathhouse, and also avoid hypothermia. If possible, eliminate stressful situations and limit physical activity. Before donating sperm, observe sexual rest, but for longer than 2–3 days, since longer abstinence negatively affects the quality of sperm. Stop drinking alcohol and smoking, or reduce the number of cigarettes you smoke. On the day of the procedure, the man should come to the clinic 60 to 90 minutes in advance to donate sperm by masturbation. If the ejaculate volume is too small, there may be a build-up of sperm. To do this, the spouse comes to the clinic several times and donates sperm, which is cleaned and frozen.

Women also need to adhere to some rules. Stop drinking alcohol and smoking (ideally 6 months before planned conception). Avoid worries and stress, eliminate physical activity and heavy lifting. It is important to maintain sexual rest for 3 to 5 days (sexual intercourse and orgasm can trigger spontaneous ovulation). Set yourself up for success.

How AI is performed

How does the AI ​​procedure work? The married couple must appear at the clinic on the appointed day. While the ejaculate is collected and the sperm is processed, the woman is examined again using an ultrasound, ovulation is confirmed and asked to take a seat on the gynecological chair. The processed sperm is drawn into a syringe without a needle, onto which a blunt tip (for intracervical insemination) or a plastic catheter (for intrauterine insemination) is installed. After inserting the speculum into the vagina, the tip is placed as close as possible to the cervix and the sperm is pushed out of the syringe with a piston. When performing intrauterine insemination, a catheter is inserted through the cervical canal into the uterine cavity, and then pressure is applied to the piston, pushing out the sperm. For safety, a cervical cap is placed on the cervix, which will prevent sperm from leaking out of the uterus. After the procedure, the woman must remain on the chair for 60–90 minutes, after which she is allowed to go home.

After completing the A.I.

After insemination, the doctor gives the patient a number of recommendations, compliance with which increases the chances of success. Not recommended:

• take a bath on the day of the procedure (water with detergent can penetrate into the vagina, which will lead to the death of some sperm and significantly reduce the likelihood of conception);
• be sexually active for three days after the manipulation (although many experts do not prohibit intimacy);
• lift weights and perform heavy physical work for a week after AI (if the egg is successfully fertilized, physical work can disrupt the process of its implantation into the uterine mucosa);
• smoking and drinking alcohol (reduces the chances of fertilization, implantation and normal pregnancy);
• take medications without a doctor's permission.

After the procedure, the patient is allowed to:

• take a shower on the day of the procedure;
• to walk outside;
• sunbathing.

In some cases, the doctor may recommend taking utrozhestan or duphaston. These drugs contain progesterone, which prepares the endometrium for successful implantation of the fertilized egg and supports the further development of pregnancy. 12 - 14 days after insemination, the patient should come to the clinic and donate blood for hCG, which will confirm the conception, implantation and development of pregnancy.

Pregnancy

If the AI ​​procedure is successful, then after a certain time, but not earlier than 7 days, the woman begins to show signs of pregnancy: changes in taste and smell, emotional lability (tearfulness, irritability), weakness, drowsiness, mild nausea, possible vomiting, change taste preferences and appetite, engorgement of the mammary glands. The most reliable subjective sign of pregnancy after insemination is the absence of menstruation after 14 days or more. Pregnancy can be confirmed by performing a rapid test 10–14 days after insemination and laboratory determination of hCG in the blood. An ultrasound is recommended no earlier than 3 to 4 weeks after the procedure. Ultrasound confirms the onset and development of pregnancy and excludes its ectopic implantation, for example, in the fallopian tube.

Discharge and pain after AI

What should the discharge be like after insemination? If the procedure was successful, then vaginal discharge is no different from normal. A slight cloudy discharge may appear on the day of AI, which indicates that part of the sperm has leaked from the genital tract. In case of violation of the rules of asepsis (use of non-sterile instruments) during the procedure, it is possible that a secondary infection may occur with the development of an inflammatory process in the vagina and cervix. In this case, colpitis/cervicitis will develop, accompanied by profuse leucorrhoea with an unpleasant odor and itching in the vagina. Also, after AI, nagging or aching pain in the lower abdomen may appear, which is explained by irritation of the uterus and cervix by the catheter and sperm that have not undergone high-quality cleaning.

Indications for AI

Insemination is carried out according to certain indications, both on the part of the woman and on the part of her sexual partner. Indications for AI in case of female problems:

• vaginismus;
• chronic endocervicitis;
• chronic endometritis;
• surgery on the cervix or scar deformation of the cervix;
• abnormalities of development and localization of the uterus;
• cervical factor - high viscosity of cervical mucus, the presence of antisperm antibodies;
• allergy to husband's sperm;
• gynecological diseases accompanied by anovulation;
• idiopathic infertility;
• mild endometriosis.

Indications for AI on the part of the husband:

• sexual impotence (lack of erection);
• hydrocele or inguinal-scrotal hernia of significant size;
• hypospadias;
• pathological postcoital test;
• abnormalities in the structure of the penis;
• retrograde ejaculation (ejaculate enters the bladder);
• sperm subfertility (reduced sperm fertility);
• undergone radiation, chemotherapy;
• bad habits;
• impotence after spinal cord injury.

Indications for AI with donor sperm:

• azoospermia (lack of sperm in the ejaculate);
• necrospermia (there are no live sperm in the ejaculate);
• lack of a permanent partner for a woman;
• genetic diseases on the part of the husband;
• incompatibility of spouses based on blood type and Rh factor.

Contraindications

Artificial insemination is not advisable in the following situations:

• severe endometriosis;
• acute or exacerbation of chronic inflammatory processes in the female genital area;
• infectious diseases in the husband;
• ovarian tumors and cysts;
• cancer of any location in a woman;
• presence of contraindications to pregnancy;
• infertility of a woman lasting more than three years;
• absence of uterus, ovaries or tubes;
• mental illness in women;
• the possibility of eliminating infertility after treatment or surgery.

Question answer

Question:
Can insemination be performed on a woman 40 years of age or older?

Yes, insemination can be done at a late reproductive age, but it should be borne in mind that the older a woman is, the less chance she has of getting pregnant. A favorable outcome of the procedure is possible only in 5–15%.

Question:
How many times can the AI ​​procedure be performed on one woman?

Question:
What are the chances of getting pregnant with AI from my husband's sperm and AI from a donor's sperm?

The effectiveness of AI with husband's sperm does not exceed 10 - 30%. Insemination with donor sperm is more effective and pregnancy occurs in 30–60% of cases.

Question:
When undergoing AI, do the chances of multiple pregnancies increase?

No, the probability of multiple pregnancy after AI is the same as after natural intercourse. But if ovulation is stimulated with drugs, it is possible that not one, but several eggs will mature, which will increase the chances of a multiple pregnancy.

Question:
Is the AI ​​procedure painful?

No. You may experience discomfort when performing intrauterine insemination, when the catheter is inserted into the uterus.

The topic of pregnancy is always relevant for women of reproductive age.

In order to learn about a special situation as early as possible, they begin to listen to the unique changes in their own body.

In order to determine on what day after fertilization the egg was implanted, you should find out the exact date of ovulation.

This period will be taken as the starting point. Most often, the implantation of the embryo occurs 9-10 days after fertilization.

But depending on the individual characteristics of the female body, the timing can be shifted by 1-6 days, down or up. It turns out that implantation can occur 8-14 days after fertilization of the egg.

When signs of pregnancy appear

The first trimester of pregnancy is characterized by the manifestation of specific symptoms such as:

They may appear a certain number of days after the expected conception.

• Implantation bleeding.

These are, which can be scarce and abundant depending on the physiological characteristics of the female body.

It appears 8-10 days after fertilization, when the embryo attaches to the wall of the uterus. This is one of the important signs of pregnancy.

• Mild uterine pain of a pulling nature.

The pain is triggered by the process of implantation of the embryo on the uterine epithelium.

On the 8-10th day after the expected conception, mild pain in the lower abdomen may appear.

This is a standard phenomenon, but if it gets worse, you should consult a doctor to avoid termination of pregnancy.

• Discharge.

The appearance may be associated with or other infectious processes.

Observed 8-10 days after conception.

• Increase in basal temperature.

Basal temperature is measured rectally in the morning, immediately after waking up.

Basal temperature rises to 37.1-37.3 °C the day before ovulation. It remains at this level until the embryo is transferred.

At the moment of attachment of the egg, the basal temperature drops to 36.8-36.9 °C. This is due to a sharp increase in estrogen in a woman’s body.

After implantation of the fertilized egg basal temperature again rises above 37.1 °C and remains at this level until 14-16 weeks of pregnancy.

Then the rectal temperature drops to 36.8-36.9 °C.

Increased sensitivity of the mammary glands may occur in the first or second week after alleged conception (7-14 days).

Changes in hormonal levels lead to such manifestations.

Some pregnant women experience swelling and pain in the breasts only 20-30 days after fertilization of the egg.

• Sudden mood swings.

Depressions followed by joy are also caused by a hormonal surge. Usually appear 10-14 days after pregnancy.

Human chorionic gonadotropin in the blood is usually determined already 9-12 days after the child is conceived.

• Second line on the test.

Many women use special tests to confirm their “interesting” position.

The test will show a second line, that is, it will give a positive result only 12-14 days after the expected conception of the fetus.

It determines the amount of the hCG hormone, the level of which in the urine does not appear immediately, but only 11-14 days after the expected date of conception.

• Diarrhea and other gastrointestinal disorders.

Heartburn, bloating, flatulence, diarrhea are characteristic signs of pregnancy that can occur 14-20 days after expected fertilization.

• Toxicosis.

This is one of the main signs that a baby will be born soon.

Usually occurs 5-7 weeks after fertilization of the egg.

• Increased fatigue, drowsiness, dizziness.

These are important signs of the special condition of the female body. The reason lies in a sharp drop in blood pressure.

2-3 weeks after the expected conception, some women may begin to periodically lose consciousness.

But this phenomenon is considered normal.

Conception is a complex physiological process that goes through several stages. The result is fertilization of the egg and the formation of an embryo, which continues to develop in the uterus until the onset of labor.

Pregnancy can be determined by numerous signs that appear in the first trimester. But each symptom has a specific time period for its manifestation. All of the above signs are quite specific and appear within 2-14 days after conception.