AI is a type of fertility treatment in which sperms are placed into a woman’s reproductive tract through means other than sexual intercourse. AI is done to ensure proximity of useful active sperms to the ova in women who have functional reproductive organs and patent passages.
The advantage of Artificial insemination (AI) is that a significantly larger number of sperm make it into the fallopian tubes which are the site of in vivo fertilization, whereas with sexual intercourse, the majority of sperm do not make it up the female genital tract. The various methods of artificial insemination include:
- Intrauterine insemination (IUI),
- Intracervical insemination (ICI),
- Intratubal Insemination and
- Intravaginal insemination (IVI).
In these processes except for the Intravaginal insemination (IVI), sperm are washed and concentrated before they are injected directly into the uterus.
Artificial inseminations (AI) are painless or least painful outpatient procedures that take less than ten minutes. These procedures are mostly done in cases of a number of male factors such as ejaculation dysfunction, Low count and Higher percentage of immotile sperms in husband’s semen.
The indications are lack of libido in either partner, cervical hostility, unexplained infertility, ovulation problems Or even on social grounds.
Each couple is briefly explained the various aspects of the Artificial Insemination Techniques. Detailed personal, social and medical history is taken including the previous fertility assessments and the treatments. The factors that influence results of the AI treatments are given special importance. Pelvic examination is performed, ultrasound and some laboratory tests done.
Professional status & the nature of employment influence the schedules. Particular notice is taken of the circumstantial separation of the partners from each other like husband working abroad or remaining away from home due to employment. His availability is to be ensured on the day of insemination.
Clinical details and some specific evaluations determine the prognosis of the treatment. Some of the investigations are required for the choice of AI technique are:
Husband: Recent Semen Analysis is the only requirement. 20 millions sperms per ml, of which 50 % with normal morphology and progressive forward motility are considered good for the AI procedures.
Wife: Functional reproductive organs and patent passages are the basic requirement of AI. Postcoital test (PCT) is most useful to decide for the type of AI. It helps to know the cervical hostility. Ovulation is detected by serial Transvaginal Ultrasound (TVS). In ovarian disturbances, presence of primordial follicles is ascertained. Progesterone levels 7 days before the onset of period (>16 mmol/L) are estimated. Right sized functional uterus is essential for implantation.
Timing the ProcedureArtificial inseminations (AI) is done at the fertile period of the woman i.e. when the ovulation is taking place. Ideally an insemination should be performed within 6 hours either side of ovulation with the sperm waiting for the egg. When TVS shows fully grown leading follicle (FD > 17 mm) ready to release its contents is the procedure time. It is repeated on alternate days until the follicle ruptures.
If the timing is based on LH surge (natural or induced), a single insemination at 36 hours is the norm, but repeating them after 24 hours is also quite common.
Where the active sperms are few, the controlled ovarian hyperstimulation (COH) by proliferating numerous ova increase chances of success. If IUI is selected, Clomiphene induced ovarian stimulation does not improve results. Gonadotrophins COH does. High female fecundity compensates male deficiency to some extent. In such cases timing is based on hCG injection, the Artificial inseminations (AI) are usually done 24 to 36 hours post-hCG. If two inseminations are scheduled, they are usually spaced 24 to 48 hours.
The Procedure t he semen of the husband is collected. Except in Intravaginal insemination, Sperms are washed, debris removed & good motile sperms separated in culture medium. Processing of semen is important otherwise contaminated semen can be harmful to the woman The dead or weak sperms are excluded so that they do not hinder the ascent of active sperms.