Assisted Reproduction
There are two categories of insemination: homologous, in which sperm from the couple’s husband is used, and heterologous, in which sperm from a donor is used, as occurs in cases of azoospermia (absence of sperm in the couple’s husband’s semen), although in these cases, a biopsy of the azoospermic man’s testicles and microinsemination can also be performed.
Indications. Insemination is indicated in the following cases:
- Unexplained infertility, i.e. in cases where the couple’s testing has failed to reveal an obvious cause of infertility. It is estimated that these couples constitute 10-15% of infertile couples.
- Mild to moderate impairment of sperm quality in men. During insemination, a sperm concentration in the fallopian tubes is achieved that is 10 to 100 times greater than the concentration during intercourse. This demonstrates how useful insemination can be in cases of oligospermia, i.e. a reduced number of sperm in the seminal fluid.
- Mild endometriosis in women.
- Cervical factor.
- Combination of one or more factors in the man and/or the woman.
Contraindications. Insemination is contraindicated in the following cases:
- When there is damage to both fallopian tubes.
- With a history of ectopic pregnancy.
- In a severely reduced amount of sperm, i.e. below 2,000,000 motile
As for the woman, there are 3 ways to deal with it.
- Insemination can be done in a natural cycle, that is, without any ovarian stimulation.
- Stimulation can be done with oral pills (clomiphene citrate) and
- A combination of clomiphene citrate and gonadotropin injections can be used.
Results. Success rates are individualized for each couple and are mainly related to the quality of the sperm, the age of the woman and the indication for the insemination itself. On average, studies give success rates of 15 to 17% per cycle, while cumulatively after 3 to 4 cycles, 25% of couples will achieve pregnancy and childbirth and thus avoid IVF. Insemination should be limited to 3 to 6 cycles, maximum, as it has been shown that the chances of success decrease after 3 to 4 attempts. If pregnancy is not achieved, the next step is to move on to either classic IVF or ICSI, depending on the quality of the sperm.
