what is artificial insemination? A Detailed Guide

What is artificial insemination?

Rachel and I were diagnosed with unexplained infertiltiy which meant that artificial insemination techniques weren’t an option for us. However we have a number of friends who have been through the procedure. Listening to them talk about the complexity and challenges made us write this post.

Artificial insemination (AI) also known as intrauterine insemination (IUI) and intracervical insemination (ICI) is a treatment for those who are struggling to conceive through intercourse. It involves in injection of sperm into the vagina (ICI) or uterus (IUI). It is a treatment most commonly used to help

  1. Same sex couples through donor sperm
  2. Single women
  3. Those unable to have vaginal sex
  4. Those who have a condition which means they need help in conceiving or aren’t safe to have unprotected sex.

An overview at artificial insemination.

As we mentioned above A.I. is the process of injecting sperm into the vagina or the uterus. You can use your partner’s sperm, an anonymous donor sperm or sperm from a known donor. As a pre-warning the waiting list for IUI in some NHS area’s is very long and you should be prepared for this.

Those who are unable to try through heterosexual intercourse to be eligible for NHS IVF treatment will have needed to do 12 months of IUI before a referral for IVF can be done.

The chances of getting pregnant using IUI vary as it does through normal intercourse, it considers your fertility, your age, and whether your treatment is being supplemented with fertility drugs. The below table shows the average IUI chance of a healthy baby being born

Age Range Chance per single cycle
Under 35 18%
35-37 14%
38-39 12%
40-42 5%
Over 42 1%

Do I need fertility testing before I start intrauterine insemination?

The simple answer is yes. You and your partner (if applicable) will need to have a number of fertility tests, which you can read more in our article fertility testing for men and women The key fertility tests include: –

 

 

  • To check you have normal open fallopian tubes – this will be checked normally through a transvaginal ultrasound, hysterosalpingogram or if required a laparoscopy
  • Semen analysis if required
  • Blood tests

These are to ensure that is safe for you and you and that you have the highest possible chance of success. If you have blocked fallopian tubes, unexplained infertility, mild endometriosis or a low sperm count or quality then you wouldn’t be suitable, this is because research has shown that your chances of conceiving with IUI vs normal methods are unlikely to improve your chances of becoming pregnant.

Natural (unstimulated) vs stimulated IUI cycles.

IUI can be either performed unstimulated or stimulated.

Unstimulated artificial insemination – This is using your own cycle to determine when you should inseminate. You will be provided with an Ovulation prediction kit (OPK) which will help you determine when you should inject the sperm. The exact timing of this depends if you are doing this at home or in a clinic and will be discussed in more detail in each specific section below. This technique is predominately used for single women, same sex couples and those unable to have vaginal sex but don’t have specific fertility problems.

Stimulated cycle – This is where you use fertility drugs to stimulate your ovaries we have an article about how fertility medications will impact you which will give you an idea of what to expect from these, but ultimately they stimulate you to create more mature follicles which should mean more eggs, whilst this does increase chances of success, it increases the risk of multiple pregnancies and also ovarian hyperstimulation syndrome, which means you will need to have transvaginal ultrasound scan to check the development and size of your ovaries. This is often used to help with mild endometriosis, infertility related to sexual problems and mild sperm abnormalities.

Finding Donor sperm for use in artificial insemination

There are 4 methods to finding donor sperm

  1. Using someone you know
  2. Through a licenced clinic
  3. Overseas sperm bank
  4. Using a sperm donor website

Many couples want to use the sperm from someone that they know, this is a sensible option which is right for many people. However, there are limits on how closely this person can be related to you.

Some clinics have specific lists of donors from which you can select based on ethnicity, age and several other key metrics it’s important to note that there can be a long waiting list for donor types in high demand. It’s also important to note that a donor can only help create 10 families in the UK plus their own.

Overseas sperm banks some clinics allow the import of donor sperm; however, this is highly regulated. Some people chose to get sperm sent to them at home through these services, please be aware of the risks associated with not having the sperm sufficiently tested.

Using a sperm matching service – these are becoming more common, if you are going to use these services, then when you meet in person, be sure to meet in a public place and take all necessary precautions when meeting someone unknown for the first time. Often the inseminations are arranged privately and without the use of a clinic, make sure to weigh up the very real risks, associated with infections and hereditary diseases and the legalities of the parents.

Sperm health and quality is very important. If you are using someone you know or someone from a matching service then all donor sperm should have a semen analysis done to look at count and quality, they should be checked for infectious and hereditary diseases. A detailed family history should be taken, and they should agree to the GP being contacted. If a donor isn’t willing, then our advice is don’t go ahead. Some communicable diseases won’t show up straight away in testing, which is why in clinics new donor sperm is frozen for half a year and not allowed to be used as a donor after this quarantine period it is then retested. If you are using fresh sperm donations, then it may be worth asking them to undergo NAAT(this is special testing which means you can get results in days rather than weeks) testing to more quickly determine the risks.

An overview of the home artificial insemination process?

Firstly, let me state that having artificial insemination is safer through a clinic than it is at home. The main reason for this is the quality of the sperm which you are using (discussed above). Secondly the legalities around the parentage of the child are complex, but ultimately it means there is a risk that your donor will be the legally defined parent and has the responsibilities which come with this – read more about this in the legalities section below.

Artificial insemination at home, is almost exclusively ICI (intracervical insemination) this means that you are injecting it into your vagina rather than past the cervix as in IUI. The process is as follows:

#1 Have fertility checks
#2 Find the donor sperm and get appropriate tests.
#3 Track cycle – for this you will use an ovulation prediction kit, this will help you understand when you are going to ovulate. Essentially you are most fertile 2 days before ovulation to 1 day after ovulation. Most OPK kits use LH to track ovulation, a such as soon as you are looking for the rise in LH levels to know when to start the insemination process.

#4 Ensure that you have arranged for the sperm to be delivered to your home, if this is fresh from your donor make sure that this is collected fresh and used as quickly as possible and goes into an appropriate container to give you the best chance of success. If you order sperm from abroad or over then internet this will likely come as liquid nitrogen cooled frozen sperm.

#5 Thaw sperm if they are frozen your supplier should give you detailed instructions on how to do this. Generally, the guidance is (this does not constitute formal guidance as most formal guidance uses temperature blocks and is done in controlled laboratory conditions). However, with many people doing this at home it is important to give as much information as possible. Make sure you wear gloves appropriate for handling liquid nitrogen cooled products, then remove the vials from the liquid nitrogen – if they are marked make sure that the semen sample matches that which you thought you should have received. Place it in room temperature (no hotter or you will denature the sperm) for 5 minutes. Then remove and roll the vial in your hand for a further 5 minutes until it has a liquid consistency.

#6 Use a 5-10ml syringe to draw up the sperm ready for insemination – DO NOT try to feed a catheter past your cervix at home, this can cause damage to your cervix and introduce infections.

#7 Lie on your back and insert the semen using the syringe – with no needle as close to the cervix as is safe. Lie down for 20-30 minutes afterwards to give the sperm a chance to get through your cervix and into the uterus. If you have enough sperm, you should inseminate 3 days before ovulation and then every other day till the day after ovulation – especially important if using fresh sperm as this allows the count to build back up. You will normally do 2-3 inseminations per cycle.

What is the fertility clinic artificial insemination process?

There are a few of key differences from home-based insemination in regard to having it in a licenced clinic.

  1. Your sperm quality is guaranteed to be safe and appropriate.
  2. You may use stimulation drugs to increase your chances of success which will mean monitoring scans will be needed
  3. You will likely have IUI (intrauterine insemination) a catheter passed through the cervix
  4. If it isn’t through the NHS, the cost will likely be much higher

The process in a clinic can be bespoke to your specific situation and your consultant will develop a treatment plan which is specific to you. A standard cycle is as follows: –

  1. Fertility testing – this is mainly to check the quality of the fallopian tubes, the quality and quantity of semen if using your partners sperm and for any specific conditions (HIV, Hepatitis) as well as a family history.
  2. Choosing your sperm – If not using your partners. If you have selected a donor, then they will need expensive testing, this may mean sperm is frozen for 180 days or they will have NAAT to get the results in a week. Some clinics also have a sperm donor list from which you can select based on specifics which are important to you. It will be advised during this period you have some counselling as choosing the right sperm can be a mentally challenging experience. Finally, some clinics will allow for import of sperm from abroad, however the regulations are very strict and must pass the same quality checks as sperm from the UK.
  3. Administration of fertility drugs – If you are having a stimulated cycle then you will normally take stimulation drugs such as Menopur or Gonal-F (these are follitropins and Human menopausal gonadotrophins respectively) for about 10 days before ovulation. They are given to stimulate the ovaries to mature more than 1 follicle and therefore release more eggs. This comes with 2 specific increased risks
    1. Greater risk of complicated more risky multiple pregnancies
    2. A risk of OHSS (Ovarian hyperstimulation Syndrome) a complication of stimulation drugs which can lead to hospital admission and serious health problems.

These drugs are given in lower doses than those through an IVF cycle as they can’t control the number of eggs released or embryo’s which will implant.

  1. Scans – during the stimulation drugs you will have a transvaginal ultrasound to see how many follicles are maturing and growing. – If there are too many the cycle may have to be cancelled due to the high chance of multiple pregnancies.
  2. A hCG trigger injection – Not all cycles have this, but you may have to inject a hCG medication which will allow specific timing of ovulation
  3. Insemination – You will be called into the clinic. If using fresh sperm from a donor or your partner, this will be collected in a container and prepared and washed in the clinic. If using donor sperm this will be done ready for your arrival. The best sperm are used which are determined on motility and use a centrifuge and microscopic analysis to be determined. You will go into a room, legs into stirrups, a syringe is loaded with the semen sample and is attached a catheter, this catheter is fed through the cervix into the uterine cavity where the sample is then inseminated. This is a little uncomfortable and feels like a smear test the process is usually done in 10 minutes.
  4. Pregnancy test, you will be given a date to do your pregnancy test – try not to test early if you can handle that as you may get false positives from the hCG injection or false negatives with hormone levels outside of normal ranges.

Costs of Artificial insemination

If you are going through the NHS and using their donor sperm or using your partner sperm and you are eligible your treatment will be free. If you use a licenced clinic the costs can vary wildly. However, on average they are usually between £800 -£1000 excluding drug costs if you are having a stimulated cycle. You can get non stimulated cycles for as low as £300.

Legalities of Artificial insemination

This is a complex area and before continuing if you are at all unsure you should seek professional legal advice regarding your specific circumstances.

There are 3 key pieces of legislation which cover artificial insemination in determination of parentage.

  1. The Human Fertilisation and Embryology Act 2008 – I would advise you understand this especially if doing home artificial insemination ICI as this law determines who legally is the parent. Full legislation can be found here, it’s not a light read.
  2. The Civil Partnership Act 2004 – This when coupled with the above act mean that same sex partnerships and civil marriages of heterosexual couples have the same rights which include issues to do with parenthood.
  3. The Equality Act (Sexual Orientation) Regulations 2007 – Which means services including healthcare have to be equal and fair to all sexual orientations and social situations, again when coupled with the HFEA 2008 removed the need for a farther from fertility clinics.

As you can see this there is a lot of legislation and this isn’t all of it which goes into determining the legal parents of a child. But to make it simple I have created a flow chart which you can see at the bottom of the post.

There is plenty of cases and case law around these areas and if you are interested, I encourage you to google these. But ultimately read the paperwork in the clinic thoroughly and if you have any questions ask before signing. Secondly, if you are an unusual case seek professional legal guidance.

Can I pay my sperm or egg donor?

No, it is illegal to pay a sperm or egg donor for their sperm or eggs in the UK. A sperm donor can claim up to a maximum of £35 for expenses and an egg donor up to £750 for her expenses.

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