Artificial insemination is the deliberate introduction of sperm into the cervix or uterine cavity for the purpose of achieving pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment for humans, and is a common practice in animal breeding, including cattle (see frozen bovine semen) and pigs.
Artificial insemination may employ assisted reproductive technology, sperm donation and animal husbandry techniques. Artificial insemination techniques available include intracervical insemination (ICI) and intrauterine insemination (IUI). Where gametes from a third party are used, the procedure may be known as 'assisted insemination'.
Humans
History The first recorded case of artificial insemination was by Lazzaro Spallanzani in 1784, who performed it on a dog. It was followed in 1790 by John Hunter, who helped impregnate a linen draper's wife. The first reported case of artificial insemination by donor occurred in 1884: William H. Pancoast, a professor in Philadelphia, took sperm from his "best looking" student to inseminate an anesthetized woman without her knowledge. The case was reported 25 years later in a medical journal. (cited in ) The sperm bank was developed in Iowa starting in the 1950s in research conducted by University of Iowa medical school researchers Jerome K. Sherman and Raymond Bunge.Kara W. Swanson, "The Birth of the Sperm Bank," Annals of Iowa, 71 (Summer 2012), 241–76.
In 1916, Australian eugenicist Marion Louisa Piddington published a pseudonymous tract titled Via Nuova or Science & Maternity in which she called for a programme of mass artificial insemination for the sweethearts of soldiers who had been killed in World War I. She described this as a "conscription of the virgins" – comparable to the conscription of men for military service – who would receive "artificial insemination from a eugenically-desirable donor". Piddington promoted her scheme for several years in Australia, Britain and the United States under the name of "scientific motherhood", but it was poorly received.
In the United Kingdom, British obstetrician Mary Barton founded one of the first fertility clinics to offer donor insemination in the 1930s, with her husband Bertold Wiesner fathering hundreds of offspring.
In the 1980s, direct intraperitoneal insemination (DIPI) was occasionally used, where doctors injected sperm into the lower abdomen through a surgical hole or incision, with the intention of letting them find the oocyte at the ovary or after entering the genital tract through the ostium of the fallopian tube.
Patients and gamete donors
Artificial insemination (AI) is a medical procedure in which sperm is introduced into a woman's reproductive system to achieve pregnancy without sexual intercourse. The sperm used may come from the recipient's partner or from a donor, whose identity may be known or anonymous. Various methods exist to obtain sperm for use in artificial insemination.
In 2016, an article was published in Seventeen magazine that highlighted the story of Kacie Saxer-Taulbee, a teenager conceived from a sperm donor father. Using her donor's cryobank number in the Donor Sibling Registry, she managed to find other siblings conceived from the same donor. They became known as the "5010ers" and formed a Facebook group to keep in touch.
Barriers for patients and donors Some countries have laws which restrict and regulate who can donate sperm and who is able to receive artificial insemination.
Preparations Timing is critical, as the window and opportunity for fertilization is little more than twelve hours from the release of the ovum. To increase the chance of success, the woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of her cervix. To improve the success rate of artificial insemination, drugs to create a stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth.
Sperm can be provided fresh or washed.
Techniques
Semen used is either fresh, raw, or frozen.
Intracervical Intracervical insemination (ICI) is the method of artificial insemination which most closely mimics the natural ejaculation of semen by the penis into the vagina during sexual intercourse. It is painless and is the simplest and most common method of artificial insemination involving the introduction of unwashed or raw semen into the vagina at the entrance to the cervix, usually by means of a needle-less syringe. The vagina acts as a filter to separate out the sperm from other chemicals in the ejaculate, as with intercourse, so that only sperm pass through the cervix on their way to the uterus.
Although ICI is the simplest method of artificial insemination, a meta-analysis has shown no difference in live birth rates compared with IUI.
During ICI, air is expelled from a needleless syringe which is then filled with semen which has been allowed to liquify. A specially designed syringe, wider and with a more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The woman lies on her back and the syringe is inserted into the vagina. Care is optimal when inserting the syringe, so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose and a catheter may be attached to the tip of the syringe to ensure delivery of the semen as close to the entrance to the cervix as possible. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for safety and for the best results, bearing in mind that the purpose of the procedure is to replicate as closely as possible a natural deposit of the semen in the vagina. The syringe (and catheter if used) may be left in place for several minutes before removal. The woman can bring herself to orgasm so that the cervix 'dips down' into the pool of semen, again replicating closely vaginal intercourse, and this may improve the success rate.
When performed at home without the presence of a professional, aiming the sperm in the vagina at the neck of the cervix may be more difficult to achieve and the effect may be to 'flood' the vagina with semen, rather than to target it specifically at the entrance to the cervix. This procedure is sometimes referred to as 'intravaginal insemination' (IVI).
A conception cap, which is a form of conception device, may be inserted into the vagina following insemination and may be left in place for several hours
Intrauterine
Intrauterine insemination (IUI) involves injection of 'washed' sperm directly into the uterus with a catheter. Washing involves the removal of chemicals other than sperm which are in the natural ejaculate. In forms of vaginal insemination, including artificial vaginal insemination and ICI, these chemicals will be filtered out by the vagina. Insemination in this way also means that the sperm do not have to swim through the cervix which is coated with a mucus layer. This layer of mucus can slow down the passage of sperm and can result in many sperm perishing before they can enter the uterus. Donor sperm is sometimes tested for mucus penetration if it is to be used for ICI inseminations but partner sperm may or may not be able to pass through the cervix. In these cases, the use of IUI can provide a more efficient delivery of the sperm. In general terms, IUI is usually regarded as more efficient than ICI or IVI. It is therefore the method of choice for single and lesbian women wishing to conceive using donor sperm since this group of recipients usually require artificial insemination because they do not have a male partner, not because they have medical problems. Owing to the high number of these recipients using donor sperm services, IUI is therefore the most popular method of insemination today at a fertility clinic. The term 'artificial insemination' has, in many cases, come to mean IUI insemination.
It is important that washed sperm is used because unwashed sperm may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, during menstruation.) Resting on the table for fifteen minutes after an IUI is optimal for the woman to increase the pregnancy rate.
For heterosexual couples, the indications to perform an intrauterine insemination are usually a moderate male factor, the incapability to ejaculate in vagina and an idiopathic infertility. A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates. For the man, a TMS of more than 5 million per ml is optimal. In practice, donor sperm will satisfy these criteria and since IUI is a more efficient method of artificial insemination than ICI and, because of its generally higher success rate, IUI is usually the insemination procedure of choice for single women and lesbians using donor semen in a fertility centre. Lesbians and single women are less likely to have fertility issues of their own and enabling donor sperm to be inserted directly into the womb will often produce a better chance of conceiving. A 2019 showed that pregnancy rates were similar between lesbian women and heterosexual women undergoing IUI. However, it was found that there is a significantly higher multiple gestation rate among lesbian women undergoing ovulation induction (OI) when compared to lesbian women undergoing natural cycles.
Unlike ICI, intrauterine insemination normally requires a medical practitioner to perform the procedure. One of the requirements is to have at least one permeable tube, proved by hysterosalpingography. The infertility duration is also important. A female under 30 years of age has optimal chances with IUI; A promising cycle is one that offers two follicles measuring more than 16 mm, and estrogen of more than 500 pg/mL on the day of hCG administration. However, GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles according to a randomized controlled trial. One of the prominent private clinic in Europe has published a data A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were associated with the live-birth rate The steps to follow in order to perform an intrauterine insemination are: Mild controlled ovarian stimulation (COS): there is no control of how many oocytes are at the same time when stimulating ovulation. For that reason, it is necessary to check the amount being ovulated via ultrasound (checking the amount of follicles developing at the same time) and administering the desired amount of hormones. Ovulation induction: using substances known as ovulation inductors. Semen capacitation: wash and centrifugation, swim-up, or gradient. The insemination should not be performed later than an hour after capacitation. 'Washed sperm' may be purchased directly from a sperm bank if donor semen is used, or 'unwashed semen' may be thawed and capacitated before performing IUI insemination, provided that the capacitation leaves a minimum of, usually, five million motile sperm. Luteal phase support: a lack of progesterone in the endometrium could end a pregnancy. To avoid that 200 mg/day of micronized progesterone are administered via vagina. If there is pregnancy, this hormone is kept administering until the tenth week of pregnancy.