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Artificial Insemination
© 2009 Teddie Joe Snodgrass, RN, MBA, MSN

Introduction

Artificial insemination is a universally accepted medical procedure in the civilized world. It is another option in the treatment of infertility, whereby, in most cases, the husband’s sperm is utilized.

An artificial insemination pregnancy will be no different from a pregnancy achieved by sexual intercourse.  Sperm can be provided by the husband or a donor. Artificial insemination provided by the woman's husband or partner is termed (artificial insemination by husband, AIH). Sperm from a donor is known as "donor sperm.” The donor may be known or anonymous, and this is termed (artificial insemination by donor, AID or DI). 

Artificial insemination is a relatively simple procedure where the sperm is specially treated and implanted or injected into the female’s uterus or reproductive tract with a small plastic catheter. Because of timing issues, the procedure is normally performed in most facilities seven days per week, and the female’s menstrual cycle is closely monitored.

Couples usually opt for this procedure after they have tried unsuccessfully for a significant amount of time to become pregnant through copulation.  There are several issues that can complicate a female’s chance of becoming pregnant through copulation.  For example, the cervical mucus may be hostile to the sperm, or there may be an insufficient amount of cervical mucus to support fertilization.  Also, there may be no apparent explanation for the couple’s failure to conceive.

Infertility in males is yet another problem. For example, infertility in men could be low sperm motility or low sperm count. One solution could be to utilize retrograde ejaculation whereby sperm is taken from the males’ urine, treated, and then placed in the uterus.

Still yet, other issues related to unexplained infertility could be that either one of the partners could be experiencing anti-sperm antibodies.

 A free brochure on infertility may be obtained from the FDA Office of Women’s Health by clicking the following link: http://www.fda.gov/downloads/ForConsumers/ByAudience/ForWomen/ucm121883.pdf

General Information on Artificial Insemination and Infertility

Artificial insemination is also an avenue often sought by women when there is an absence of a male partner, but a pregnancy is desired. In many situations, artificial insemination is the only logical solution for a couple, or the woman herself, to seek when copulation consistently fails to bring about a successful pregnancy.

The downside to artificial insemination is that, to a large extent, it is not effectively regulated, and there seems to be enormous secrecy surrounding the sperm donor’s identity in many cases.

Most women undergo three to six cycles of AI before a successful pregnancy is achieved. If irregular ovulation patterns are the issue, then drugs are frequently used to induce ovulation before AI is attempted.

The artificial insemination success rate is estimated as high as 15% per cycle according to The American Society for Reproductive Medicine. Artificial insemination is normally one of the first methods attempted even though other fertility treatments have a higher success rate.

Human artificial insemination rates have a reputation of being costly due to the expertise involved to perform the procedure. More information on the exact costs can be obtained from your selected fertility specialist. However, the cost of Intracervical Insemination (ICI) is usually less expensive than Intrauterine Insemination (IUI). The IUI technique has a distinct advantage over other techniques in that it is a simple procedure with little to no side effects.

When costs of AI are estimated, they normally include the following:

v  Cost of drug therapy.

v  Cost of the hospital stay.

v  Cost of the procedure being utilized.

v  Other charges that your infertility specialist can relay to you.

Your fertility specialist may have you take drugs such as CLOMID that will induce super-ovulation in which multiple eggs are produced before artificial insemination is attempted. It should be noted that women that use fertility drugs while seeking artificial insemination are at a much higher risk of developing complications that are normally specific to the medication itself.

CLOMID is a drug of considerable pharmacologic potency. With careful selection and proper management of the patient, CLOMID has been demonstrated to be a useful therapy for the anovulatory patient desiring pregnancy. For more information on CLOMID,  click the following link from the National Institute of Health:  http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=7613.

Intracervical Insmination (ICI) costs approximately $2000 per attempt. This procedure is usually performed with the husband’s sperm.

As far as fertility treatment goes, artificial insemination is a procedure that is normally effective with few side effects. Artificial insemination is an extremely viable option to infertility issues. Nevertheless, artificial insemination has its pros and cons and needs careful consideration before embarking into it.

A woman who bears a child for another person is termed the “surrogate”. This is normally accomplished for pay purposes for the most part. The surrogate is impregnated by artificial insemination using the husbands’ semen or by having an embryo produced and implanted by in- vitro fertilization (IVF).

The Center for Surrogate Parenting (CSP) located at following link can provide up-to-date costs on this program: http://www.creatingfamilies.com/home/default.aspx . It should be noted that laws regarding artificial insemination can also conflict with surrogacy agreements.

Recently, the CSP reported estimated costs of $56,000+ for a traditional surrogacy in which artificial insemination was used. They also reported that the cost of using another woman’s egg was estimated at $69,000+. 

History of Artificial Insemination

Artificial insemination dates as far back as the late 1800s to early 1900s.  Doctors would have their patients take a fertility prescription before attempting artificial insemination to improve their chances of becoming pregnant.

Artificial insemination was used as a way of managing male infertility for over one hundred years. It kept the traditional family intact and allowed couples to have children added to their domain.

As time progressed, brokers entered the scene and started the process of hiring women to become pregnant by artificial insemination normally with the semen of the husband due to the infertility of the wife.

Human artificial insemination was first developed by the dairy cattle industry which would allow dairy cows to be impregnated with sperm from a bull with traits that would improve milk production. Some of these same methods were used to develop modern human artificial insemination techniques.

Artificial insemination in humans gained widespread popularity as an infertility treatment in the 1970s.  The original technique used for artificial insemination (AI), Intracervical insemination (ICI), is a fairly uncomplicated procedure. Some women have described it as being similar to a pap smear.   Ovarian kits, ultrasounds, and blood tests are frequently used during artificial insemination treatments to monitor the female’s menstrual cycle closely.

Human artificial insemination success rates vary based on the age of the patient and the type of fertility problem being treated. Procedures are simple but yet advanced in order to place a thin flexible tube containing the donor sperm into the females reproductive tract. With each menstrual cycle, most women have a 5 to 25 percent chance of becoming pregnant. AI simply allows sperm to by-pass the cervical mucus in its entirety.

Methods of Artificial Insemination

v  Intratubal Insemination (ITI)

v  Intrauterine Insemination (IUI)

v  Intracervical Insemination (ICI)

v  Intravaginal Insemination (IVI)

As previously stated, artificial insemination (AI) is simply placing sperm into the female reproductive tract with a needleless syringe rather than by copulation. AI is just another avenue or method to treat fertility issues, especially if the man’s sperm cannot reach the females uterus.

Of the reference four types of artificial insemination, ICI and IUI are the two most common methods used; with IUI being the more efficient by placing semen directly into the uterus by the husband and is termed Artificial Insemination by Husband (AIH).  ICI is placing semen into the women’s cervix (ICI), were as (IUI) is placing semen into the uterus.

Normally, artificial insemination treatments are sought to place semen into the female reproductive system when copulation is either not possible or difficult to achieve.  ITI is not typically initiated due to this infertility method being attributed to high costs, and it is a more intrusive artificial insemination procedure.  ITI can aid couples who have experienced infertility problems when other forms of artificial insemination procedures such as IUI have proven to be unsuccessful. 

For couples where the man has some sperm deficiencies or the woman has problems with cervical mucus, IUI is a good approach for these type of infertility problems.

Artificial Insemination Usage

v  Unexplained fertility problems that cannot be defined by doctors.

v  Endometriosis or abnormalities of any of the female reproductive parts.

v  AI is another avenue to building a family.

v  AI could be entertained if one partner or the couple are diagnosed with:

o   Impotence

o   Low sperm count

o   Premature ejaculation

o   Abnormal sperm morphology (structure and shape are abnormal)

o   Decreased sperm motility (inability of sperm to move)

o   Hypospadias (the urethra opens on the underside of the male’s penis)

o   Poor interaction between the cervical mucus and sperm.

o   Drug induced erectile dysfunction.

o   Retrograde ejaculation (semen travels backward into the bladder during climax)

o   Sperm allergy.

o   As with the male carrying a genetic disorder.

v  Artificial Insemination is also used by heterosexual single women and lesbians who have the desire to conceive without sexual intercourse with males.

v  AI is normally the method of choice when gay men want to create families through surrogacy or co-parenting. 

v  Women may also undergo artificial insemination using sperm from a donor (a man other than their partner.) 

v  Artificial insemination is used for women with a diagnosis of unreceptive cervical mucus.

Infertility Assistance

Since 1995 Einstein Industries has been providing Internet marketing services to doctors through their privately held company DocShop at  http://www.docshop.com/.  DocShop is a directory to connect physicians with patients who are searching for health services online in their particular area.

Their system is very easy to navigate. You simply click on your problem from a drop-down menu and insert your zip-code. DocShop will search its database for doctors in your area that can assist you with your particular specialty problem – in this case we are referring “Infertility Specialists” for infertility problems.

As of this writing the DocShop was offering services in the following areas presented below:

If you are a doctor looking to provide your services in your area, then the DocShop has a Toll Free number for you to call to enroll by simply calling the DocShop at 1-800-258-9221.

If the sperm is viable a woman may choose to be inseminated with their husbands’ sperm; a process termed Artificial Insemination by Husband (AIH). However, they may opt to choose Artificial Insemination by Donor (AID) where the sperm of a donor is retrieved from a sperm bank. The latter is normally chosen in lieu of if the husbands’ if he infertility problems.

In addition, AID may be elected by a single woman to conceive or opted by the same-sex couples who are looking to start a family.

Sperm banks are found in many locations. A partial list of some sperm banks are listed below:

v  Spermbank Directory - A National Directory of Sperm Cryobanks

v  California Cryobank

v  sperm bank and sperm donor information - xytex

v  IHR.com sperm banks directory, for infertility and semen storage

v  Rainbow Flag Health Services

v  Sperm Banks: Directory of Sperm Donation Centers

v  Sperm Banking with Cryogenic Laboratories, Inc. - Welcome to CLI

Innovative approaches for In Vitro Fertilization (IVF) can be viewed by this video at the following link from Wake Forest Baptist Medical Center in Winston Salem, North Carolina. http://www.or-live.com/distributors/NLM/rnh.cfm?id=228

Benefits of Using Artificial Insemination

Artificial insemination in humans is a revolutionary fertility procedure with enormous benefits. For example, artificial insemination using donor sperm may be an alternative for treatments such as ICSI (Intracytoplasmic Sperm Injection) which are more advanced and more expensive. ICSI is an in vitro fertilization procedure whereby a single semen or sperm is injected directly into the female’s egg.

If the male partner has had a vasectomy performed in the past, then artificial insemination is most definitely a viable option to starting a family from donor sperm. AI also allows other fertility defective individuals the ability to reproduce that would normally be impossible or not a viable option for them to start a family.

Yet another benefit to artificial insemination would allow the same-sex partners to conceive a child.

Who Should Not Use Artificial Insemination

 If women are experiencing problems such as active pelvic infections, uterine malformations tubal problems, that are making them less fertile, or anovulation, which is defined as the failure or absence of ovulation, then artificial insemination is not recommended. An anovulatory cycle is a cycle in which the ovaries fail to release an oocyte (a immature ovum or egg cell). Therefore, ovulation will not take place. However, this does not mean a woman who does not ovulate at each menstrual cycle is going through menopause. Chronic or long term anovulation is a common cause of infertility.

Care should also be salient in HIV patients. A case report from the US revealed that processing ejaculate via centrifugation to remove cells failed to prevent HIV transmission and the woman seroconverted after artificial insemination. Seroconversion is the development of detectable specific antibodies to microorganisms in the blood serum as a result of immunization or infection. The word “seroconverted” is often used in reference to blood testing for anti-HIV antibodies. In particular, "seroconverted" has been used to mean "became HIV positive" and is the opposite of seroconversion.

Partial List of Artificial Insemination Problems or Issues

 v  High divorce rates

v  Single-parent childbearing

v  Same-sex marriage support

v  Proposals that would allow children conceived via artificial insemination to have three legal parents with the use of sperm and / or egg donors.

v  Religious Insights

References

 http://www.geocities.com/wellesley/1483/artificial.html

http://www.amazingpregnancy.com/pregnancy-articles/324.html

http://legal-dictionary.thefreedictionary.com/Artificial+Insemination

http://www.dailykos.com/story/2009/6/29/725/18020

http://www.geocities.com/wellesley/1483/artificial.html

http://www.amazingpregnancy.com/pregnancy-articles/323.html

http://www.vermesh.com/artificial_insemination_california.html

http://www.ucdmc.ucdavis.edu/fertility/artificial_insemination/

http://www.5min.com/Video/How-Artificial-Insemination-works-27107259

http://en.wikipedia.org/wiki/Intracytoplasmic_sperm_injection

http://womens-health.health-cares.net/intracytoplasmic-sperm-injection.php

Hawaiian Joe is a critical care healthcare professional. For more great information on Infertility, sign-up for our FREE Infertility Course http://www.E-Infertility.com.

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Joe

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Teddie Joe Snodgrass, MBA, RN, FNP
Hawaii's Rolls-Royce Copywriter & Consultant

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