Artificial insemination

 

Artificial insemination

Artificial insemination is a process when the sperms are deposited in the female genital tract artificially when the female cannot conceive through the sexual intercourse with her husband. The sperms may be introduced in the cervical canal or inside the uterus. Less common techniques are intrafallo­pian and intraperitoneal insemination when the sperms are placed near the mouth of the fallopian tube and ovaries, respectively.

Indications:

 (i) Incurable defects in the husband’s semen rendering him incapable of procreation.

 (ii) Premature or retrograde ejacu­lation.

 (iii) Hereditary disease in the husband as to contraindicate paternity.

 (iv) Rhesus incompatibility resulting in failure of children to survive because of erythroblastosis foetalis and husband being homozygous rhesus positive

(v) When the hus­band is impotent making sexual intercourse impossible (vi) Abnormalities of penis such as epispadias or hypospadias etc.

(vii) When the hus­band is being treated for cancer with radiotherapy or chemotherapy.

(viii) Cervical mucus may not be enough to allow sperm to move easily, or it may be too thick and sticky. Some­times, cervical mucus is not compatible with the sperms.

 (ix) Women with mild uterine endometrio­sis thus preventing the passage of ovum.

 (x) Anatomical defects of the uterus or cervix that prevents sperm from reaching the ovum.

 

Types:

Artificial Insemination Homologous (A.I.H.): In this type of the semen of woman’s husband is used. This is usually employed when the husband is oligospermic.

Artificial Insemination Donor (A.I.D.): The semen from some unrelated donor is used. This is usually undertaken when the hus­band is impo­tent, azoospermic, sterile or suffering from some genetic or hereditary abnormality.

Artificial Insemination Hetero­logous Donor (A.I.H.D.) or Polled donor: In this to the husband’s semen the semen of the donor is mixed.

 

Prerequisites:

(i) Consent of the husband and wife as well as donor’s wife should be taken.

(ii) Identity of the donor should not be revealed, and the donor should not know the recipient parents’ identity and the results of the technique.

(iii) Donor should be less than 40 years of age, unrelated to the couple and should have his own children (iv) Donor should be of sound physical, mental, and emotional health as well as devoid of any hereditary or genetic disease.

(v) Race and physical characteristics of donor should resemble as closely as possible to that of the husband.

(vi) Procedure should be properly explained to the donor and his wife.

(vii) Husband of the woman should be sterile or suffer­ing from some genetic or hereditary disorder.

(viii) Pooled semen should be preferably used as in that case there is a technical possibility of the husband being the father of the child.

(ix) Physician should select the donor after carrying out the semen analysis, chromo­somal studies, testing for HIV status and other sexually transmitted diseases.

 (x) Physi­cian should maintain relevant records of the donor avoiding the possibility of single fecund donor and consanguineous marriages in future.

 (xi) While carrying out the procedure presence of a disinter­ested witness preferably a nurse is must.

Procedure:

Artificial insemination is carried out close to ovulation as the time of maximum fertility coinci­des with it. About one ml of semen is injected into the top of vagina, cervix, or uterus through a small plastic tube.

The male partner produces a semen sample by means of mastur­bation. The patient is advised to avoid coitus three days before the sample is taken to obtain excellent quality sperms. The sample can be collected at the hospital or should be delivered from home within one to two hours. The semen is injected into the top of the vagina of the female. A plastic cap, to be taken out about 6 hours later, can sometimes be placed in the vagina to keep the sperm near the cervix. Intracervical insemi­nation is used for couples in whom sperms cannot reach the cervix.

Intrauterine insemination is often used when the cervical mucus is incompatible to sperms and many other unexplained infertility problems. Sperm washing prior to intrauterine infiltration remo­ves most of the bacteria from the semen, but it is impossible to completely sterilize the sperm or the cervix.

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