Insemination

Jennifer Chang = = = **Insemination** =

Insemination is the act of introducing semen into the oviduct or uterus of a female through sexual intercourse or by injecting with a syringe through the process of artificial insemination. During artificial insemination, the sperm is inserted directly into the female reproductive system and obstacles of the genital tract are bypassed. This makes the chance of pregnancy much more likely. Insemination that occurs through sexual intercourse is known as natural insemination, and is often a term used for sexual intercourse between a woman who wishes to become pregnant and a sperm donor who is not a usual sex partner.

= = Artificial insemination has long been used as a method to breed livestock and other animals. The first successful artificial insemination was performed by Italian biologist and physiologist Lazzaro Spallanzani in 1784, in which he impregnated a dog (Foote, 2002). Since then, it has been a common practice used on horses, cattle, and pigs. Artificial insemination in humans began to gain momentum and interest in the mid to late 20th century, when the first successful pregnancy resulting from artificial insemination occurred in the 1950s. Towards the end of the century, the sperm bank industry was developed, more sperm was demanded, and artificial insemination became commercialized.
 * Artificial Insemination**

In humans, artificial insemination is a technique used to achieve pregnancy typically by an infertile female, female with an infertile male partner, or females without long-term male partner. Candidates for receiving artificial insemination include women with male partners with low sperm count or poor sperm motility, and women with endometriosis, damage to the fallopian tubes, or any other reproductive issues. Females without long-term male partners include women in a same-sex relationship, a woman who chooses to raise a child without a partner, etc. Artificial insemination is often the first procedure that candidates choose to attempt before moving onto other methods of assisted reproduction like in-vitro fertilization.

The sperm used during the procedure is from the woman’s sexual partner or a sperm donor. If the sexual partner has a low sperm count, he can make multiple donations over a specified course of time, in which his collection is frozen and combined into one insertion. Anonymous donors can also be found at sperm banks, or non-anonymous donors may already be a friend or associate of the recipient woman. Sperm banks typically screen donors with a medical history of genetic disorders, sexually transmitted diseases, and other health issues. Interested parties are able to choose sperm based on the donors race, physical attributes, and other details of the donor’s personal background. = =
 * The Use of Sperm**

The recipient female may be given fertility drugs near the beginning of the menstrual cycle to stimulate the ovaries into producing mature eggs for fertilization. Prior to insemination, it must be determined when the woman will ovulate; either by taking an ovulation detection kit at home or by having a doctor perform an ultrasound or blood test. These tests detect luteinizing hormone (LH), in which levels rise prior to ovulation. Or, the woman will be given medication to induce ovulation. Once the woman is ovulating, a semen sample will be required.
 * Preparation**

If the semen sample was frozen, it must be thawed and in liquid form prior to insemination. If the sample is collected from a partner who is available to provide a specimen at any time, he will be required to ejaculate into a sterile container. The sample must undergo a process called “sperm washing” in which the strongest sperm are separated from weaker sperm into a more concentrated amount. It is also used to remove chemicals that may have harmful effects in the uterus. During sperm washing, protein supplements and antibiotics are added and the sample is centrifuged. The sample is then ready to be inserted into the woman’s reproductive system.

= =  The female recipient will have to decide which method of artificial insemination is best for her. Factors she should take into consideration are time and money. Costs to remember include the clinic chosen, hormones, and the fee of sperm washing. Patients are suggested to talk to an OB-GYN to discuss their options and other details. The simplest method is intracervical insemination, commonly referred to as the “turkey baster method.” In intracervical insemination (ICI), a flexible catheter is placed at the cervix. The catheter is attached to a syringe that is filled with semen sample, which is pushed through once the catheter is properly placed. A cervical cap is then placed over the cervix. This procedure can be performed by a doctor at a clinic, but can be done at home by the female recipient herself, her partner, or a midwife.
 * Methods**

Another popular method of artificial insemination is intrauterine insemination, or IUI. IUI is the most common method of assisted reproduction, and is used even more often than in-vitro fertilization (Jewell, 2011). This is method is more expensive than intracervical insemination, but has also been found to be more successful. Intrauterine insemination is done by inserting a very thin catheter into the cervix, in which the sperm sample is injected through a syringe and directly into the uterus. The process should only take around a few minutes, and is performed without anesthesia. The female recipient is usually asked to lie down for 15-20 minutes after the sperm is injected. IUI is relatively painless, but some women report mild discomfort, cramping, or spotting after the procedure.

A newer method of artificial insemination is ** intrauterine tuboperitoneal insemination (IUTPI) where both the uterus and fallopian tubes are injected with semen. Intratual insemination (ITI) was sometimes performed with IUI, but was found to be ineffective. **

There are several factors that could decrease a woman’s chances of becoming pregnant after artificial insemination. These factors include older age, severe endometriosis, poor egg or sperm quality, or damage to the fallopian tubes. Unfortunately, artificial insemination may take multiple attempts or may never be successful at all. Patients must be prepared to potentially undergo many rounds of IUI, only to never become pregnant and move onto another form of assistive reproduction. However, patients who choose IUI have a 5 to 20 percent chance of becoming pregnant with each cycle (Nihira, 2009).
 * Success Rates**

Healthcare providers who will be counseling patients undergoing artificial insemination must keep in mind many factors. First, simply diagnosing an infertile male or female can be difficult as complete openness about infertility can be questioned. It has been found that husbands are less open to male infertility as they are to female infertility. Therefore, it has been found that subtly conveying information about infertility while treating patients is helpful (Balen, 1996).
 * Communicating with Patients about Artificial Insemination**

To best care for those who are undergoing artificial insemination, patients should be educated and counseled on the different steps of the procedure. The patient should be given an examination to confirm she is physically and emotionally healthy. She should then be advised about taking the appropriate supplements and medications to stimulate ovulation. Because there are different options for obtaining a semen sample, patients should be educated in order to make the appropriate choice for them. Issues for patients to keep in mind are STD transmission, cost, and convenience. Providers should also explain the different methods of artificial insemination, and talk about the benefits and risks of each one. Frequently asked questions include asking about pain during the procedure, whether sperm can fall back out of the cervix, how long the procedure takes, etc. Since the patient may be anxious about the success of the insemination, it is important that the health care provider be there to answer questions honestly and openly (Colenso, 2008).

Balen, F. van, Trimbos-Kemper, T., Verdurmen, J. (1996). Perception of diagnosis and openness of patients about infertility. //Patient Education and Counseling//, //28, 247-252//
 * References**

Colenso, Helen. (2008, Mar 8). How Sperm Banks Work. Retrieved from http://health.howstuffworks.com/pregnancy-and-parenting/pregnancy/fertility/sperm-bank.htm

Foote, R.H. (2002). The History of Artificial Insemination: Selected Notes and Notables. //Journal of Animal Science, 80, 1-10.//

Jewell, Roger. (2011). How to Do Artificial Insemination. Retrieved from http://www.ehow.com/how_2302356_do-artificial-insemination.html

Nihira, Mikio. (2009, Sept 21). Infertility and Artificial Insemination. Retrieved from http://www.webmd.com/infertility-and-reproduction/guide/artificial-insemination

Steele, L.H. & Stratmann, H. (2006). Counseling Lesbian Patients about Getting Pregnant. //Canadian Family Physician, 52, 605-611//.