Artificial insemination

Transcription

1 Artificial insemination

2 What is involved? Artificial insemination is an assisted reproduction technique that consists of inserting laboratory-treated spermatozoa into the woman s uterus or cervical canal. This is done when the woman is ovulating, with the aim of obtaining gestation. The aim is to shorten the distance that separates the spermatozoa from the ovum and thus facilitate their union. If the spermatozoa are from the woman s partner, the technique is termed Artificial Insemination using Husband s semen (AIH). Alternatively, the technique can be done by using donor semen (AID). In this case, the sample comes from a legally authorized sperm bank with optimal conditions present with respect to the quantity and quality of the spermatozoa. The procedure is simple, painless and has significant success rates. When is it recommended? AIH Male symptoms Decrease in the number or mobility of spermatozoa and/or anomalies therein (minor or moderate oligozoospermia / astenozoospermia / teratozoospermia) Difficulty with sperm penetrating the uterine cavity (anomalies that prevent coitus and/or make ejaculation difficult) Female symptoms Anatomical or functional alternations in the uterus, particularly the cervix (cervical or uterine factor) Alterations in the menstrual cycle (ovulatory dysfunction) Endometriosis Other Sterility with unknown origins: Namely, couples for whom the cause of sterility has not been determined after the basic sterility study has been conducted Mixed AID Male symptoms Absence of spermatozoa in the semen (azoospermia), whenever it is not possible to recover them from the testicles and/or epididymis Severe drop in the number or mobility of the spermatozoa present in the semen (severe oligozoospermia and/or astenozoospermia), at times after the failure of in vitro fertilisation Different chromosomal or genetic alterations with no possibility of pre-implantation genetic diagnosis Risk of transmission of other types of pathologies, such as infectious diseases Women without male partners Other causes Requirements Artificial inseminations can be performed provided that the fundamental requirements below are met: There is at least one permeable fallopian tube Suitable motile sperm count (for AIH) No more than 6 previous insemination cycles have been done

3 Control of cycle and procedure Artificial insemination can be done during a natural cycle or after an ovarian stimulation process (OS). The pregnancy rate is significantly higher in stimulated than spontaneous cycles. OS is done by using drugs whose action is similar to that of hormones that women produce called gonadotropins. The purpose of this treatment is to obtain the development of one or more follicles. An egg will then mature inside this follicle. At present, the most commonly employed drug formats are injections that are applied subcutaneously, and which offer patients both independence and comfort. The dose of gonadotropin and its start date may vary depending on the case. The ovarian stimulation process is regularly monitored through vaginal ultrasounds that report on the number and size of developing follicles, as well as the endometrial thickness. At time these data are complemented by hormonal determinations. After optimal follicular development is attained, a drug will be administered (the hcg hormone), whose action is similar to the luteinizing hormone (LH) that will trigger ovulation. Then the date and time for the insemination will be scheduled. It is extremely important to respect the instructions provided by the Centre with regard to the time of administration. On the day scheduled for insemination, the andrology laboratory will proceed to sperm capacitation, using either the couple s semen sample (AIH) or the semen sample from the sperm bank (AID), with the aim of selecting the sperm of the highest quality. The aim of capacitation techniques is to eliminate the seminal plasma from the ejaculate and select the sperm with the best motility for insemination, eliminating immotile sperm. Later, during the appointment with the gynaecologist, these sperm will be inserted into the woman s uterus, using a thin flexible catheter. The process is completely painless and requires neither anaesthesia nor hospitalisation. The aim of this procedure is to deposit the sperm as close as possible to the ovulation site. This helps avoid the obstacles that the 'hostile' environment of the vagina produces to fight sperm concentration and motility. Diagram of the insemination procedure Tubs Ovary Uterus Cannula

4 After insemination, the woman can carry on with her normal daily routine. Lastly, hormone treatment may be recommended to support the luteal phase, with the aim of favouring gestation. Risks their identity. Likewise, under extraordinary circumstances that represent danger to the newborn s life or health, or when proceeding in accordance with criminal procedural law, the donor s identity may be disclosed on a restricted nature and without this act ever changing the previously established particulars. Like all medical procedures, artificial insemination also has its risks, although they can be prevented in the majority of cases. The main complications from this therapeutic procedure are: Multiple pregnancies: their frequency ranges from 12 to 27%, according to different records. This complication may entail physical risks to the mother and the fetus, particularly for more than two. Other risks that could occur exceptionally: Infections of the female genital tract Allergic reactions Legal information (AID) Particular legal issues stemming from donor intervention The regulatory legal framework for assisted human reproduction is primarily comprised of the Assisted Human Reproduction Act 14/2006 dated 26 May. Gamete donation is a free, forma and confidential arrangement made between the donor and the authorized centre. The sperm bank, donors records and the centres' activities have an obligation to guarantee the confidentiality of the donors identity data. Without prejudice to this, the recipients and the children born have the right to obtain general information on the donors, which does not include The selection of donors will be done by the medical team who is applying the technique, seeking the greatest phenotypic and immunological similarity. This choice cannot be made at the request of the recipient patient or couple. The quality and safety requirements of sperm donation will also have been complied with that are set forth in Royal Decree 1301/2006 of 10 November. Semen donors must be at least 18 years of age and no older than 50, be in good psychophysical health and have full capacity to act. Their psychophysical state must comply with the requirements of a compulsory study protocol for all donors, which includes their phenotypic and psychological characteristics, as well as clinical conditions and the analytic determinations necessary to show that donors do not suffer from genetic, hereditary or infectious diseases that are transmittable to offspring.

5 Results The objective of all fertility treatments is to obtain pregnancy, so that their effectiveness is evaluated by conception rates. According to different records (including the Spanish Fertility Society), the pregnancy rate for AIH ranges from 12% to 18% per cycle realized, and is 20.5% for AID. The pregnancy rate by patient increases to 30 to 42% after 6 cycles. This depends largely on the woman s age, the cause of sterility and the number of years it has evolved. The initial quality of the semen is also a determining factor in the final result, as the artificial insemination will be executed with a greater or lesser number of recovered motile spermatozoa. Gravida Fertilitat Avançada Av. Diagonal 660, Pl 16 Hosp. de Barcelona Barcelona Tel: Fax: gravida@gravidabcn.com Together we can find the best solution