How does artificial insemination work?

The artificial insemination procedure, regardless of the chosen protocol or methodology, requires careful preparation, patience, precise and well-coordinated work by laboratory staff, related specialists and a married couple.

• Preparing for in vitro fertilization
• Ovarian puncture during artificial insemination
• How artificial insemination occurs in an embryology laboratory
• Embryo cultivation
• Embryo transfer

How to prepare for artificial insemination

Artificial insemination in the embryology laboratory

Embryologists, being in sterile conditions, search for eggs in the follicular fluid under a microscope, move them into a test tube or Perti dish filled with a nutrient medium, and send them to an incubator for 4–6 hours.

At the same time, the sperm is prepared: washed and cleaned. The sperm becomes concentrated.

After specified period“improved” sperm is added to the eggs and sent back to the incubator. To fertilize one egg, 100-200 thousand live sperm are needed. One penetrates inside, all the others serve to melt the shell of the egg at the site of entry of the “main” sperm.

Observation is carried out for 48 hours. Then they look at which eggs are fertilized. And the development of the embryos is observed for another two days. Only the best will be placed in the uterus: those that develop in a timely manner and do not have anomalies.

• number of cells;
• fragmentation percentage;
• fission rate;
• presence of deviations in the division process;
• the presence or absence of inclusions in the cytoplasm;
• absence of multinucleated blastomeres;
• regularity of form;
• equal size, etc.

In case of a repeated process, after and for a number of other reasons, a more subtle procedure of artificial insemination can be used - (, or) intracytoplasmic injection of sperm into the egg. The membrane is pierced with a thin needle under an electron microscope and the selected male germ cell is introduced into the cytoplasm. This development of events is discussed in advance with the doctor. One of the undoubted advantages of the ICSI technique is the possibility and prevention of possible deformities.

Cultivation

Depending on the quality and rate of development, within 2–4 days. There is an option for long-term cultivation for 5–6 days, in which the percentage increases. allows you to reduce the likelihood, since the need to transfer large quantity embryos disappear. At the same time, the likelihood of pregnancy increases. In case the embryos good quality a lot, then after the completion of the artificial insemination process, the “extra” are offered to be sent to.

Embryo transfer day

The main recommendation on the eve and on the day of the transfer is not to worry. Be patient and have a positive attitude. often prescribed in the morning. Therefore, breakfast should be light, with limited liquid intake.

Before the procedure, the couple has a conversation with an embryologist. The doctor shows photographs of embryos taken under multiple magnification. Characterizes the development and degree of their maturity, gives recommendations on choice and answers questions. Together with the doctor, the couple decides which ones.

Embryo transfer technique

Then they begin the procedure on a gynecological chair. It only takes 10–15 minutes. An embryologist collects embryos into a long sterile plastic tube - a catheter attached to a syringe. The attending physician, having previously exposed the cervix in the speculum, inserts a catheter into the uterine cavity through the cervical canal and performs the transfer. To make sure that all the embryos from the tube have entered the uterus, the catheter is examined under a microscope.

The sensations during the manipulation will most likely be slightly unpleasant, but the discomfort quickly passes. The woman remains in a horizontal position for 20 to 45 minutes, after which she is invited to the doctor’s office, where the doctor will schedule further treatment - hormonal support, antispasmodics, vitamins, give recommendations, schedule the next consultation and the date of delivery.

The effectiveness of artificial insemination

The effectiveness of IVF ranges from 25 to 33%. There is continuous scientific work to increase positive results. Since its inception, the procedure and technology of artificial insemination have not stood still, but continue to improve.

Artificial insemination

Artificial insemination

Artificial insemination is a fertilization process that is performed by introducing sperm directly into the uterus (artificial insemination) or by in vitro method (outside the body, “in vitro”), i.e. extracorporeally (IVF).

Types of artificial insemination:

1. artificial insemination with husband's or donor's sperm (AISM/AISD);
2. in vitro fertilization(ECO).

Depending on the indications, an artificial insemination program is selected for the woman.

1. Intrauterine insemination is the introduction of specially prepared sperm using a special catheter directly into the uterine cavity.

   Thus, sperm does not pass through the barriers of the acidic environment of the vagina and the dense protective mucus of the cervix, and immediately enters the neutral environment of the uterine cavity.

   After this, the sperm move independently to the fallopian tubes and fertilization of the egg occurs in the same way as during natural sexual intercourse.

   According to the literature, artificial insemination of women as a treatment for infertility has been used for more than 100 years. This procedure is carried out only in specialized medical clinics, subject to a complete examination of the man and woman.

   It is mandatory to examine the condition of the uterus and fallopian tubes - hysterosalpingography (x-ray examination using a contrast agent) or laparoscopy (examination of the uterus using an optical device - laparoscope) to ensure the patency of the reproductive tract.

   For insemination, both native (“live”) and cryopreserved sperm (previously thawed) can be used. The sperm is cleaned and concentrated before artificial insemination.

   Artificial insemination is recommended for women with increased viscosity of cervical mucus or acidity of the vaginal environment. On the part of the partner, there may be indications such as erectile dysfunction, a decrease in the number of motile sperm, or increased sperm viscosity, etc.

   The procedure takes place in the operating room of the clinic, on a gynecological chair with a special syringe with a catheter, with the help of which sperm is injected into the uterine cavity. After this procedure, you need to lie down for 15-20 minutes. The procedure does not require pain relief.

2. IVF - in vitro fertilization - is a method of artificial fertilization in which male sperm and female eggs (previously extracted from the ovaries) are combined outside the body, in vitro (in “glass”, i.e. in a laboratory test tube).

   There, independent fertilization occurs, and the resulting embryos (1 or 2) a few days later are transferred to the woman’s uterus, where one or both are implanted into the endometrium (the mucous membrane of the uterine cavity) and develop over 9 months.

   To obtain eggs, ovulation is stimulated with hormonal drugs over a period of 2-3 weeks. After several eggs have matured at once, the reproductologist removes them from the ovaries (performs a puncture of the follicles) and transfers them to the embryology laboratory.

   Artificial insemination using ICSI method- This is one of the types of IVF. In this case, the embryologist, using special instruments under a highly magnified microscope, injects the most fertile sperm into the egg.

   The embryo obtained after such fertilization is no different from embryos conceived naturally, and also, after a few days, it is transferred to the woman’s uterus and develops over the course of 9 months. This in vitro fertilization procedure is successfully used in patients with male factor infertility, when there are deviations from normal sperm parameters or after TESA biopsy for azoospermia.

Donor programs for artificial insemination

If one of the spouses does not have their own healthy reproductive cells, IVF conception can also be carried out with donor sperm or donor eggs. Before donating his germ cells, the donor undergoes a thorough medical and genetic examination. Artificial insemination with donor sperm is carried out only after twice examination with an interval of 3 months.

In couples where it is contraindicated for a woman to bear a child (for example, with severe heart disease) or is physically impossible (due to the absence of a uterus), IVF with a surrogate mother is used.

Another great advantage of infertility treatment using IVF is that during the cultivation of embryos in the embryology laboratory, it is possible to conduct preimplantation genetic diagnostics of the embryo. This modern method makes it possible to identify (if any) genetic diseases, chromosomal abnormalities, and developmental abnormalities (deformities). Unlike many other clinics, at VitroClinic PGD is performed on the entire set of human chromosomes (i.e., on all 46 chromosomes). After this analysis, only healthy embryos will be transferred into the uterus.

Before any artificial insemination program, the couple undergoes a thorough medical examination to identify possible contraindications. The list of such examinations is regulated by the Order of the Ministry of Health “On the use of assisted reproductive technologies (ART) in the treatment of female and male infertility” and is strictly observed in our clinic.

Where to get artificial insemination in Moscow?

Before consulting a doctor about overcoming infertility, any married couple asks the question: “Where can artificial insemination be performed at a high professional level?”

Before choosing such a clinic, adhere to the following recommendations:

• The clinic should employ narrow specialists specifically in the treatment of infertility: gynecologists-reproductologists, urologists-andrologists, embryologists and geneticists.
• The artificial insemination center must use only high-quality and original products in its work. medications And Consumables for IVF.
• Real reproductive professionals work with each couple individually, i.e. selection of method, stimulation schemes and support early dates pregnancy is selected by a specialist only after a thorough study of the spouses’ medical history, past IVF experience (if any), age, current health status, and many others.
• Experienced fertility specialists use gentle hormonal stimulation regimens, taking care of the health of their patients and avoiding hyperstimulation.
• To exclude multiple pregnancies, a reproductive specialist should transfer only one or two embryos (according to indications). Three or more are unacceptable.
• The specialists of the clinic you choose must be proficient in all the most modern techniques in reproductive medicine: ICSI, PIXI, assisted hatching, genetic diagnosis of the embryo, etc.
• Sperm tests should be performed in the clinic’s own laboratory by specialist embryologists who evaluate not only the morphology of sperm, but also their fertility.
• Choose a clinic that cooperates with a clinical diagnostic laboratory certified according to international ISO standards. The quality of the analyzes performed matters vital role in preparation for IVF.
• Make sure in advance that from the initial consultation to the end of the entire IVF or artificial insemination program you will be cared for by the same reproductive specialist (except in force majeure situations). This indicates the responsibility and focus of the doctor and the clinic on a positive result.
• Give preference to those clinics where doctors leave their contact information for patients. You will have the opportunity to call or write to email your doctor if you need any clarification or have questions.
• It’s good if in the same clinic where you will do IVF fertilization you have the opportunity to stay to monitor your pregnancy. Doctors, knowing all the nuances of your pregnancy and having continuity among themselves, will do everything to bring it to the end - the birth of a healthy child.
• The price in Moscow for artificial insemination programs in different clinics can vary significantly. Be sure to check with the manager how much artificial insemination costs and what exactly is included in each program you are interested in, whether it is possible to add any additional services, for example, ICSI or hatching, whether there are options with donor cells and embryos. A wide range of various programs is a big plus for the clinic. This means that in such a center, doctors are proficient in all modern ART techniques and can afford to select any program for each couple.

Artificial insemination is not a method of treating infertility, but a method of overcoming infertility. Thus, it overcomes obstacles to achieving pregnancy. Currently modern methods artificial conception is used to overcome almost any cause of male and female infertility and allows one to bypass many problems with reproductive health for those who previously could not even hope to become parents.

When it comes to artificial insemination, patients are most often offered the IVF procedure. However, reproductive medicine also has other methods that are more effective in certain cases. Each artificial insemination has its own characteristics, indications and contraindications.

Conventionally, methods of assisted reproductive medicine are divided into inseminations and injections. Inseminations are not expensive, but the chances of successful conception less, and the list of indications is shorter. In vitro conception is more expensive, but it is more effective and is possible even in severe cases of female and male infertility.

Artificial insemination has long become familiar and normal. People can constantly debate the ethics of such conception, but one thing cannot be denied - a medical procedure is often the only way to have natural children.

Artificial insemination allows you to control and regulate the process of fusion of germ cells. This phrase is usually used to refer to the IVF procedure, although there are other methods of assisted reproductive medicine. There are three methods that combine all varieties: IVF and insemination. All of them lead to the fusion of the egg and sperm, but under different conditions.

Artificial insemination is possible only if the woman is potentially capable of bearing and giving birth to a child. Drastic measures are usually recommended after 1.5-2 years of infertility treatment (except for cases that cannot be treated).

Artificial insemination is legal in Russia. Official registration Marriage is not required, but if it is present, confirmation of the spouse is required. Patients must be over 18 years of age. Every country has donor cell banks.

Women under 38 years of age must receive official confirmation of the diagnosis and ineffectiveness of treatment before artificial insemination (usually 1.5-2 years). Women over this age can undergo the procedure immediately and without prior treatment.

If the examination reveals any diseases that may interfere with any of the stages of artificial insemination, pregnancy or childbirth, the procedure is postponed. Patients are prescribed treatment and undergo manipulations only when their condition is stable.

All methods of artificial insemination are short-lived and are well tolerated by patients. Therefore, it is possible to repeat the procedure without long breaks.

IVF and its modifications, ICSI, IISM and IISD, donor programs and surrogacy are classified as assisted reproductive technologies. They are used in cases where there is no chance of pregnancy occurring naturally or the probability is less than with the use of reproductive technologies. All methods of artificial insemination can be divided into two groups: artificial insemination and intracytoplasmic injections. Insemination involves the fertilization of an egg within the female body, and with IVF and ICSI - outside the body.

Donor programs and surrogacy

In cases where partners have problems directly with the germ cells, it is possible to use donor material. All donors undergo a full medical and genetic examination, which eliminates the risk of inheriting dangerous diseases.

Women who are unable to bear a child can turn to. Donor sperm is used only after it has been examined twice with an interval of three months. Before IVF, preimplantation genetic diagnostics are performed, which identifies genetic pathologies, chromosome abnormalities, and possible developmental anomalies.

Intracytoplasmic injections

The injection method is more complex than insemination; it requires certain conditions to be met and is divided into several stages. First, the woman is prescribed hormonal drugs to stabilize the endocrine system and prepare the body for ovulation and fertilization. The doctor regularly checks the maturation of the eggs. Stimulation helps to grow a few good eggs.

After the eggs are retrieved and combined with sperm, the cells are placed in an incubator at a specific temperature that will facilitate conception. This process takes several days. Artificial insemination can be carried out using the ICSI or IVF method.

In Vitro Fertilization

The IVF procedure is the most popular method of artificial insemination. In this case, conception occurs outside the woman’s body under artificially created conditions. IVF is a fairly new method, which nevertheless has already become the gold standard of reproductive medicine. The procedure was first performed in 1978 in England. According to statistics, IVF reduces the risk of fetal pathologies.

In vitro fertilization is considered the most effective and reliable method of assisted reproductive medicine. The egg is removed from the woman's body and fertilized "in vitro" using the sperm of her husband or donor. After the cells fuse, the embryo is placed in the uterus. Subsequent pregnancy is no different from pregnancy after natural conception. Children born this way do not suffer from any specific diseases and do not have any abnormalities.

Indications for IVF

• endocrine disorders;
• complete obstruction of the fallopian tubes;
• absence of fallopian tubes;
• endometriosis;
• unknown causes of infertility.

Doctors manage the process of egg maturation by monitoring hormone levels. During this period, a woman can lead her usual lifestyle, but taking into account doctors’ recommendations on nutrition, physical activity and emotional state.

After hormonal therapy, the maturation of eggs is stimulated, then they are removed from the ovaries using puncture and ultrasound scanning. At this time, the partner donates sperm, it is processed and prepared. Then, under special conditions, the spouses' materials are mixed and placed in an incubator to allow natural cell union to occur.

After fertilization, the embryologist analyzes the development of the embryos. The most viable ones are transferred to the uterus. Typically, several fertilized cells are used to increase the chances of at least one attaching. Therefore, twins and triplets are often born after IVF. The resulting embryos can be cryopreserved for use in the future or if there is no pregnancy after the procedure. If several embryos are implanted, some can be removed, but the woman must make this decision.

Contraindications to IVF

• psychical deviations;
• uterine deformation;
• inability to bear a child;
• ovarian tumor;
• benign formation in the uterus;
• malignant pathologies;
• acute inflammation.

If the patient has serious problems with egg maturation, donor cells can be used. In vitro fertilization is much more effective than insemination. The first procedure is successful in 33% of cases. The disadvantages of IVF are long-term hormonal therapy and high cost. Prices start at 80 thousand rubles, but on average an IVF procedure costs 120-200 thousand rubles. The final figure is determined by the complexity of the chosen technique, the degree of stimulation, the need to use donor sperm and additional services in each specific clinic.

Injection of sperm into the egg

The ICSI procedure is the fertilization of an egg through intraplasmic infection of the sperm. Typically, the method is recommended for male infertility caused by a violation of the quantity and quality of sperm composition. This method is a real salvation for many patients, since it requires only one sperm. The doctor selects the most mobile and viable one and injects it into the egg. After a few weeks, the uterus and the attachment of the embryo are checked using an ultrasound. Often, during artificial insemination, a woman is prescribed hormonal drugs to maintain pregnancy.

ICSI is recommended when IVF and other methods are ineffective. The procedure is indicated for female and male infertility, even in the most severe cases. According to statistics, pregnancy occurs in every third woman as a result of ICSI (60-70% chance of successful fertilization).

Compared to IVF, the procedure is more delicate: one sperm is selected, which is injected into one egg using an ultra-thin glass needle. ICSI offers hope even in the most severe cases of infertility, especially male infertility. After several days, the doctor selects the most viable embryos.

Stimulation of folliculogenesis

The goal of this event is to produce several normal eggs so that doctors have a choice. Hormone dosing regimens are called protocols. They differ for different methods of artificial insemination and are selected and adjusted individually for each patient. All protocols are divided into short and long.

Usually, before stimulation, a course of oral contraceptives is prescribed for 1-2 weeks to suppress the secretion of sex hormones. This is necessary to prevent natural ovulation, when one cell matures.

The protocol usually begins on days 1-2 of the menstrual cycle. The patient is prescribed follicle-stimulating drugs, human chorionic gonadotropin, agonists or antagonists of gonadotropin-releasing hormone agonists. The woman is given injections of follicle-stimulating hormone (Gonal or Puregon) and gonadotropin-releasing hormone (Buserelin, Goserelin, Diferelin). The drugs are administered daily. Every few days, a blood test is performed to determine the concentration of estrogen, and an ultrasound is performed to measure the follicles.

Follicle-stimulating hormone is canceled when the concentration of estrogen E2 is 50 mg/l and the follicle size is 16-20 mm. Typically, such indicators are available on days 12-15 of stimulation. On this day, injections of human chorionic gonadotropin are added. Gonadotropin-releasing hormone is canceled the day before hCG is discontinued. The duration of the course is determined by the doctor based on the results of the ultrasound. 36 hours after discontinuation of hCG, cells are collected.

The short protocol also begins on the second day of the cycle. The woman is administered all three drugs every day, analyzing the growth of follicles every 2-3 days. If there are three follicles of 18-20 mm each, the drugs are discontinued (hCG is administered for another 1-2 days). 35-36 hours after the last injection, the eggs are collected.

Sex cells are obtained using a needle that is inserted into the ovaries through the peritoneum or vagina. The woman is under anesthesia, so she does not experience discomfort. The procedure takes up to 30 minutes. Sperm is obtained by masturbation. If there are difficulties, male reproductive cells are removed through similar manipulations.

Insemination

Insemination methods involve the introduction of sperm into the uterine cavity using a catheter. Conception occurs in almost the same way as during natural fertilization. For artificial insemination, sperm from a partner or donor is used.

Indications for insemination

• absence of a partner;
• vaginismus (spasm of the vaginal walls, during which sexual intercourse is impossible);
• potency disorders;
• ejaculation disorders;
• insufficient number of active sperm;
• cervicitis that cannot be treated;
• immunological incompatibility of spouses (presence of antisperm antibodies in cervical mucus).

Before insemination, both partners need to undergo a full examination and identify the causes of infertility. Preparation for the procedure includes a consultation with a therapist and gynecologist, a blood test (HIV, viral hepatitis, syphilis and other infections), and a smear test. It is necessary to determine the blood type and Rh factor of the partners and evaluate their compatibility. The man must submit a sample for a spermogram, and the woman must determine the time of ovulation and examine the uterus and fallopian tubes.

If no contraindications are identified, you can begin preparation. According to indications, doctors may prescribe drug stimulation of ovulation. Sperm collection is carried out in advance (2-3 hours before). When choosing donor material, frozen sperm is used.

The sperm is processed and the sperm are separated from the seminal fluid. The resulting mixture is injected into the uterus through a catheter. The procedure takes a few minutes and does not cause discomfort to the patient.

Contraindications to insemination

• pathologies of the uterus that make bearing a child impossible;
• ovarian tumor;
• malignant pathologies;
• acute inflammation;
• psychical deviations.

On average, artificial insemination costs from 30 thousand rubles when using partner’s sperm and from 40 thousand when using donor sperm.

Artificial insemination with husband's sperm

The IISM procedure is recommended in cases where the woman’s reproductive system has not been subject to pathological changes, there are no adhesions, erosions, or convolutions, and the fallopian tubes are passable, but the partner’s sperm has insufficient characteristics for natural conception. The sperm is processed and given the properties necessary for fertilization. During the procedure, the partner's processed sperm is artificially introduced into the uterus.

IISM can be appointed if partners are incompatible. The reasons for this phenomenon are different, but usually it is an aggressive effect of the flora of the vagina or uterus on sperm. Injecting sperm directly into the uterus eliminates contact of the seed with the vaginal microflora, which significantly increases the chances of successful fertilization. The insertion procedure is painless; the embryos are passed through a thin catheter.

During one menstrual cycle, intrauterine insemination can be performed 2-4 times. It is necessary to undergo an examination and tests to calculate the most favorable time.

Artificial insemination with donor sperm

The IISD procedure is recommended if the partner’s sperm count is poor. Donor sperm should also be used in cases where the reason for the incompatibility of the spouses is not clear, there is a high risk of blood conflict, or there were dangerous hereditary pathologies in the family. IISD is carried out only with the joint consent of the partners.

The procedure itself is not much different from insemination with the husband’s sperm. IISD and IISM are similar procedures that are carried out under the same conditions. You can also repeat it 2-4 times per cycle, but the effectiveness of the procedure is 30% greater (according to statistics, with IISM the chances of success are 40%).

The IISM and IISD methods are recommended for male infertility, sexual disorders, and immunological conflict. During preparation, the patient should visit the clinic regularly to monitor the number of maturing follicles and the growth of the endometrium in the uterus.

Transplantation of germ cells into the fallopian tubes

GIFT (gamete intrafallopian transfer) is a procedure for transplanting egg and sperm gametes into fallopian corpses. Artificial insemination using this method requires special preparation and the fulfillment of certain conditions. Gametes can only be placed in patent fallopian tubes and at a strictly selected time. Since only one ovulation occurs per menstrual cycle, GIFT can only be performed once a month.

ZIFT (zygote intrafallopian transfer) is a procedure for transplanting a zygote into the fallopian tubes. In this case, fertilization of the egg is carried out outside the body, after which the embryo is placed in the fallopian tubes.

The GIFT and ZIFT procedures are performed in a hospital. The doctor uses a laparoscope and ultrasound scanning. If during the placement of gametes the mixture is introduced from the peritoneum through a small puncture, then the embryo is implanted through the cervix. The ZIFT procedure is carried out after ovulation and hormonal preparation of the uterus. The methods of GIFT and ZIFT are extremely rarely used in reproductive clinics in Russia, since they are inferior in effectiveness to standard IVF.

Instructions

Artificial insemination or insemination is used for certain diseases (impotence, lack of ejaculation, hypospadias, etc.) with anatomical changes in the cervix, vaginismus, as well as when antisperm antibodies are detected in the cervical mucus in women. With this method of artificial insemination, sperm is injected into the uterine cavity or into the lumen of the fallopian tubes. One of the sperm produces a mature egg, after which it is implanted into the wall of the uterus.

Insemination is carried out two to three times during one menstrual cycle, the procedure must be repeated at least three cycles. If pathological changes were detected in the husband during examination, donor sperm is used. The reason for using donor sperm is also a Rh-conflict that cannot be treated, as well as genetic diseases in the husband’s closest relatives. The positive result of the procedure will largely depend on the diseases that the couple has. As a rule, after insemination, pregnancy occurs in eighty percent of cases.

In vitro fertilization is performed outside the body. This procedure is resorted to if a woman has had her fallopian tubes removed, in case of low patency or obstruction of the fallopian tubes, in the absence of effect from long-term treatment (longer than five years), in case of unexplained infertility. Before IVF, the condition of the genital organs is examined. A woman’s uterus and ovaries must retain their functions, in reproductive organs there should be no neoplasms, inflammation or anatomical changes.

The in vitro fertilization procedure includes: obtaining eggs from a woman, fertilizing eggs with the sperm of a husband or donor, observing embryos in the laboratory, transferring embryos into the uterine cavity. Miscarriage during IVF occurs in 40% of cases, and fetal death during childbirth is often observed. Doctors associate these circumstances with the age of women in labor, as well as with pathologies in their reproductive system.

Artificial insemination using the ICSI method (intracytoplasmic injection) is performed for severe male infertility. During the procedure, a sperm is injected into an egg that is removed from the body of the woman's ovary. The difference between this method and IVF is that with ICSI, one, the most viable sperm is selected, which is placed inside the egg with a needle, and with in vitro fertilization, the sperm are present with the eggs in a special solution and penetrate inside on their own.

What to do if a couple cannot conceive a child naturally? There is no need to despair, modern medicine has made progress in the field of reproduction, and now married couples or single women can resort to artificial conception using IVF or artificial insemination.

Types of artificial insemination used in modern medicine

A couple is considered infertile if the woman has not been able to become pregnant through sexual intercourse at least 2 times a week for 12 months. A man, a woman, or both spouses may be infertile. According to WHO statistics, approximately 8% of married couples of reproductive age experience difficulties conceiving.

Modern medicine offers various assisted reproductive technologies that help couples conceive a baby. There are several types of artificial insemination, which are used depending on the type of infertility, its causes, and the health status of the expectant mother:

• in vitro fertilization (IVF);
• cryopreservation (freezing) of gametes;
• use of donor material;
• surrogacy.

Assisted reproductive technologies used in modern medicine, often give rise to discussions about their ethics. There are many supporters of banning the use of artificial insemination and the donation of sperm, eggs and embryos, but these methods have helped more than one couple experience the happiness of parenthood.

Artificial insemination

Artificial insemination is the introduction into the cervical canal or uterine cavity of sperm that were previously isolated outside of natural coitus. This method of artificial insemination was first tested in 1784 in Italy, where a dog was impregnated with it. In 1790, an insemination operation took place in Scotland on a woman whose husband suffered from hypospadias.

Indications and contraindications

The scheme for intrauterine insemination is regulated by the Ministry of Health. Depending on the factors causing infertility, fertilization is performed with sperm from the donor or the patient’s partner. Indications for insemination with donor sperm:

• azoospermia - absence of live sperm in the ejaculate;
• disorders associated with impaired ejaculation;
• the presence of severe hereditary pathologies on the part of the man.

If the husband's sperm is viable, but for some reason natural conception is impossible, then intrauterine insemination is performed using the sperm of the patient's partner. Indications for use of husband's material:

• sedentary spermatozoa;
• female infertility caused by pathological processes in the cervical canal;
• Vaginismus is a pathology that prevents any vaginal contact, be it penetration of the penis or insertion of a tampon.

Can a single girl who does not have a partner, but wants to give birth to a baby, go to the clinic for help? Yes, she will be offered to use donor sperm for intrauterine insemination.

This method has contraindications:

• illnesses, including psychiatric ones, for which pregnancy is prohibited;
• pathologies of the uterine body that make pregnancy impossible;
• benign ovarian tumors;
• oncological diseases of any organs, not just the pelvis;
• acute inflammatory processes.

Progress of the procedure

The intrauterine insemination procedure is not very difficult and lasts no longer than 10 minutes. However, it is necessary to carry out a number of preparatory measures in advance.

The collection of sperm from a partner often occurs immediately before its introduction - 2 hours before. If donor material is introduced, then frozen sperm is taken. Donor material is used after six months of quarantine. This is necessary to exclude infections.

The sperm is processed before injection. In a centrifuge, sperm are separated from semen. Sometimes unprocessed sperm can be used, but this increases the risk of a woman developing anaphylactic shock.

The insemination itself is done during the period of ovulation. The moment of egg maturation is monitored by a gynecologist; if a woman has problems with this, then ovulation is stimulated with the help of hormones. The material is introduced into the uterus through a catheter, the procedure is completely painless. In one cycle you can do 2-4 inseminations.

In Vitro Fertilization

With in vitro fertilization, conception occurs outside the woman's body. In other words, this procedure is called “in vitro conception.” Experiments to develop the IVF method have been conducted since 1944. The first pregnancy was achieved only in 1973, but it ended in miscarriage. The first test-tube birth occurred in 1983.

During the IVF procedure, both material from the future mother and father of the child and donor material can be used.

Indications and contraindications for IVF

Indications for fertilization using IVF:

• tubal infertility - obstruction of the fallopian tubes or their absence;
• endometriosis;
• problems with ovulation - less than 5-6 ovulations per year, hormonal stimulation does not produce results;
• a woman’s age over 40 years and age-related changes in the reproductive organs;
• low sperm quality - inactive, dead, sperm with an abnormal structure.

Is it possible to do IVF for women who do not have a husband, but want to have a child? Yes, this is allowed, as is the case with intrauterine insemination.

In what cases is an extracorporeal procedure prohibited? Contraindications for this procedure are the same as for intrauterine insemination.

The IVF method has a number of advantages and disadvantages. The most significant advantage of the technique is the ability to give birth to a healthy baby, despite infertility. There are many more disadvantages of the procedure - replantation is successful only in 35% of cases, there is a high risk of ectopic pregnancy, side effects from medications taken, multiple pregnancy.

How does IVF work?

The in vitro fertilization procedure consists of several stages:

1. Receiving an egg. To increase the effectiveness of the procedure, several eggs are needed. Since only one female gamete matures in one menstrual cycle, doctors resort to hormonal stimulation of the ovaries. The patient is injected with follicle-stimulating hormone, luteinizing hormone, and human chorionic gonadotropin. The administration protocol is determined individually for each woman. Follicle monitoring before IVF is done on days 2, 5 and 7 of the cycle. Oocyte maturation is determined using folliculometry. When the follicle matures, a puncture is taken transvaginally using a special needle, sucking out its contents. This operation takes place under general anesthesia. Oocytes are isolated from the resulting liquid and placed in an incubator.
2. Receiving sperm. Sperm is obtained on the day of follicle puncture; the partner obtains it independently through masturbation. If a man has problems with ejaculation, it can be obtained using a testicular biopsy. Before fertilization, male gametes are separated from the seminal fluid.
3. Fertilization. If the sperm are viable and active, they are simply added to the nutrient medium to the eggs at the rate of 100-200 thousand male gametes per female. If the sperm are inactive and are not able to fuse with the oocyte on their own, then an introcytoplasmic injection is used. Using micro-instruments, sperm is artificially introduced into the egg. The resulting embryo is placed in an incubator. How the fusion of sperm and egg occurs in a test tube can be seen in the video below.
4. Embryo transfer. 2-6 days after fertilization of the egg, the embryo is implanted into the woman’s uterus. This is a painless procedure, it is performed on a gynecological chair and lasts a few minutes. 2-4 embryos are implanted through a catheter to increase the chances of pregnancy. The remaining embryos are frozen. They can be reused if the previous IVF failed.

Donor programs

What should those couples do who want to become parents, but their own reproductive cells are not suitable for conception? This is possible for several reasons:

• severe hereditary pathologies that will be passed on to the child if the mother’s egg or father’s sperm is used;
• lack of live sperm;
• absence of ovaries;
• menopause, during which oocyte maturation stops.

A woman who wants to become an egg donor must be healthy, have no hereditary pathologies and be fertile. Before the cell collection procedure, hormonal stimulation is carried out, and then the eggs are collected using a puncture.

The same strict requirements apply to male donors: age between 18-35 years, they should not have hereditary diseases, and the spermogram should show excellent results. Before submitting the material, both men and women undergo a full examination for the presence of infections and other diseases.

Donation is anonymous. Couples who use the services of donors cannot find out who the germ cells belonged to. Likewise, donors have no information about the further fate of their gametes and do not have any rights to the born child.

Where to go?

So, a couple or a single woman decided to get pregnant through artificial insemination. Where should I contact? In Russia, there are special departments of assisted reproductive technologies, which are located at family planning centers or perinatal centers. This government agencies, where patients can receive the necessary services within the quota, waiting for their turn.

In addition, many private medical centers dealing with reproduction issues are licensed to carry out various types artificial insemination. If a woman wants to conceive a child as soon as possible, she can go to a private clinic.

Cost of procedures

One of the disadvantages of assisted reproductive technology methods is their high cost. How much does artificial insemination cost? Excluding medications The average cost of procedures is as follows:

• artificial insemination - 15,000 rubles;
• in vitro fertilization - 55,000 rubles;
• IVF with introcytoplasmic injection - from 70,000 rub.

These prices do not include the necessary hormonal medications and other medications. In general, the IVF procedure in Russia costs 120-150 thousand rubles. Donation services are paid additionally if needed.

Is it possible to do IVF for free? Since 2013, IVF has been included in compulsory medical insurance. The procedure is available not only to married couples who are officially married: this means that it can be done by civil partners, same-sex couples, single women, and patients diagnosed with HIV. Under compulsory medical insurance, in vitro fertilization can be done not only in a public clinic, but also in some private centers.

Compulsory medical insurance covers most of the cost of the procedure: ovarian stimulation, oocyte collection itself, conception and embryo transfer. If a woman needs donor services or an introcytoplasmic injection, then these services are paid for independently.