Differences between IVF and artificial insemination
Currently, with the help of new reproductive technologies, the artificial conception process gives many childless couples diagnosed with infertility the hope of becoming parents.
How is conception
AI is a technology that is used to produce a baby in women with various types of infertility. Today they are widely used The 2 most popular methods of fertilization, each of which has its own specifics:
- Artificial insemination
- In Vitro Fertilization
IVF involves the creation of conditions for conception outside the woman's body, while artificial insemination occurs directly inside it.
Intrauterine insemination method
The essence of the method lies in the introduction of male semen into the female body, bypassing many different obstacles. The main condition is the patency of the fallopian tubes. The fact is that, despite the guaranteed “landing” in the uterine cavity, the sperm must get to the egg by themselves. But they can do this only through the fallopian tubes. If there are problems with permeability, this method is not recommended.
Before the sperm are injected, they undergo a special treatment, during which only healthy sperm are left. Thus, not only the quality of sperm increases, but also the risk of having a child with pathological changes decreases.
IVF - the laboratory way of the birth of life
Among the scientific achievements of the twentieth century, the method of in vitro fertilization is perhaps one of the most outstanding. With the help of this method, the problem of infertility was almost completely solved.
IVF is a technology that allows you to reproduce the necessary conditions for conception outside the human body. As a rule, this procedure is resorted to by people who, for several years, attempts to conceive a child ended in failure, and the treatment turned out to be ineffective.
Today, there are about five million IVF children on earth, many of whom have already become parents themselves. At present, it can be safely said that children conceived in a laboratory do not differ from babies conceived naturally.
IVF technology involves going through several stages, during which patients are under constant supervision of doctors.
- The first phase involves the intake of hormonal drugs, with the help of which ovulation is stimulated. This procedure is necessary for the maturation of a large number of eggs.
- The second stage involves transvaginal follicular puncture, during which mature eggs are removed.
- Next comes the third phase. The so-called cultivation of embryos: the resulting egg and sperm are subjected to special processing, after which they merge (fertilization). Then the embryos must reach a certain stage of development.
- At the final stage, embryos are transferred into the uterine cavity for their further development.
Typically, several embryos are placed in the uterus at once to increase the likelihood of a favorable outcome.
The cost of the procedure and statistics
It should be noted that no one can guarantee one hundred percent result, which will follow after the artificial conception. Some women manage to get pregnant in this way after the first attempt, while others get a negative result after several procedures.
In the case of artificial insemination, the probability of a positive result is about 30%. The cost of the procedure ranges from 15 to 30 thousand rubles.
When using in vitro fertilization, the chance of getting pregnant will be about 40%. The price for IVF varies from 115 to 200 thousand rubles.
If you are unable to conceive a child naturally, this does not mean that you cannot become the genetic parent of your child. Modern medicine really works miracles. The main thing is not to lose hope and only move forward.
Fertilization is the very first stage in the birth of a new life. It begins with the meeting and joining of two sex cells: male and female - a sperm and an egg. At the place of their fusion, a zygote is formed - a cell that combines a complete set of 46 chromosomes with genetic information obtained from parental cells. At the stage of fertilization, the sex of the future person has already been determined. It is chosen randomly, like a lottery. It is known that both the egg and the sperm contain 23 chromosomes, one of which is sexual. Moreover, the egg cell can contain only the X-sex chromosome, and the sperm - both X and Y-sex chromosome (about 50% each). If a sperm with the X-sex chromosome joins the egg, the child will be female, with the Y-chromosome male.
How does the fertilization process take place?
Around the middle of the monthly cycle, a woman ovulates - from the follicle located in the ovary, a mature egg that is capable of fertilization comes out into the abdominal cavity. It is immediately picked up by the cilia-villi of the fallopian tubes, which contracting, push the egg inside. From this moment, the woman's body is ready for fertilization, and for about a day a viable egg in the fallopian tubes will wait for a meeting with the sperm. For it to take place, he will have to travel a long, thorny path. Having got into the vagina with a portion of semen during intercourse, almost half a billion spermatozoa, wagging their tails to accelerate, rush upward.
Before the cherished meeting, you need to walk a distance of about 20 centimeters, which will take several hours. On the way of sperm, many obstacles will come across, overcoming which, most of the tailed beasts will die. The most hardy sperm will reach the goal. For fertilization to take place, at least 10 million must enter the uterus, which will help pave the way for each other. Only a few thousand will reach the finish line, and only one of them will get inside. Not necessarily the strongest, but rather the lucky one who will be the closest to the mink-entrance, on the digging of which everyone worked to break through the protective shell of the egg.
As soon as the sperm is inside the egg, they merge, i.e. fertilization. Now it is no longer a sperm and an egg separately, but a single cell - a zygote. It will soon begin its first division, forming two cells. Then their further division into four, eight cells, etc. will take place. Gradually, the dividing cells will turn into an embryo, which the fallopian tubes, contracting, will push towards the uterus. He needs to leave this place as soon as possible, because if it is delayed, then implantation will occur directly in the oviduct, which will lead to an ectopic pregnancy. Approximately on the fifth or sixth day, the embryo reaches its goal: it enters the uterus, where it will be in free swimming for a couple of days, looking for a place where to attach. Embryo implantation occurs on average on the seventh to tenth day after fertilization, sometimes a little earlier or later. Having found a convenient place, it will take almost two days, like a gimlet, to bite into the lush endometrium in order to gain a foothold. Diving deeper, it touches the blood vessels located in the wall of the uterus, so small hemorrhages occur at the implantation site. At this time, a woman may notice minor bleeding in herself, which is called implantation bleeding and is referred to as early pregnancy symptoms. The implanted embryo begins to release hCG into the mother's blood - the pregnancy hormone to which pregnancy tests respond. Therefore, ten days after ovulation, you can try to soak the first test. In case of confirmation of pregnancy and its successful development, the embryo will continue its growth and formation, and after 9 months a new person will be born.
Artificial insemination
Artificial insemination helps couples to conceive a long-awaited baby in case of male or female infertility. Depending on the cause of infertility, one or another method of artificial insemination is prescribed. Pregnancies resulting from any of them are absolutely natural and do not require further special monitoring. There are three main methods of artificial insemination:
- AI (artificial insemination);
- IVF (in vitro fertilization);
- ICSI (intracytoplasmic sperm injection).
The simplest and most affordable is artificial insemination. In this procedure, male semen is injected through a catheter directly into the woman's uterus, then the sperm move independently into the fallopian tubes to meet with the egg, where fertilization occurs naturally. Before the introduction, the sperm is specially prepared: weak spermatozoa are discarded, leaving the most active and mobile, capable of fertilization.
Before the AI, the couple undergoes a medical examination, tests for genital infections, a man is given a spermogram (semen analysis), a woman is checked for patency of the fallopian tubes in order to avoid an ectopic pregnancy. Often, for a better effect of the procedure, they additionally stimulate ovulation with medications.
Artificial insemination is prescribed for:
- lack of ovulation;
- vaginismus, when, due to spasms and involuntary contractions of the pubococcygeal muscle in a woman, the penetration of the penis is extremely difficult;
- cervical factor of infertility, when sperm cannot enter the uterus and die in the vagina;
- sexual disorder of the partner and the inability to have a full sexual intercourse;
- poor semen analysis;
- infertility in young couples. AI is chosen as the first way to deal with unexplained infertility.
The effectiveness of this method is on average 20-25%. This percentage can be more or less, depending on the age of the couple, sperm quality and other factors.
IVF - in vitro fertilization, the procedure is quite lengthy and laborious. It is prescribed when all methods of treating infertility have been tried, but there are no results. Initially, the couple undergoes a full medical examination and examination, tests urine, blood, for genital infections, hormones, women do an ultrasound of the pelvis, check the patency of the fallopian tubes, men do a spermogram. Then proceed directly to the IVF procedure. It consists of several stages. First, the woman is hyperstimulating the ovaries, injecting injections with certain hormones into the body, so that several full-fledged eggs, ready for fertilization, mature. Then these eggs are removed: under general anesthesia, punctures are made in the lower abdomen from the side of the ovary, or a needle is inserted through the vagina under local anesthesia.
Before fertilization, the selected portion of the male semen is prepared: the sperm are separated from the semen, transferred to an incubator and placed in a nutrient medium. Further, the most active and full-fledged spermatozoa (about 100 thousand) in a glass bowl are mixed with eggs taken from a woman. In a day, it will already be possible to see if fertilization has occurred. If it happened, then the most viable zygotes are selected in order to grow embryos from them. After another 24 hours, it can be determined whether the embryos are developing. They are given another 2-3 days to grow up and are transplanted with a thin catheter through the vagina into the uterus.
Usually two or three embryos (sometimes more) are transferred so that at least one of them takes root. The remaining high-quality embryos are frozen and stored at a temperature of -196C. In the future, if the couple still wants to have children, it will not be necessary to re-fertilize, it will be enough to use ready-made embryos. If the transplant is successful, the embryos have taken root and implanted into the uterus, then a normal pregnancy develops. If menstruation begins after 10-14 days, then the attempt was unsuccessful. The probability of pregnancy by the IVF method - when replanting two embryos is 20%, three - 30%.
In those rare cases when 3 or more embryos take root during the IVF procedure, according to medical indications or the request of a woman, reduction can be performed. The excess embryos are removed without endangering the rest. Depending on the chosen reduction method, the procedure is carried out for a period of 5 to 10 weeks of pregnancy.
A few decades ago, conception in a test tube seemed like a fantasy; now it is a reality.
ICSI - intraplasmic sperm injection, is prescribed for male factor infertility, when for some reason the sperm cannot enter the egg. Most often this happens due to a small number of motile spermatozoa, the absence of spermatozoa themselves in the seminal fluid, teratospermia and other sperm pathologies.
In this procedure, the sperm is injected into the egg with the help of the thinnest needle. The egg is previously removed from the woman's ovary. All manipulations are carried out under a microscope. First, the egg is treated with a special solution to dissolve the outer shell, then the sperm is injected with a needle.
In the ICSI procedure, the couple undergoes the same training and examination as in IVF. The difference is that with IVF, the sperm are in a special solution with the eggs and independently penetrate, while with ICSI, one, the healthiest and most viable sperm is selected and placed inside the egg with a needle. The selection of the sperm takes place under a very powerful microscope, with a four-hundredfold magnification. A variation of the ICSI method is IMSI, when sperm is sampled under a more powerful microscope, with a magnification of 6000 times. The likelihood of pregnancy with ICSI is approximately 30%.
Is artificial insemination a real chance for infertile couples to find parental happiness or is it an unnatural procedure, the chances of success of which are negligible?
Motherhood is the greatest happiness and joy for a woman, her vocation and the most natural state. When, for some objective reason, a woman cannot become a mother, then artificial insemination comes to the rescue. What is it, what methods of artificial insemination exist, what are the features of the procedure, as well as other issues of concern to women, we will consider in this article.
The value of artificial insemination
Artificial insemination is a modern method of solving the problem of infertility, when the conception of a child cannot occur naturally. The artificial insemination procedure can be performed for a number of reasons in which both one of the partners is ill with infertility.
The main indications for artificial insemination are:
- polycystic ovary
- endometriosis
- low quality of the partner's sperm, which can manifest itself in the inactivity of sperm, their low concentration and in a large number of pathological units
- hormonal infertility
- tubal infertility
- infertility, the causes of which are not established
Thanks to the progress in medicine, hundreds of thousands of infertile married couples can finally experience the joy of motherhood and fatherhood, because artificial insemination gives the opportunity to have children with forms of infertility, which in the past put an end to reproductive function.
Video: Conception in vitro
In vitro fertilization methods
When it comes to artificial insemination, many people think of the widespread and popular IVF procedure. In fact, there are several methods of artificially solving the problem of infertility:
- ISM is a method in which a woman's sperm are transferred into the uterus of her husband. This technique is used in cases where a woman's reproductive functions are not impaired and she cannot become a mother due to the poor quality of her husband's sperm or when the mucus in the woman's vagina is an aggressive environment for the existence of sperm and they die before reaching the egg
- ISD - if the husband's sperm is unfit for conception or he is completely infertile, then the spouses are offered a method of artificial insemination with donor sperm. The procedure of this method itself is practically no different from the previous one: a woman is also injected with sperm into the uterus, but her husband is not the only sperm donor
- GIFT - when the cause of infertility lies in the fact that the woman's egg does not enter the fallopian tube for fertilization, then the method of intratubar transfer of gametes is effective. It consists in transferring an egg, previously taken from a woman, to the fallopian tube, connected artificially with male spermatozoa. Male reproductive cells can belong to both the spouse and the donor
- ZIFT is a method in which a fertilized egg is injected into a hormone-prepared uterus. Previously, a healthy egg cell suitable for conception is taken from a woman by the method of puncturing the ovary and fertilized outside the female body with spermatozoa. The embryo is then inserted through the cervix
- ICSI is an effective method of artificial insemination, which involves the fertilization of an egg with a sperm cell using the finest needle. Through the puncture of the testicles, the most active sperm is removed and inserted into the egg
- IVF is the most common type of artificial fertilization of an egg outside the woman's body, after which the embryo is implanted into the uterus
IVF fertilization method
In vitro fertilization is a modern reproductive technology, which is most often used not only in our country, but all over the world. What explains such a popularity of the method? Firstly, this technique gives the best results; secondly, with the help of IVF it is possible to achieve pregnancy even in very difficult cases of infertility, when both partners have serious problems of reproductive function.
In vitro fertilization procedure
IVF requires multiple eggs. But since in a woman's body only one egg can be formed in one cycle, the amount of egg production is stimulated by hormones.
When, using an ultrasound scan, it is determined that the ovary is enlarged and eggs are formed in it, they are removed. After that, the oocytes are washed from the follicular fluid and placed in an incubator, where the eggs are kept until the moment of artificial insemination.
If it is not possible to obtain eggs from a woman, donor eggs are used.
On the same day, sperm are collected, which are obtained by masturbation or interrupted intercourse. In the obtained sperm, spermatozoa are isolated and the most active of them are selected. After that, the required number of active spermatozoa is added to the test tube with eggs, in the calculation of 100-200 thousand per egg. It is also possible to use donor sperm.
Within 2-3 hours, the sperm fertilizes the egg. Further, the resulting embryo is placed in a favorable environment, where it stays for 2 to 6 days. All this time, the necessary vitamins, physiological ions, substrates and amino acids are introduced into the test tube. After that, the embryos are directly transferred to the uterus, which is carried out in a matter of minutes on the gynecological chair.
If a woman cannot bear pregnancy herself, then they resort to surrogacy.
Video: In Vitro Fertilization. Komarovsky
In vitro fertilization pros and cons
Despite the fact that IVF opens up the opportunity for infertile people to have children, this procedure can also have negative consequences, which sometimes turn into deplorable ones:
- hormonal imbalance
- ovarian hyperstimulation
- fetal malformations
- multiple pregnancy, in which it is necessary to kill "extra" embryos for the survival of at least one or two
In addition, the IVF procedure is an expensive event that not everyone can afford, and sometimes childless couples have to give up any hopes of becoming parents, since the amount is simply too much for them.
On the other hand, in society there is a prejudice against the procedure of artificial insemination - "test tube babies" are mistaken for inferior and developmentally retarded.
Today the IVF procedure is being improved in many ways. New technologies are applied, the exact dosage of hormones is established, which ensures the necessary processes and at the same time delivers the least harm to the woman's body.
It is also important that it is extremely rare that a large number of embryos are placed in the uterine cavity, usually only two, which prevents the need to eliminate the excess embryo. And the very joy of motherhood exceeds all possible risks and undesirable consequences that an IVF procedure can cause.
How much does artificial insemination cost?
The price of the issue depends on the method of artificial insemination. It may vary in different clinics, but on average the price list looks like this:
- IGO from 28 to 40 thousand rubles
- IVF from 40 to 100 thousand rubles
- ICSI from 100 to 150 thousand rubles
Other methods of artificial insemination in Russia are not widespread due to their lower efficiency.
Artificial insemination of single women
For women who do not have a partner for conceiving a child, but desperately want to have a child, the artificial insemination procedure will help. During this procedure, active donor sperm are placed in the woman's uterus, after which the egg is fertilized.
Immediately before the procedure, a woman undergoes examinations and tests, if necessary, hormonal stimulation is carried out.
Artificial insemination at home
The artificial insemination procedure can also be carried out at home. Its essence lies in the fact that a dose of sperm obtained during ejaculation is injected into the woman's uterus with the help of a syringe and a catheter. Thanks to this manipulation, the chance of fertilization increases significantly, because all sperm are sent to the egg, while during natural fertilization, part of the seed is poured out and neutralized by vaginal mucus, without even getting into the uterus.
To carry out artificial insemination at home, sterile ones are required:
- syringe
- catheter
- gynecological speculum
- pipette
- disinfectant
- tampons
- towel
- gynecological gloves
It is important to carry out the procedure during ovulation, which can be determined using a special test.
The problem of artificial insemination
Detailed instructions on how artificial insemination is carried out at home can be obtained from a gynecologist, but it is important to understand that the implementation of such an important process at home can carry the risk of bringing various infections into the uterine cavity, due to the possible non-sterility of the devices used.
Artificial insemination: reviews
After analyzing the reviews of women who decided on artificial insemination, several key aspects of the procedure can be distinguished:
- pregnancy does not always occur. There are couples who have decided on IVF five or six times in a row, but have not achieved the desired
- many infertile women are worried about the moral aspect, because the problem of artificial insemination still causes discussion in various circles, especially from the church, which considers such events unnatural, and condemns families without children, since they must bear their cross and not go against the will of god
- artificial insemination - a colossal burden on a woman's body, both in a moral and physical sense
- despite the problems faced by married couples who nevertheless decide on artificial insemination, the positive result and the joy of having a child exceeds all the risks and negative aspects and many are stopped only by the cost of the procedure from having a child artificially again
Video: Types of artificial insemination
In recent years, unfortunately, there has been an increase in the percentage of women who cannot get pregnant naturally. The reason for this is the deteriorating environmental situation, various inflammations of the female genital organs and many other factors. The union of a man and a woman is considered to be sterile when the partners have an active sex life without using contraceptives for 1-2 years, but the long-awaited pregnancy never occurs. This problem is diagnosed in about every fifth married couple. In such situations, methods of artificial insemination of a female egg come to the rescue.
Artificial insemination methods
In modern medicine today there are several methods of artificial insemination, which have been successfully used for many years. Every couple who decides to resort to one of the IVF methods should know how IVF is done and what to expect during this procedure. In this article we will try to answer the most interesting questions regarding such a difficult topic. Nowadays, you can become a full-fledged family, conceive and give birth to a healthy baby using methods such as:
- In vitro fertilization (IVF) - the fusion of male and female cells is performed under laboratory conditions in a sterile test tube, after which the developing embryo is transferred to the uterus of an infertile woman.
- Intracytoplasmic sperm injection (ICSI) - the technique of this procedure is almost identical to the previous one, however, in the case of ICSI, fertilization occurs using purified prepared male sperm (the patient's spouse or donor).
- Artificial insemination (AI) - this type of artificial insemination is used in cases where problems of the reproductive sphere have been identified in a man (insufficient sperm activity, abnormalities in the work of sexual functions, the presence of any other diseases).
- Donation of male genetic material.
- Conception using an egg from a professional or individual donor.
Important! If you have been trying unsuccessfully to become parents for many years and have already used all the methods of conception available for this, you should not despair - every couple has the opportunity to resort to the services of a surrogate mother. However, if you cannot or do not want to use this method, you can always adopt a baby who is left without parents.
Understanding the mystery of conception
Fertilization itself is the initial stage in the emergence of a new life. Its beginning is considered the moment of joining the female and male germ cells. From this second on, the sex of the child is already randomly determined in advance. We know that the sperm and the egg contain 23 chromosomes, one of which is responsible for the gender of the unborn baby. When an egg cell meets a male sperm with an X chromosome - the couple has a girl, if with a Y chromosome - soon you can be congratulated on the birth of a boy.
As a rule, 12-14 days after the onset of menstruation, almost every woman of the weaker sex begins ovulation - the release of an egg from the follicle, which is ready for fertilization. She gradually moves deeper through the fallopian tubes, where she will languish for some time from the expectation of a meeting with the sperm. The egg cell remains fertile for approximately 24 hours from the moment it leaves the follicle. Thousands of spermatozoa enter the woman's vagina along with semen and begin their long and difficult journey.
It takes 3-4 hours for sperm to travel this short distance. There are a lot of obstacles on their way, and most of them die. Only the highest quality and most mobile of them achieve the cherished goal. In order for conception to occur, about 10 million male cells are required, but only one of them will be able to merge with the egg, which will be able to penetrate the dense protective shell. The moment of their merger is considered the moment of fertilization.
Two merged cells eventually turn into a zygote, and then into an embryo - the prototype of the future little man. Pregnancy occurs when the fertilized egg reaches the uterus and attaches itself to the inner lining of the uterus - the endometrium. This happens around 7-10 days. After that, a special hormone responsible for pregnancy (hCG) begins to be produced in the woman's body, which makes it possible to diagnose the onset of pregnancy at home - all you need to do is purchase a special test at the pharmacy. After nine months, a new person is born.
Artificial conception and its types
If a woman or her partner has been diagnosed with infertility, then in this case they resort to the procedure of artificial insemination. But you should not be intimidated by the word "artificial", because babies conceived in this way are absolutely no different from children who were born naturally.
The most accessible and simple method of artificial insemination is considered to be artificial insemination. In the course of this manipulation, the male sperm is placed directly into the uterine cavity through a special catheter, where the sperm cells independently find the egg and merge with it. Of course, the sperm is pre-purified and prepared, only the highest quality and most motile sperm are selected.
On the eve of manipulation, a married couple must undergo a complete examination of the body, pass the necessary tests. The woman is checked the fallopian tubes for patency, the man takes a spermogram analysis, both partners take tests for genital infections. Often, if necessary, a woman's ovulation is stimulated with the help of special hormonal injections.
This type of artificial insemination is used when:
- the woman does not ovulate;
- the fallopian tubes are impassable or absent altogether;
- a woman experiences spasms and muscle contractions during intercourse;
- a woman's body produces antisperm bodies that deprive sperm cells of the viability;
- the man is diagnosed with impotence or other disorders in the genital area;
- age factor;
- the woman has endometriosis or other diseases in the genital area;
- semen analysis has an unsatisfactory result.
In case of primary infertility (infertility of 1 degree), married couples prefer this particular method of artificial insemination.
Important! The effectiveness of this type of artificial insemination is approximately 25%. However, the degree of effectiveness is also determined by a number of factors: the age of the partners, the degree and duration of infertility, the quality of the ejaculate and some others.
In vitro fertilization (IVF) is a more expensive, complex and time-consuming procedure. They resort to it in situations where there are many attempts at unsuccessful conception in a natural and artificial way behind them, but the long-awaited pregnancy never happened. The couple together must pass a number of tests, the woman is diagnosed with ultrasound, the fallopian tubes are checked for patency, and the man is given a spermogram. After a long preparatory stage, they go directly to the process of artificial conception.
The male biomaterial is pre-processed and cleaned, after which it is placed in a favorable nutrient medium in an incubator. In a sterile test tube, the most active and high-quality sperm are mixed with female cells. After about a day, it can be ascertained whether fertilization has occurred. And after 2-3 days, the developing embryos are transferred to the uterus of the infertile patient for further development.
In the process of IVF, several embryos are usually implanted into the uterus in order to increase the efficiency of the procedure. If desired, the couple can freeze the remaining embryos so that they do not go through all the previous IVF stages in the future. The chance of pregnancy with this method is approximately 20-30%.
Itroplasmic sperm injection (ICSI) is usually used in cases of male infertility. In most cases, this is due to insufficient mobility of sperm, or their complete absence in the ejaculate. The procedure is quite simple - the selected sperm cell is delivered directly into the egg cell by means of a very thin needle. This does not happen in a woman's body, but in a laboratory using a pre-extracted and processed egg. The course of manipulation is monitored using a microscope.
Preparing for ICSI is about the same as for IVF. The only difference is that with IVF sperm are given the opportunity to independently reach the egg, and with ICSI - an experienced specialist takes on this task. The chance of pregnancy with this assisted reproduction technique is approximately 30%. To be more precise and refer to statistics, the probability also depends on the woman's age:
- the chance of getting pregnant with IVF in women under 35 is approximately 40%;
- at the age of 35 to 37 years - 30%;
- at the age of 38-40 years - 20%;
- women over 40 are given about 10%, and at 45 - about 1%.
Alternative methods of conception
It should be noted that in especially difficult cases, for childless couples, there are also ways to become happy parents:
- using the services of a surrogate mother (another woman carries and gives birth to your unborn child);
- in vitro fertilization using donor biomaterials;
- the use of frozen embryos;
- adoption of a child without real parents.
Curious facts
There is an opinion that artificially conceived children develop several times more actively than their peers, but at the same time they are more susceptible to various diseases. However, these are just assumptions, and in fact, test tube babies are absolutely no different from naturally conceived babies. Perhaps such opinions are based on the fact that usually a child conceived with the help of IVF is born to older parents, thereby becoming even more desirable, long-awaited and loved. In addition, the opportunity to carry out this procedure is mainly available to people whose financial component is sufficiently reliable and stable, and such parents in the future are able to give their child a decent education and excellent living conditions.
Difficulties of choice
In the overwhelming majority of cases, almost any form of both female and male infertility is amenable to successful treatment, and spouses eventually manage to learn the joy of having a child. However, it sometimes happens that the cause of infertility has been established, but it is not possible to eliminate it either with the help of medications or by surgery.
What method of artificial insemination should you choose? There is no single answer to this question. Each of them has its own advantages and disadvantages. For example, the artificial insemination procedure is financially accessible to almost everyone and is simple to perform. But you cannot vouch for its very high efficiency. While in vitro fertilization has a rather high price, and its implementation may take more than one year, but the likelihood of getting the desired result is quite high.
Couples with similar difficulties come to the aid of methods of artificial insemination, which for several years have been successfully carried out by Dr. Alexander Pavlovich Lazarev, candidate of medical sciences, author of more than 30 scientific papers in the field of various forms of infertility. Remember that all, without exception, couples who managed to get pregnant and give birth to a long-awaited baby with the help of modern advances in reproduction experience great parental happiness. The same cannot be said about sterile men and women who still doubt and still have not been able to make this decision. However, it should be borne in mind that after thirty years it is much more difficult for any woman to become a mother, even with the help of artificial insemination. Weigh all the pros and cons, make the right decision and experience the joy of having a baby!
(Insemination Artificial) is a combination of several methods, the essence of which boils down to the introduction of a male sperm or a 3-5-day-old embryo into the reproductive tract of a woman during medical procedures. Artificial insemination is performed for the purpose of pregnancy in women who cannot conceive in natural ways for various reasons.
In principle, the methods of artificial insemination are reduced to various methods and options for fertilizing an egg outside a woman's body (in a test tube under laboratory conditions), followed by replanting the finished embryo into the uterus in order to engraft it and, accordingly, further development of pregnancy.
In the course of artificial insemination, sex cells are first removed from men (sperm) and women (eggs), followed by their artificial combination in laboratory conditions. After combining the eggs and spermatozoa, fertilized zygotes, that is, the embryos of the future person, are selected in one test tube. Then such an embryo is implanted into the woman's uterus and it is hoped that it will be able to gain a foothold on the wall of the uterus, as a result of which the desired pregnancy will occur.
Artificial insemination - the essence and brief description of manipulation
For an accurate and clear understanding of the term "artificial insemination" it is necessary to know the meaning of both words of this phrase. So, fertilization is understood as the fusion of an egg and a sperm to form a zygote, which, when attached to the wall of the uterus, becomes a fertilized egg, from which the fetus develops. And the word "artificial" means that the process of fusion of an egg and a sperm does not occur naturally (as provided by nature), but is provided purposefully by special medical interventions.
Accordingly, it can be generally said that artificial insemination is a medical method of ensuring the onset of pregnancy in women who, for various reasons, cannot conceive in the usual way. When using this method, the fusion of the egg and sperm (fertilization) does not occur naturally, but artificially, in the course of a specially designed and targeted medical intervention.
Currently, the term "artificial insemination" at the everyday colloquial level means, as a rule, the procedure of in vitro fertilization (IVF). However, this is not entirely true, since specialists in the field of medicine and biology under artificial insemination mean three methods (IVF, ICSI and insemination), which are united by a general principle - the fusion of the egg and sperm does not occur naturally, but with the help of special medical technologies, which ensure successful fertilization with the formation of the ovum and, accordingly, the onset of pregnancy. In the further text of this article, under the term "artificial insemination" we will mean three different methods of fertilization, produced with the help of medical technologies. That is, the term will have its medical meaning.
All three methods of artificial insemination are united by one general principle, namely, the fertilization of an egg by a sperm cell does not occur completely naturally, but with the help of medical manipulations. The degree of interference in the fertilization process in the production of artificial insemination by various techniques varies from minimal to very significant. However, all methods of artificial insemination are used in order to ensure the onset of pregnancy in a woman who, for various reasons, cannot conceive in the usual, natural way.
Artificial insemination to ensure conception is used only in cases where a woman is potentially able to bear a child during the entire pregnancy, but is not able to become pregnant in the usual way. The causes of infertility for which artificial insemination is indicated are different and include both female and male factors. So, doctors recommend resorting to artificial insemination if a woman has no or impassable both fallopian tubes, has endometriosis, rare ovulation, unexplained infertility, or other methods of treatment did not lead to pregnancy within 1.5 - 2 years. In addition, artificial insemination is also recommended in cases where a man has low sperm quality, impotence or other diseases, against which he is not able to ejaculate into the woman's vagina.
For the procedure of artificial insemination, you can use your own or donor sex cells (sperm or eggs). If the partners' sperm and eggs are viable and can be used for conception, then they are used for artificial insemination techniques, preliminarily isolating from the genitals of a woman (ovaries) and a man (testicles). If sperm or eggs cannot be used for conception (for example, they are completely absent or have chromosomal abnormalities, etc.), then donor sex cells obtained from healthy men and women are taken for artificial insemination. Each country has a bank of donor cells, where anyone who wants to receive biological material for the production of artificial insemination can apply.
The artificial insemination procedure is voluntary, and all women and married couples (both in legal and civil marriage) who have reached the age of 18 can use this medical service. If a woman in an official marriage wishes to resort to this procedure, then the consent of the spouse will be required for the production of fertilization. If a woman is in a civil marriage or is single, then only her consent is needed for artificial insemination.
Women over 38 years old may immediately require artificial insemination for the purpose of pregnancy without prior treatment or attempts to conceive naturally. And for women under 38 years of age, permission for artificial insemination is given only after documented confirmation of infertility and the lack of effect from the treatment performed within 1.5 - 2 years. That is, if a woman is younger than 38 years old, then artificial insemination is resorted to only when, within 2 years, subject to the use of various methods of treating infertility, pregnancy has not occurred.
Before carrying out artificial insemination, a woman and a man undergo an examination, according to the results of which their fertility and the ability of the fair sex to bear a fetus during 9 months of pregnancy are established. If everything is in order, then the procedures are carried out in the near future. If any diseases have been identified that can interfere with the normal development of the fetus and the bearing of pregnancy, then they are first treated, achieving a stable state of the woman, and only after that artificial insemination is performed.
All three methods of artificial insemination are short in time and well tolerated, which allows them to be used several times without interruption to ensure the onset of pregnancy.
Methods (methods, types) of artificial insemination
Currently, in specialized medical institutions for artificial insemination, the following three techniques are used:
- In Vitro Fertilization (IVF);
- Intracytoplasmic sperm injection (ICSI or ICIS);
- Artificial insemination.
For example, if a woman's genitals are functioning normally, but the mucus in the cervix is too aggressive, as a result of which the sperm cannot liquefy it and enter the uterus, then artificial insemination is performed by insemination. In this case, sperm is injected directly into the uterus on the day of ovulation in a woman, which leads to pregnancy in most cases. In addition, insemination is indicated when the quality of sperm is low, in which there are few motile spermatozoa. In this case, this technique allows sperm to be delivered closer to the egg, which increases the likelihood of pregnancy.
If pregnancy does not occur against the background of any diseases of both the genital area (for example, obstruction of the fallopian tubes, absence of ejaculation in a man, etc.) and somatic organs (for example, hypothyroidism, etc.) in a man or woman, then for artificial insemination, the IVF method is used.
If there are indications for IVF, but additionally a man has very few high-quality and motile sperm in his semen, then ICSI is performed.
Let us consider in more detail each method of artificial insemination separately, since, firstly, the degree of interference in the natural process when using different methods varies, and secondly, in order to get a holistic idea of the type of medical intervention.
In Vitro Fertilization - IVF
IVF (in vitro fertilization) is the most famous and widespread method of artificial insemination. The name of the method "IVF" stands for in vitro fertilization. In English speaking countries, the method is called in vitro fertilization and is denoted by the abbreviation IVF. The essence of the method is that fertilization (the fusion of a sperm and an egg with the formation of an embryo) occurs outside the woman's body (extracorporeally), in a laboratory, in test tubes with special nutrient media. That is, sperm and eggs are taken from the organs of a man and a woman, placed on nutrient media, where fertilization takes place. It is because of the use of laboratory glassware for IVF that this method is called "in vitro fertilization".
The essence of this method is as follows: after preliminary special stimulation, eggs are taken from a woman's ovaries and placed on a nutrient medium that allows them to be maintained in a normal viable state. Then the woman's body is prepared for the onset of pregnancy, imitating natural changes in hormonal levels. When the woman's body is ready for pregnancy, the man's sperm are obtained. To do this, a man either masturbates with ejaculation of sperm in a special cup, or sperm are obtained during a puncture of the testicles with a special needle (if sperm outflow is impossible for some reason). Then, viable spermatozoa are isolated from the sperm and in a test tube under the control of a microscope they are placed on a nutrient medium to the eggs previously obtained from the woman's ovaries. They wait for 12 hours, after which fertilized eggs (zygotes) are isolated under a microscope. These zygotes are injected into a woman's uterus, hoping that they can attach to its wall and form a fertilized egg. In this case, the desired pregnancy will come.
2 weeks after the transfer of embryos into the uterus, the level of chorionic gonadotropin (hCG) in the blood is determined in order to determine whether pregnancy has occurred. If the hCG level has increased, then pregnancy has begun. In this case, the woman registers for pregnancy and begins to visit a gynecologist. If the hCG level remains within the normal range, then pregnancy has not occurred, and the IVF cycle must be repeated.
Unfortunately, even when a ready-made embryo is introduced into the uterus, pregnancy may not occur, since the fertilized egg will not attach to the walls and die. Therefore, for the onset of pregnancy, several IVF cycles may be needed (no more than 10 is recommended). The likelihood of the embryo attaching to the wall of the uterus and, accordingly, the success of the IVF cycle largely depends on the woman's age. So, for one IVF cycle, the probability of pregnancy in women under 35 years old is 30-35%, in women 35-37 years old - 25%, in women 38-40 years old - 15-20% and in women over 40 years old - 6- ten%. The probability of pregnancy with each subsequent IVF cycle does not decrease, but remains the same, respectively, with each subsequent attempt, the total probability of getting pregnant only increases.
Intracytoplasmic sperm injection - ICSI
This method is the second most frequently used after IVF and, in fact, is a modification of IVF. The abbreviation of the name of the ICSI method is not deciphered in any way, since it is a tracing paper from the English abbreviation - ICSI, in which the sound of the letters of the English language is written in Russian letters that convey these sounds. And the English-language abbreviation stands for IntraCytoplasmic Sperm Injection, which translates into Russian as "intracytoplasmic sperm injection". Therefore, in the scientific literature, the ICSI method is also called ICIS, which is more correct, since the second abbreviation (ICIS) is derived from the first letters of the Russian words that make up the name of the manipulation. However, along with the name ICIS, the not quite correct abbreviation ICSI is used much more often.
The difference between ICSI and IVF is that the sperm cell is targeted in the cytoplasm of the egg with a thin needle, and not just placed with it in the same test tube. That is, with conventional IVF, eggs and spermatozoa are simply left on a nutrient medium, allowing the male sex gametes to approach the female and fertilize them. And with ICSI, spontaneous fertilization is not expected, but it is produced by introducing a sperm cell into the cytoplasm of the egg with a special needle. ICSI is used when there are very few spermatozoa, or they are immobile and unable to fertilize an egg on their own. The rest of the ICSI procedure is completely identical to IVF.
Intrauterine insemination
The third method of artificial insemination is insemination, during which the man's sperm is injected directly into the woman's uterus during ovulation using a special thin catheter. Insemination is used when sperm for some reason cannot enter the woman's uterus (for example, when a man is unable to ejaculate in the vagina, with poor sperm motility or with excessively viscous cervical mucus).
How does artificial insemination take place?
General principles of IVF-ICSI artificial insemination
Since all IVF and ICSI procedures are performed in the same way, with the exception of the laboratory method of egg fertilization, we will consider them in one section, specifying the details and distinctive features of ICSI if necessary.
So, the IVF and ICSI procedure consists of the following successive stages that make up one cycle of artificial insemination:
1.
Stimulation of folliculogenesis (ovaries) in order to obtain several mature eggs from a woman's ovaries.
2.
Collection of mature eggs from the ovaries.
3.
Sperm collection from a man.
4.
Fertilization of eggs with sperm and obtaining embryos in the laboratory (with IVF, sperm and eggs are simply placed in one test tube, after which the strongest male gametes fertilize the female one. And with ICSI, spermatozoa are injected with a special needle into the cytoplasm of the egg).
5.
Growing embryos in the laboratory for 3 - 5 days.
6.
Transfer of embryos to a woman's uterus.
7.
Monitoring the onset of pregnancy 2 weeks after the transfer of embryos to the uterus.
The entire cycle of IVF or ICSI lasts 5-6 weeks, the longest being the stages of stimulating folliculogenesis and two weeks of waiting to control pregnancy after embryo transfer into the uterus. Let's consider each stage of IVF and ICSI in more detail.
The first stage of IVF and ICSI is the stimulation of folliculogenesis, for which a woman takes hormonal drugs that affect the ovaries and cause the growth and development of several dozen follicles at once, in which eggs are formed. The purpose of stimulating folliculogenesis is the formation of several eggs in the ovaries at once, ready for fertilization, which can be selected for further manipulations.
For this stage, the doctor chooses the so-called protocol - a regimen for taking hormonal drugs. There are different protocols for IVF and ICSI, differing from each other in dosages, combinations and duration of hormonal drugs. In each case, the protocol is selected individually, depending on the general condition of the body and the cause of infertility. If one protocol was unsuccessful, that is, after its completion, the pregnancy did not take place, then the doctor may prescribe a different protocol for the second cycle of IVF or ICSI.
Before the start of stimulation of folliculogenesis, the doctor may recommend taking oral contraceptives for 1 to 2 weeks in order to suppress the production of her own sex hormones by the woman's ovaries. It is necessary to suppress the production of your own hormones so that natural ovulation does not occur, in which only one egg matures. And for IVF and ICSI, you need to get several eggs, and not one, for which stimulation of folliculogenesis is carried out.
Next, the actual stage of stimulation of folliculogenesis begins, which is always timed to 1 - 2 days of the menstrual cycle. That is, you need to start taking hormonal drugs to stimulate the ovaries from 1 to 2 days of the next menstruation.
Ovarian stimulation is carried out according to various protocols, but always involves the use of drugs of the follicle-stimulating hormone group, chorionic gonadotropin and agonists or antagonists of gonadotropin-releasing hormone agonists. The order, duration and dosage of the use of drugs of all these groups are determined by the attending reproductive physician. There are two main types of ovulation stimulation protocols - short and long.
In long protocols, ovulation stimulation begins on the 2nd day of the next menstruation. In this case, the woman first makes subcutaneous injections of follicle-stimulating hormone preparations (Puregon, Gonal, etc.) and gonadotropin-releasing hormone agonists or antagonists (Goserelin, Triptorelin, Buserelin, Dipherelin, etc.). Both drugs are administered daily as subcutaneous injections, and once every 2 to 3 days a blood test is performed to determine the concentration of estrogen in the blood (E2), as well as an ultrasound scan of the ovaries with measurement of the follicle size. When the concentration of estrogen E2 reaches 50 mg / l, and the follicles grow to 16 - 20 mm (on average, this happens in 12 - 15 days), stop injections of follicle-stimulating hormone, continue the administration of agonists or antagonists of gonadotropin-releasing hormone and add injections of chorionic gonadotropin ( HCG). Further, by ultrasound, the response of the ovaries is monitored and the duration of injections of chorionic gonadotropin is determined. The administration of gonadotropin-releasing hormone agonists or antagonists is stopped one day before the injections of chorionic gonadotropin are stopped. Then, 36 hours after the last injection of hCG, mature eggs are taken from the woman's ovaries using a special needle under anesthesia.
In short protocols, ovarian stimulation also starts from day 2 of your period. In this case, a woman simultaneously daily injects three drugs at once - follicle-stimulating hormone, agonist or antagonist of gonadotropin-releasing hormone and chorionic gonadotropin. Every 2 - 3 days, an ultrasound scan is performed with the measurement of the size of the follicles, and when at least three follicles 18 - 20 mm in diameter appear, then the administration of follicle-stimulating hormone preparations and agonists or antagonists of gonadotropin-releasing hormone is stopped, but for another 1 - 2 days chorionic gonadotropin. In 35 - 36 hours after the last injection of chorionic gonadotropin, eggs are taken from the ovaries.
Egg collection procedure produced under anesthesia, therefore it is completely painless for a woman. The eggs are collected with a needle inserted into the ovaries through the anterior abdominal wall or through the vagina under ultrasound guidance. The collection of cells itself lasts 15 - 30 minutes, but after the completion of the manipulation, the woman is left in a medical institution under supervision for several hours, after which she is allowed to go home, recommending to refrain from work and driving for a day.
Then sperm is obtained for fertilization. If a man is able to ejaculate, then the sperm is obtained by the method of ordinary masturbation directly in a medical institution. If a man is not capable of ejaculation, then sperm is obtained by puncture of the testicles, performed under anesthesia, similar to the manipulation of taking eggs from a woman's ovaries. In the absence of a male partner, donor sperm, selected by the woman, is retrieved from the storage.
The sperm is taken to the laboratory, where it is prepared by sperm secretion. Then according to IVF method eggs and sperm are mixed on a special nutrient medium, and left for 12 hours for fertilization. Usually 50% of the eggs that are already embryos are fertilized. They are selected and grown under special conditions for 3 - 5 days.
According to the ICSI method After preparing the sperm, under a microscope, the doctor selects the most viable spermatozoa and inserts them directly into the egg with a special needle, and then leaves the embryos on a nutrient medium for 3 - 5 days.
Ready 3 - 5 day old embryos are transferred into the woman's uterus using a special catheter. Depending on the age and condition of the woman's body, 1 to 4 embryos are transferred into the uterus. The younger the woman, the fewer embryos are implanted into the uterus, since the likelihood of their engraftment is much higher than that of older women. Therefore, the older the woman, the more embryos are implanted into the uterus, so that at least one can attach to the wall and begin to develop. Currently, it is recommended that women under 35 years old transfer 2 embryos into the uterus, women 35 - 40 years old - 3 embryos, and women over 40 years old - 4 - 5 embryos.
After embryo transfer to the uterus you need to monitor your condition and immediately consult a doctor if the following symptoms appear:
- Foul-smelling vaginal discharge;
- Pain and cramps in the abdomen;
- Bleeding from the genital tract;
- Cough, shortness of breath, and chest pain;
- Severe nausea or vomiting;
- Pains of any location.
Whether a pregnancy has taken place is determined by the concentration of chorionic gonadotropin (hCG) in the blood. If the level of hCG corresponds to pregnancy, then an ultrasound scan is performed. And if the fetal egg is visible on the ultrasound, then the pregnancy has come. Further, the doctor determines the number of embryos, and if there are more than two of them, then it is recommended to reduce all other fetuses so that there is no multiple pregnancy. Reduction of embryos is recommended because the risks of complications and unfavorable termination of pregnancy are too high in multiple pregnancies. After establishing the fact of pregnancy and reduction of embryos (if necessary), the woman goes to an obstetrician-gynecologist to manage the pregnancy.
Since pregnancy does not always occur after the first IVF or ICSI attempt, several IVF cycles may be required for successful conception. It is recommended to carry out IVF and ICSI cycles without interruption until pregnancy (but no more than 10 times).
During the IVF and ICSI cycles it is possible to freeze embryos that turned out to be "extra" and were not transplanted into the uterus. These embryos can be thawed and used for the next pregnancy attempt.
Additionally, during the IVF-ICSI cycle, you can produce prenatal diagnostics embryos before they are transplanted into the uterus. In the course of prenatal diagnostics, various genetic abnormalities in the formed embryos are revealed and embryos with gene disorders are culled. Based on the results of prenatal diagnostics, only healthy embryos without genetic abnormalities are selected and transferred into the uterus, which reduces the risk of spontaneous miscarriage and the birth of children with hereditary diseases. Currently, the use of prenatal diagnostics can prevent the birth of children with hemophilia, Duchenne myopathy, Martin-Bell syndrome, Down syndrome, Patau syndrome, Edwards syndrome, Shershevsky-Turner syndrome and a number of other genetic diseases.
Prenatal diagnostics before transferring embryos to the uterus is recommended in the following cases:
- The birth of children with hereditary and congenital diseases in the past;
- The presence of genetic abnormalities in the parents;
- Two or more unsuccessful IVF attempts in the past;
- Bladder moles during previous pregnancies;
- Large sperm count with chromosomal abnormalities;
- The woman is over 35 years old.
General principles of artificial insemination by insemination
This method allows you to conceive in conditions that are as close to natural as possible. Due to its high efficiency, low invasiveness and relative ease of implementation, artificial insemination is a very popular method of infertility therapy.
The essence of the technique artificial insemination consists in the introduction of specially prepared male sperm into the female genital tract during ovulation. This means that for insemination, according to the results of ultrasound and disposable test strips, the day of ovulation in a woman is calculated, and on the basis of this, the time for the introduction of sperm into the genital tract is established. As a rule, to increase the likelihood of pregnancy, sperm is injected into the genital tract of a woman three times - one day before ovulation, on the day of ovulation and one day after ovulation.
Sperm is taken from a man directly on the day of insemination. If a woman is single and does not have a partner, then donor sperm is taken from a special bank. Before being introduced into the genital tract, sperm is concentrated, pathological, immobile and non-viable spermatozoa, as well as epithelial cells and microbes are removed. Only after processing, sperm containing a concentrate of active spermatozoa without admixtures of microbial flora and cells is injected into the female genital tract.
The insemination procedure itself is quite simple, therefore it is carried out in a polyclinic on an ordinary gynecological chair. For insemination, a woman sits on a chair, a thin elastic flexible catheter is inserted into her genital tract, through which concentrated, specially prepared sperm is injected using a conventional syringe. After the introduction of sperm, a cap with sperm is put on the cervix and the woman is left to lie in an unchanged position for 15 to 20 minutes. After that, without removing the cap with semen, the woman is allowed to get up from the gynecological chair and do her usual usual things. The semen cap is removed by the woman on her own after a few hours.
The prepared sperm, depending on the cause of infertility, can be inserted by the doctor into the vagina, into the cervix, into the uterine cavity and into the fallopian tubes. However, most often sperm is injected into the uterine cavity, since this insemination option has an optimal balance of efficiency and ease of implementation.
The artificial insemination procedure is most effective in women under 35 years of age, in whom pregnancy occurs in about 85 - 90% of cases after 1 - 4 attempts to inject sperm into the genital tract. It must be remembered that women of any age are recommended to make no more than 3 - 6 attempts of artificial insemination, because if they all failed, then the method should be recognized as ineffective in this particular case and move on to other methods of artificial insemination (IVF, ICSI).
Lists of drugs used for various methods of artificial insemination
Currently, the following drugs are used at various stages of IVF and ICSI:
1. Gonadotropin-releasing hormone agonists:
- Goserelin (Zoladex);
- Triptorelin (Dipherelin, Decapeptyl, Decapeptyl-Depo);
- Buserelin (Buserelin, Buserelin-Depo, Buserelin Long FS).
- Ganireliks (Orgalutran);
- Cetrorelix (Cetrotide).
- Follitropin alpha (Gonal-F, Follitrop);
- Follitropin beta (Puregon);
- Corifollitropin alpha (Elonva);
- Follitropin alpha + lutropin alpha (Pergoveris);
- Urofollitropin (Alterpur, Bravell);
- Menotropins (Menogon, Menopur, Menopur Multidose, Merional, HuMoG).
- Chorionic gonadotropin (Chorionic gonadotropin, Pregnil, Ecostimulin, Horagon);
- Choriogonadotropin alpha (Ovitrel).
- Progesterone (Iprozhin, Krainon, Prajisan, Utrozhestan).
- Dydrogesterone (Duphaston);
- Megestrol (Megeis).
For artificial insemination, all the same drugs can be used as for IVF and ICSI cycles, if it is planned to inject sperm into the genital tract against the background of induced rather than natural ovulation. However, if insemination is planned for natural ovulation, then, if necessary, only preparations of pregnene and pregnadiene derivatives are used after the introduction of sperm into the genital tract.
Artificial insemination: methods and their description (artificial insemination, IVF, ICSI), in which cases they are used - video
Artificial insemination: how it happens, description of methods (IVF, ICSI), comments of embryologists - video
Artificial insemination step by step: egg retrieval, fertilization by ICSI and IVF methods, embryo transplantation. Freezing and storage of embryos - video
List of tests for artificial insemination
Before starting IVF, ICSI or insemination in order to select the optimal method of artificial insemination, the following studies are carried out:
- Determination of the concentrations of prolactin, follicle-stimulating and luteinizing hormones and steroids (estrogens, progesterone, testosterone) in the blood;
- Ultrasound of the uterus, ovaries and fallopian tubes by transvaginal access;
- The patency of the fallopian tubes is assessed during laparoscopy, hysterosalpingography or contrast echohysterosalpingoscopy;
- The state of the endometrium is assessed during ultrasound, hysteroscopy and endometrial biopsy;
- Spermogram for the partner (in addition to the spermogram, a mixed antiglobulin reaction of sperm is performed, if necessary);
- Tests for the presence of genital infections (syphilis, gonorrhea, chlamydia, ureaplasmosis, etc.).
- Blood test for syphilis (MRI, ELISA) for a woman and a man (sperm donor);
- A blood test for HIV / AIDS, hepatitis B and C, as well as for the herpes simplex virus for both women and men;
- Microscopic examination of smears from the vagina of women and the urethra of men for microflora;
- Bacterial culture of smears from the genital organs of men and women for Trichomonas and gonococci;
- Microbiological examination of the detachable genitals of men and women for chlamydia, mycoplasma and ureaplasma;
- Detection of herpes simplex viruses of types 1 and 2, cytomegalovirus in the blood of women and men by PCR;
- General blood test, biochemical blood test, coagulogram for a woman;
- General urine analysis for a woman;
- Determination of the presence in the blood of antibodies of types G and M to the rubella virus in a woman (in the absence of antibodies in the blood, they are vaccinated against rubella);
- Analysis of a smear from a woman's genital organs for microflora;
- Cytological smear from the cervix;
- Ultrasound of the pelvic organs;
- Fluorography for women who have not done this study for more than 12 months;
- Electrocardiogram for a woman;
- Mammography for women over 35 and ultrasound of the mammary glands for women under 35;
- Consultation with a geneticist for women whose blood relatives have had cases of giving birth to children with genetic diseases or congenital malformations;
- Spermogram for men.
Indications for artificial insemination
Indications for IVF are the following conditions or diseases in both or one of the partners:
1. Infertility of any origin, which does not lend itself to therapy with hormonal drugs and laparoscopic surgical interventions, performed for 9 to 12 months.
2. The presence of diseases in which the onset of pregnancy without IVF is impossible:
- Absence, obstruction or abnormalities in the structure of the fallopian tubes;
- Endometriosis that does not respond to therapy;
- Lack of ovulation;
- Depletion of the ovaries.
4. Low sperm motility.
Indications for ICSI are the same conditions as for IVF, but with the presence of at least one of the following factors on the part of the partner:
- Low sperm count;
- Low sperm motility;
- A large number of abnormal sperm;
- The presence of antisperm antibodies in semen;
- A small number of eggs obtained (no more than 4 pieces);
- Inability of a man to ejaculate;
- Low percentage of oocyte fertilization (less than 20%) in previous IVF cycles.
1. From the man's side:
- Sperm with low fertility (low number, low motility, high percentage of defective sperm, etc.);
- Small volume and high viscosity of semen;
- The presence of antisperm antibodies;
- Violation of the ability to ejaculate;
- Retrograde ejaculation (discharge of semen into the bladder);
- Anomalies of the structure of the penis and urethra in a man;
- Condition after vasectomy (ligation of the vas deferens).
- Infertility of cervical origin (for example, too viscous cervical mucus, which prevents sperm from entering the uterus, etc.);
- Chronic endocervicitis;
- Surgical interventions on the cervix (conization, amputation, cryodestruction, diathermocoagulation), which led to its deformation;
- Unexplained infertility;
- Antisperm antibodies;
- Infrequent ovulation;
- Semen allergy.
Contraindications for artificial insemination
Currently, there are absolute contraindications and restrictions to the use of methods of artificial insemination. In the presence of absolute contraindications, the fertilization procedure should not be carried out under any circumstances until the contraindication factor has been removed. If there are restrictions on artificial insemination, the procedure is undesirable, but it is possible with caution. However, if there are limitations to artificial insemination, it is recommended to first eliminate these limiting factors, and only then carry out medical manipulations, as this will increase their effectiveness.
So, according to the order of the Ministry of Health of the Russian Federation, contraindications for IVF, ICSI and artificial insemination are the following conditions or diseases in one or both partners:
- Active tuberculosis;
- Acute hepatitis A, B, C, D, G or exacerbation of chronic hepatitis B and C;
- Syphilis (fertilization is postponed until the infection is cured);
- HIV / AIDS (at stages 1, 2A, 2B and 2B, artificial insemination is postponed until the disease turns into a subclinical form, and at stages 4A, 4B and 4C, IVF and ICSI are postponed until the infection goes into remission);
- Malignant tumors of any organs and tissues;
- Benign tumors of the female genital organs (uterus, cervical canal, ovaries, fallopian tubes);
- Acute leukemia;
- Myelodysplastic syndromes;
- Chronic myeloid leukemia in the terminal stage or requiring therapy with tyrosine kinase inhibitors;
- Blast crises in chronic myeloid leukemia;
- Severe aplastic anemia;
- Hemolytic anemias during periods of acute hemolytic crises;
- Idiopathic thrombocytopenic purpura, refractory to therapy;
- Acute attack of porphyria, provided that remission lasted less than 2 years;
- Hemorrhagic vasculitis (Shenlein-Henoch purpura);
- Antiphospholipid syndrome (severe course);
- Diabetes mellitus with end-stage renal failure in the impossibility of kidney transplantation;
- Diabetes mellitus with progressive proliferative
- Polyarteritis with lung involvement (Churg-Strauss);
- Polyarteritis nodosa;
- Takayasu syndrome;
- Systemic lupus erythematosus with frequent exacerbations;
- Dermatopolymyositis, requiring treatment with high doses of glucocorticoids;
- Systemic scleroderma with a high process activity;
- Sjogren's syndrome in severe cases;
- Congenital malformations of the uterus, in which it is impossible to carry a pregnancy;
- Congenital defects of the heart, aorta and pulmonary artery (atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic stenosis, coarctation of the aorta, pulmonary artery stenosis, transposition of great vessels, full form of atrioventricular communication, common arterial trunk, single ventricle of the heart
- Low ovarian reserve according to ultrasound data or according to the concentration of anti-Müllerian hormone in the blood (only for IVF and ICSI);
- Conditions in which the use of donor eggs, sperm or embryos is indicated;
- Complete inability to endure pregnancy;
- Hereditary diseases linked to the female sex X chromosome (hemophilia, Duchenne muscular dystrophy, ichthyosis, Charcot-Marie amyotrophy, etc.). In this case, IVF production is recommended only with mandatory pre-implantation diagnostics.
Complications of artificial insemination
Both the artificial insemination procedure itself and the drugs used in various methods can in very rare cases lead to complications, such as: 
For any method of artificial insemination, the sperm of both a woman's partner (official or common-law husband, partner, lover, etc.) and a donor can be used.
If a woman decides to use her partner's sperm, then he will have to undergo an examination and hand over biological material in the laboratory of a specialized medical institution, indicating the necessary information about himself (name, year of birth) in the reporting documentation and signing an informed consent to the desired method of artificial insemination. Before donating sperm, a man is recommended not to have sex or masturbate with ejaculation for 2 to 3 days, as well as refrain from drinking alcohol, smoking and overeating. Usually, sperm is donated on the same day the woman's eggs are collected or when the insemination procedure is scheduled.
If the woman is single or her partner cannot provide sperm, then you can use donor sperm from a special bank. The sperm bank stores frozen sperm samples from healthy men aged 18 to 35 years, among which you can choose the most preferred option. To facilitate the selection of donor sperm, the databank contains template cards that indicate the physical parameters of a donor man, such as height, weight, eye and hair color, shape of the nose, ears, etc.
Having chosen the desired donor sperm, the woman begins to make the necessary preparations for the artificial insemination procedures. Then, on the appointed day, laboratory staff defrost and prepare donor sperm and use it as intended.
Currently, only donor sperm from men with negative tests for HIV herpes simplex virus in their blood is used;
For each sperm donor, according to order 107n of the Ministry of Health of the Russian Federation, the following individual card is drawn up, which reflects all the basic and necessary parameters of the physical data and the state of health of a man:
Individual sperm donor card
FULL NAME.___________________________________________________________________
Date of birth ________________________ Nationality ______________________
Race ___________________________________________________
Place of permanent registration ____________________________________________
Contact number_____________________________
Education _________________________ Profession ____________________________
Harmful and / or hazardous production factors (yes / no) What: _________
Marital status (single / married / divorced)
The presence of children (yes / no)
Family hereditary diseases (yes / no)
Bad habits:
Smoking (yes / no)
Drinking alcohol (with a frequency of ___________________) / do not drink)
Use of narcotic drugs and / or psychotropic substances:
Without a doctor's prescription
(never used / with a frequency of ______________________) / regularly)
Syphilis, gonorrhea, hepatitis (not sick / sick)
Have you ever had a positive or uncertain response when tested for HIV, hepatitis B or C virus? (Not really)
Is / is not under dispensary supervision in a dermatovenerologic dispensary / neuropsychiatric dispensary ________
If so, which specialist doctor _______________________________________________
Phenotypic traits
Height Weight__________________
Hair (straight / curly / curly) Hair color _____________________________
Eye shape (European / Asian)
Eye color (blue / green / gray / hazel / black)
Nose (straight / crooked / snub / wide)
Face (round / oval / narrow)
Stigma ____________________________________________________________
Forehead (high / low / normal)
Additional information about yourself (optional)
_________________________________________________________________________
What was sick in the last 2 months ___________________________________________
Blood group and Rh factor ________________ (________) Rh (________).
Artificial insemination of single women
According to the law, all single women over the age of 18 are allowed to use the artificial insemination procedure for the purpose of having a child. For the production of artificial insemination in such cases, as a rule, they resort to using donor sperm.
Price of procedures
The cost of artificial insemination procedures is different in different countries and for different methods. So, on average, IVF in Russia costs about 3-6 thousand dollars (together with medicines), in Ukraine - 2.5-4 thousand dollars (also together with medicines), in Israel - 14-17 thousand dollars (together with drugs ). The cost of ICSI is approximately $ 700 - $ 1000 more than IVF in Russia and Ukraine, and 3000 - 5000 in Israel. The price of artificial insemination ranges from $ 300 to $ 500 in Russia and Ukraine, and about $ 2,000 to $ 3500 in Israel. We have given the prices for artificial insemination procedures in dollar terms, so that it is convenient to compare, and also easily converted into the required local currency (rubles, hryvnia, shekels).
