2023-05-02 14:36:31
L’artificial insemination also called intrauterine insemination with spouse’s sperm is a technique of medically assisted procreation (PMA). It consists in injecting the spermatozoa of the spouse or of a donor directly into the uterine cavity of the woman, on the day of ovulation.
Artificial insemination helps women who fail to have a child either because of cervical mucus (cervical infertility) or because the sperm fail to reach the oocyte due to moderate sperm disorders (male infertility) or without a clearly established cause (unexplained infertility).
ART, IVF, artificial insemination: concepts not to be confused
We often use these notions to refer to assisted procreation. However, they have a different meaning.
What is PMA?
The PMA, medically assisted procreation, brings together all the techniques making it possible to respond to a parental project outside the natural process. Among these techniques we find in vitro fertilization (IVF)but also artificial insemination or embryo reception.
What is the difference between IVF and artificial insemination?
IVF allows the fertilization of the oocyte by a sperm in the laboratory, before being transferred to the woman’s uterus. It can be the sperm of the spouse or of a donor. Thus, IVF and artificial insemination are different: while in vitro fertilization takes place in the laboratory, insemination takes place inside the woman’s uterus (only the sperm are treated in the laboratory). IVF is therefore intended for people for whom artificial insemination is not sufficiently effective: women with an obstruction of the tubes or an ovarian problem, male infertility and people for whom insemination attempts have failed. Finally, these two techniques differ on many other points: methods, chances of success, risks involved, price…
Who is entitled to artificial insemination?
According the bioethics law of August 2, 2021artificial insemination can be proposed to women who have a parental project with uterine tubes in good condition and who are in the following situations:
– Single and therefore wishes to appeal to a donor;
– in a relationship with another woman and therefore wishes to appeal to a donor;
– in a relationship with a man but who cannot conceive. In this case, obstacles to artificial insemination are:
- the death of one of the members of the couple;
- filing a petition for divorce;
- the introduction of a request for legal separation;
- the signing of a divorce or legal separation agreement by mutual consent in accordance with the procedures provided for in Article 229-1 of the Civil Code;
- the termination of the community of life;
- the written revocation of the consent provided for in the third paragraph of this article by one or other of the members of the couple to the doctor in charge of implementing medically assisted procreation.
What examinations are necessary?
A first series of examinations follows request for medically assisted procreation to determine which is the most appropriate technique. The prescribed examinations include:
- A complete sanguin bilan ;
- A gynecological exploration including a cytology and an transvaginal ultrasound ;
- Un bilan hormonal basal which consists in quantifying the main female hormones having an impact on the menstrual cycle, ovulation and the functioning of the reproductive system in general. It is carried out from a blood test to be taken between the 2nd and 3rd day of the menstrual cycle. It measures different hormones: FSH, LH, AMH, TSH, PRL…
- A pelvic ultrasound which makes it possible to count the antral follicles and participates in the evaluation of the ovarian reserve.
Of the Additional tests may be necessary in order to clarify the results of these first tests.
In the case of artificial insemination, a hysterosalpingography is necessary. This is an imaging that checks if the fallopian tubes are not blocked and if there are no obstacles on the way of the spermatozoa to the ovum. If the request comes from a couple, the woman’s tests are completed with those of the man – the most important of which will be the spermocytogramme to check the quality of sperm and the absence of sexually transmitted infections.
Procedure: how is an insemination carried out?
Artificial insemination generally goes through 4 stages: ovarian stimulation (which is not always necessary), triggering of ovulation, collection and processing of sperm and finally insemination.
1. Ovarian stimulation
The ovarian stimulation is not always necessary, if the infertility is related to an obstacle at the level of the fallopian tubes. The LH surge is then checked to be sure ovulation is occurring.
Nevertheless, ovarian stimulation is often necessary. Treatment begins on the 3rd or 5th day of the cycle (1st day of the cycle = 1st day of menstruation). These are daily intramuscular or subcutaneous injections of an ovulation-inducing treatment (Gonal-f® or Puregon® (recombinant FSH)).
The stimulation monitoring begins on the 10th day of the cycle. It includes an ultrasound and a hormonal assay (estradiol).
The triggering of ovulation
When stimulation and follicular maturation are sufficient and the monitoring parameters are good, ovulation can be triggered. HCG (chorionic gonadotropic hormone) is therefore injected in the middle of the cycle. The products used can be Ovitrelle® 250mg (recombinant HCG) or Decapeptyl® 0.1mg (GnRH analogue), which mimic an LH surge. Ovulation occurs 37 to 40 hours following this injection.
Sperm collection and processing
Sperm collection is carried out the same day as the inseminations by masturbation. It takes place following a period of sexual abstinence of between 2 and 6 days. It is essential that men urinate just before collection in order to “clean the urethra” to avoid bacterial contamination. Men are asked to wash their penises and hands thoroughly. The collection is done in a room provided for this purpose alone or with the spouse if the couple wishes. The semen is then analyzed and prepared to select the most mobile sperm. It is then transported in a sterile manner to the place of insemination.
When sperm donation is necessary, it is provided by the Centers for the Study and Conservation of Eggs and Sperm (CECOS). The donor must be between 18 and 44 years old. The donation is always free and anonymous.
insemination
Two inseminations are performed per cycle: the day following and two days following the onset. Sperm are injected into the uterus using a small tube (catheter) inserted through the cervix. The patient can then resume her usual activities.
After artificial insemination: how many days to be pregnant?
In case of failure, menstruation should occur approximately 12 days following insemination.
If the rules do not appear, apregnancy testis realised 18 days following insemination.
What is the success rate of intrauterine insemination?
On average, the success rate of artificial insemination per treatment cycle is of 12%. The six-cycle cumulative success rate approaches 50%. Generally, between 3 and 6 treatment cycles are needed to get pregnant.
What is the cost of artificial insemination?
Artificial insemination still average price of 950 euros. The price depends on the breeding center and the origin of the sperm. Prices are higher when the mother uses a donor. Fee overruns are possible.
Medically assisted procreation is 100% covered by Medicareup to 43 years for a woman, at the rate of a single artificial insemination per cycle, with a maximum of six to achieve pregnancy. Some mutuals can take care of excess fees.
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