(Insemination Artificial) is a combination of several methods, the essence of which is the introduction of a male seed or a 3-5-day-old embryo into the female genital tract during medical manipulations. Artificial insemination is performed for the purpose of pregnancy in women who cannot conceive naturally for various reasons.

In principle, artificial insemination methods come down to various methods and options for fertilizing an egg outside a woman’s body (in a test tube under laboratory conditions) with the subsequent implantation of the finished embryo into the uterus in order to engraft and, accordingly, further development of pregnancy.

In the course of artificial insemination, first, the germ cells are removed from men (spermatozoa) and women (eggs), followed by their artificial connection in the laboratory. After the eggs and sperm are combined in one test tube, the fertilized zygotes, that is, the embryos of the future person, are selected. Then such an embryo is planted in the woman's uterus and they hope 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 the 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 the egg and sperm to form a zygote, which, when attached to the wall of the uterus, becomes a fetal egg, from which the fetus develops. And the word "artificial" implies that the process of fusion of the egg and sperm does not occur naturally (as envisaged by nature), but is provided purposefully by special medical interventions.

Accordingly, we can generally say that artificial insemination is a medical way to ensure 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 common principle - the fusion of the egg and sperm does not occur naturally, but with the help of special medical technologies, which and ensure successful fertilization with the formation of a fetal egg and, accordingly, the onset of pregnancy. In the following text of the article, under the term "artificial insemination" we will mean three different methods of fertilization produced with the help of medical technologies. That is, its medical meaning will be invested in the term.

All three methods of artificial insemination are united by one general principle, namely, the fertilization of an egg by a spermatozoon occurs not in a completely natural way, but with the help of medical manipulations. The degree of interference in the process of fertilization during the production of artificial insemination by various methods 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 carry a child throughout her pregnancy, but is not able to become pregnant in the usual way. Causes of infertility, in 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 obstructed both fallopian tubes, endometriosis, rare ovulation, infertility of unknown origin, or other methods of treatment have not led 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 in the woman's vagina.

For the procedure of artificial insemination, you can use your own or donor germ cells (spermatozoa or eggs). If the spermatozoa and eggs of the partners are viable and can be used for conception, then they are used for artificial insemination techniques, having previously been isolated from the genitals of the woman (ovaries) and the man (testicles). If sperm or eggs cannot be used for conception (for example, they are completely absent or have chromosomal abnormalities, etc.), then donor germ cells obtained from healthy men and women are taken for artificial insemination. Each country has a bank of donor cells, where those who wish to receive biological material for artificial insemination can apply.

The procedure of artificial insemination is voluntary, and all women and couples (both in official and civil marriages) who have reached the age of 18 can use this medical service. If a woman who is officially married wants to resort to this procedure, then the consent of the spouse will be required for fertilization. If a woman is in a civil marriage or is single, then only her consent is necessary for artificial insemination.

Women over the age of 38 may immediately request 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 absence of the effect of treatment carried out for 1.5 - 2 years. That is, if a woman is younger than 38 years old, then artificial insemination is resorted to only when pregnancy has not occurred within 2 years, subject to the use of various methods of infertility treatment.

Before artificial insemination, a woman and a man undergo an examination, the results of which determine their fertility and the ability of the fair sex to bear a fetus during 9 months of pregnancy. 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 carrying 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 pregnancy.

Methods (methods, types) of artificial insemination

Currently, in specialized medical institutions for artificial insemination, the following three methods are used:

• in vitro fertilization (IVF);
• intracytoplasmic sperm injection (ICSI or ICIS);
• Artificial insemination.

All three of these methods are currently used very widely in various types of infertility, both in couples and in single women or men. The choice of technique for the production of artificial insemination is made by a reproductive specialist in each case individually, depending on the condition of the genital organs and the cause of infertility.

For example, if a woman has all the reproductive organs functioning normally, but the mucus in the cervix is ​​too aggressive, as a result of which the spermatozoa cannot thin 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 for low quality sperm, in which there are few motile spermatozoa. In this case, this technique allows you to deliver the sperm 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, lack 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 spermatozoa in his semen, then ICSI is performed.

Let's take a closer look at each method of artificial insemination separately, because, firstly, the degree of intervention in the natural process varies when using different methods, and secondly, in order to get a holistic view 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 IVF method stands for in vitro fertilization. In English-speaking countries, the method is called in vitro fertilization and is abbreviated as IVF. The essence of the method is that fertilization (the fusion of a spermatozoon 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, spermatozoa 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 a preliminary special stimulation, the eggs are taken from the 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 the natural changes in the hormonal background. When the woman's body is ready for pregnancy, the man's spermatozoa are obtained. To do this, a man either masturbates with ejaculation of sperm into a special cup, or spermatozoa are obtained during testicular puncture with a special needle (if the ejaculation of sperm is impossible for any reason). Further, viable spermatozoa are isolated from the sperm and placed in a test tube under the control of a microscope on a nutrient medium to the eggs obtained earlier from the woman's ovaries. They wait for 12 hours, after which fertilized eggs (zygotes) are isolated under a microscope. These zygotes are introduced into the woman's uterus, hoping that they will be able to attach to her wall and form a fetal egg. In this case, the desired pregnancy will come.

2 weeks after the transfer of embryos into the uterus, the level of human chorionic gonadotropin (hCG) in the blood is determined to determine whether pregnancy has occurred. If the level of hCG has increased, then pregnancy has occurred. In this case, the woman registers for pregnancy and begins to visit a gynecologist. If the hCG level remained within normal limits, then pregnancy did not occur, and the IVF cycle should be repeated.

Unfortunately, even when a ready-made embryo is introduced into the uterus, pregnancy may not occur, since the fetal egg will not attach to the walls and will die. Therefore, for the onset of pregnancy, several IVF cycles may be needed (no more than 10 are recommended). The likelihood of the embryo attaching to the uterine wall and, accordingly, the success of the IVF cycle largely depends on the woman's age. So, for one cycle of IVF, 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- 10%. 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 becoming pregnant only increases.

Intracytoplasmic sperm injection - ICSI

This method is the second most 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 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, because. the second abbreviation (ICIS) is formed from the first letters of the Russian words that make up the name of the manipulation. However, along with the name ICIS, the not entirely correct abbreviation ICSI is used much more often.

The difference between ICSI and IVF is that the spermatozoon is accurately introduced into 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, the eggs and sperm are simply left on a nutrient medium, allowing the male sex gametes to approach the female gametes and fertilize them. And with ICSI, they do not expect spontaneous fertilization, but produce it by introducing a spermatozoon 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 sperm of a man is injected directly into the uterus of a woman during the period of ovulation using a special thin catheter. Insemination is resorted to when, for some reason, sperm 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 artificial insemination by the IVF-ICSI method

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, if necessary, clarifying the details and distinctive features of ICSI.

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 spermatozoa and obtaining embryos in the laboratory (with IVF, spermatozoa 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 using a special needle into the cytoplasm of the egg).
5. Growing embryos in the laboratory for 3-5 days.
6. Transfer of embryos into a woman's uterus.
7. Pregnancy control 2 weeks after embryo transfer to the uterus.

The entire cycle of IVF or ICSI lasts 5-6 weeks, with the longest being the stages of folliculogenesis stimulation and a two-week wait to control pregnancy after embryo transfer to 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 stimulation of 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 taking 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 for the second cycle of IVF or ICSI, the doctor may prescribe another protocol.

Before the stimulation of folliculogenesis begins, the doctor may recommend taking oral contraceptives for 1 to 2 weeks in order to suppress the production of the woman's 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 just one, for which folliculogenesis is stimulated.

Next, the actual stage of folliculogenesis stimulation begins, which is always timed to coincide with 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.

Stimulation of the ovaries is carried out according to various protocols, but always involves the use of drugs from the group of follicle-stimulating hormone, human chorionic gonadotropin and gonadotropin-releasing hormone agonists or antagonists. The order, duration and dosage of the use of drugs of all these groups are determined by the attending physician-reproductologist. 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, Diferelin, 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 estrogens in the blood (E2), as well as an ultrasound of the ovaries with measurement of the size of the follicles. 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), the injections of follicle-stimulating hormone are stopped, the administration of agonists or antagonists of gonadotropin-releasing hormone is continued and injections of chorionic gonadotropin are added ( HCG). Further, by ultrasound, the response of the ovaries is monitored and the duration of injections of chorionic gonadotropin is determined. The introduction of agonists or antagonists of gonadotropin-releasing hormone is stopped one day before the termination of injections of human chorionic gonadotropin. Then, 36 hours after the last hCG injection, mature eggs are taken from the woman's ovaries using a special needle under anesthesia.

In short protocols, ovarian stimulation also begins on the 2nd day of menstruation. At the same time, a woman simultaneously injects three drugs daily at once - a follicle-stimulating hormone, an agonist or antagonist of gonadotropin-releasing hormone and chorionic gonadotropin. Every 2-3 days, an ultrasound is performed with a measurement of the size of the follicles, and when at least three follicles 18-20 mm in diameter appear, the administration of follicle-stimulating hormone preparations and gonadotropin-releasing hormone agonists or antagonists is stopped, but for another 1-2 days they are administered chorionic gonadotropin. 35-36 hours after the last injection of chorionic gonadotropin, the eggs are taken from the ovaries.

egg retrieval procedure It is performed under anesthesia, so it is completely painless for a woman. Eggs are collected with a needle, which is inserted into the ovaries through the anterior abdominal wall or through the vagina under ultrasound guidance. The cell sampling itself lasts 15-30 minutes, but after the completion of the manipulation, the woman is left in a medical facility under observation for several hours, after which she is allowed to go home, recommending to refrain from work and driving for a day.

Next, semen 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 facility. If a man is not capable of ejaculation, then sperm is obtained by puncture of the testicles, performed under anesthesia, similarly to the manipulation of taking eggs from a woman's ovaries. In the absence of a male partner, the donor sperm selected by the woman is retrieved from the storage.

The sperm is delivered to the laboratory, where it is prepared by isolating the spermatozoa. Then according to the IVF method eggs and spermatozoa are mixed on a special nutrient medium, and left for 12 hours for fertilization. Usually, 50% of 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 injects them directly into the egg with a special needle, after which he leaves the embryos on a nutrient medium for 3-5 days.

Ready-made 3-5 day old embryos are transferred to the woman's uterus using a special catheter. Depending on the age and condition of the woman's body, 1-4 embryos are transferred into the uterus. The younger the woman, the fewer embryos are placed in 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 placed in 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 of age transfer 2 embryos into the uterus, women 35-40 years old - 3 embryos, and women over 40 years old - 4-5 embryos.
After the transfer of embryos into 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;
• Pain of any localization.

After the embryos are transferred into the uterus, the doctor prescribes progesterone preparations (Utrozhestan, Duphaston, etc.) and waits for two weeks, which are necessary for the embryo to attach to the walls of the uterus. If at least one embryo attaches to the wall of the uterus, then the woman will become pregnant, which can be determined two weeks after the implantation of the embryo. If none of the implanted embryos attach to the wall of the uterus, then the pregnancy will not take place, and the IVF-ICSI cycle is considered unsuccessful.

Whether pregnancy has taken place is determined by the concentration of human chorionic gonadotropin (hCG) in the blood. If the level of hCG corresponds to pregnancy, then an ultrasound is performed. And if the ultrasound shows a fetal egg, then the pregnancy has come. Next, the doctor determines the number of embryos, and if there are more than two, then the reduction of all other fetuses is recommended so that there is no multiple pregnancy. Embryo reduction is recommended because the risk of complications and adverse pregnancy outcomes is too high in multiple pregnancies. After establishing the fact of pregnancy and the reduction of embryos (if necessary), the woman goes to the obstetrician-gynecologist to manage the pregnancy.

Since pregnancy does not always occur after the first attempt of IVF or ICSI, several cycles of artificial insemination may be required for successful conception. It is recommended to carry out IVF and ICSI cycles without interruptions until pregnancy (but not more than 10 times).

During IVF and ICSI cycles, it is possible to freeze embryos that turned out to be "extra" and were not transplanted into the uterus. Such embryos can be thawed and used for the next attempt at pregnancy.

Additionally, during the IVF-ICSI cycle, it is possible to produce prenatal diagnostics embryos before they are transferred into the uterus. During prenatal diagnosis, various genetic abnormalities are detected in the resulting embryos and embryos with gene disorders are culled. According to the results of prenatal diagnosis, only healthy embryos without genetic abnormalities are selected and transferred to the uterus, which reduces the risk of spontaneous miscarriage and the birth of children with hereditary diseases. Currently, the use of prenatal diagnostics makes it possible to 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 diagnosis before embryo transfer to the uterus is recommended in the following cases:

• Birth of children with hereditary and congenital diseases in the past;
• The presence of genetic abnormalities in parents;
• Two or more unsuccessful IVF attempts in the past;
• Vesical mole during past pregnancies;
• A large number of spermatozoa with chromosomal abnormalities;
• The woman is over 35 years of age.

General principles of artificial insemination by insemination

This method allows you to conceive in conditions 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 is the introduction of a specially prepared male sperm into the genital tract of a woman 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 period for introducing sperm into the genital tract is set. As a rule, to increase the likelihood of pregnancy, sperm is injected into the woman's genital tract 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, the 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 impurities 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 clinic on a conventional gynecological chair. For insemination, a woman is located 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 down in the same position for 15-20 minutes. After that, without removing the cap with sperm, the woman is allowed to get up from the gynecological chair and do the usual usual things. The cap with sperm is removed by the woman herself after a few hours.

Prepared sperm, depending on the cause of infertility, the doctor can enter into the vagina, into the cervix, into the uterine cavity and into the fallopian tubes. However, most often sperm is introduced into the uterine cavity, since this option of insemination has an optimal ratio 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 introduce 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 fail, 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 (Diferelin, Decapeptyl, Decapeptyl-Depot);
• Buserelin (Buserelin, Buserelin-Depot, Buserelin Long FS).

2. Gonadotropin-releasing hormone antagonists:

• Ganirelix (Orgalutran);
• Cetrorelix (Cetrotide).

3. Preparations containing gonadotropic hormones (follicle-stimulating hormone, luteinizing hormone, menotropins):

• Follitropin alfa (Gonal-F, Follitrope);
• Follitropin beta (Puregon);
• Corifollitropin alfa (Elonva);
• Follitropin alfa + lutropin alfa (Pergoveris);
• Urofollitropin (Alterpur, Bravelle);
• Menotropins (Menogon, Menopur, Menopur Multidose, Merional, HuMoG).

4. Preparations of chorionic gonadotropin:

• Chorionic gonadotropin (Chorionic gonadotropin, Pregnyl, Ecostimulin, Horagon);
• Choriogonadotropin alfa (Ovitrelle).

5. Pregnene derivatives:

• Progesterone (Iprozhin, Crinon, Prajisan, Utrozhestan).

6. Pregnadiene derivatives:

• Dydrogesterone (Dufaston);
• Megestrol (Megeis).

The above hormonal preparations are used in IVF-ICSI cycles without fail, as they provide stimulation of follicle growth, ovulation and maintenance of the corpus luteum after embryo transfer. However, depending on the individual characteristics and condition of the woman's body, the doctor may additionally prescribe a number of other medications, for example, painkillers, sedatives, etc.

For artificial insemination, all the same drugs can be used as for IVF and ICSI cycles, if it is planned to introduce 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 sperm is introduced 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. The process of freezing and storing embryos - video

List of tests for artificial insemination

Before starting IVF, ICSI or insemination In order to choose 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 condition of the endometrium is assessed during ultrasound, hysteroscopy and endometrial biopsy;
• Spermogram for a partner (in addition to the spermogram, a mixed antiglobulin reaction of spermatozoa is performed if necessary);
• Tests for the presence of genital infections (syphilis, gonorrhea, chlamydia, ureaplasmosis, etc.).

If any deviations from the norm are detected, the necessary treatment is carried out, ensuring the normalization of the general condition of the body and making the readiness of the genital organs maximum for the upcoming manipulations.

• Blood test for syphilis (MRP, ELISA) for a woman and a man (sperm donor);
• Blood test for HIV / AIDS, hepatitis B and C, as well as for the herpes simplex virus for both a woman and a man;
• Microscopic examination of smears from the vagina of women and the urethra of men for microflora;
• Bacterial sowing of smears from the genital organs of a man and a woman for Trichomonas and gonococci;
• Microbiological examination of the separated genital organs of a man and a woman for chlamydia, mycoplasma and ureaplasma;
• Detection of herpes simplex viruses types 1 and 2, cytomegalovirus in the blood of a woman and a man by PCR;
• Complete blood count, biochemical blood test, coagulogram for a woman;
• General urinalysis 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, rubella is vaccinated);
• Analysis of a smear from the genital organs of a woman for microflora;
• Pap 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 breast ultrasound for women under 35;
• Consultation of a geneticist for women whose blood relatives have had children born with genetic diseases or congenital malformations;
• Spermogram for men.

If the examination reveals endocrine disorders, then the woman is consulted by an endocrinologist and prescribes the necessary treatment. In the presence of pathological formations in the genital organs (uterine fibroids, endometrial polyps, hydrosalpinx, etc.), laparoscopy or hysteroscopy is performed with the removal of these neoplasms.

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 is not amenable to therapy with hormonal drugs and laparoscopic surgical interventions performed for 9-12 months.

2. The presence of diseases in which the onset of pregnancy without IVF is impossible:

• Absence, obstruction or anomalies in the structure of the fallopian tubes;
• Endometriosis, not amenable to therapy;
• Lack of ovulation;
• Depletion of the ovaries.

3. The complete absence or small amount of spermatozoa in the partner's semen.

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 pathological spermatozoa;
• The presence of antisperm antibodies in semen;
• A small number of eggs received (no more than 4 pieces);
• The inability of a man to ejaculate;
• Low percentage of egg fertilization (less than 20%) in past IVF cycles.

Indications for artificial insemination

1. From the man's side:

• Sperm with low fertility (small number, low motility, high percentage of defective spermatozoa, etc.);
• Small volume and high viscosity of semen;
• The presence of antisperm antibodies;
• Violation of the ability to ejaculate;
• Retrograde ejaculation (ejection of semen into the bladder);
• Anomalies in the structure of the penis and urethra in a man;
• Condition after vasectomy (ligation of the vas deferens).

2. From the woman's side:

• 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;
• Rare ovulation;
• Allergy to semen.

Contraindications for artificial insemination

Currently, there are absolute contraindications and restrictions to the use of artificial insemination methods. 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 restrictions to artificial insemination, it is recommended to first eliminate these limiting factors, and only then perform medical manipulations, since 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:

• Tuberculosis in active form;
• 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 2C, artificial insemination is postponed until the disease passes into a subclinical form, and at stages 4A, 4B and 4C, IVF and ICSI are postponed until the infection enters the remission stage);
• Malignant tumors of any organs and tissues;
• Benign tumors of the female genital organs (uterus, cervical canal, ovaries, fallopian tubes);
• Acute leukemias;
• myelodysplastic syndromes;
• Chronic myeloid leukemia in the terminal stage or requiring therapy with tyrosine kinase inhibitors;
• Blast crises in chronic myeloid leukemia;
• Aplastic anemia of severe form;
• Hemolytic anemia during periods of acute hemolytic crises;
• Idiopathic thrombocytopenic purpura, not amenable to therapy;
• An acute attack of porphyria, provided that the remission lasted less than 2 years;
• Hemorrhagic vasculitis (purpura of Shenlein-Genoch);
• Antiphospholipid syndrome (severe);
• Diabetes mellitus with end-stage renal failure with impossibility of kidney transplantation;
• Diabetes mellitus with progressive proliferative
• Polyarteritis with damage to the lungs (Churg-Strauss);
• Nodular polyarteritis;
• Takayasu syndrome;
• Systemic lupus erythematosus with frequent exacerbations;
• Dermatopolymyositis requiring treatment with high doses of glucocorticoids;
• Systemic scleroderma with high process activity;
• Sjögren's syndrome in severe course;
• Congenital malformations of the uterus, in which it is impossible to carry a pregnancy;
• Congenital malformations of the heart, aorta and pulmonary artery (atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic stenosis, aortic coarctation, pulmonary artery stenosis, transposition of the great vessels, complete form of atrioventricular communication, common truncus arteriosus, single ventricle of the heart

Limitations for IVF, ICSI and artificial insemination are the following conditions or diseases:

• Low ovarian reserve according to ultrasound or the concentration of anti-Mullerian hormone in the blood (only for IVF and ICSI);
• Conditions in which the use of donor eggs, spermatozoa or embryos is indicated;
• Complete inability to bear pregnancy;
• Hereditary diseases linked to the female sex X chromosome (hemophilia, Duchenne myodystrophy, ichthyosis, Charcot-Marie amyotrophy, etc.). In this case, it is recommended to perform IVF 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 carrying out any method of artificial insemination, sperm can be used as a partner of a woman (official or common-law husband, cohabitant, lover, etc.) and a donor.

If a woman decides to use her partner's sperm, then he will have to undergo an examination and submit biological material to the laboratory of a specialized medical institution, indicating the necessary information about himself (full 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 for 2 to 3 days and not to masturbate with ejaculation, and also to refrain from drinking alcohol, smoking and overeating. Sperm donation is usually done on the same day that the woman's eggs are collected or the insemination procedure is scheduled.

If a woman is single or her partner is unable to provide sperm, then you can use donor sperm from a special bank. The sperm bank stores frozen sperm samples of healthy men aged 18-35 years, among which you can choose the most preferable option. To facilitate the selection of donor sperm, the database contains template cards that indicate the physical parameters of the male donor, such as height, weight, eye and hair color, nose, ear shape, 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, the laboratory staff defrost and prepare the donor sperm and use it for its intended purpose.

Currently, only donor sperm is used from men with negative HIV tests for the herpes simplex virus in their blood;

Determination of antibodies of types M, G to HIV 1 and HIV 2;

Determination of antibodies of types M, G to hepatitis B and C viruses;

Examination of smears from the urethra for gonococcus (microscopic), cytomegalovirus (PCR), chlamydia, mycoplasma and ureaplasma (bakposev);

Spermogram.

Based on the results of the examination, the doctor signs a permit for sperm donation, after which the man can donate his seed material for further storage and use.

For each sperm donor, in accordance with order 107n of the Ministry of Health of the Russian Federation, the following individual card is created, which reflects all the main and necessary parameters of the physical data and 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)
Presence of children (yes/no)
Hereditary diseases in the family (yes/no)
Bad habits:
Smoking (yes/no)
Drinking alcohol (with frequency ___________________) / 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 indeterminate response to an HIV, hepatitis B or C virus test? (Not really)
Is / is not under dispensary observation in a dermatovenerological 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/brown/black)
Nose (straight/hooked/snub/broad)
Face (round/oval/narrow)
Presence of stigmas____________________________________________________________
Forehead (high/low/normal)
Additional information about yourself (optional)
_________________________________________________________________________
What have you been sick for the last 2 months?
Blood type 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 in order to have a child. For the production of artificial insemination in such cases, as a rule, resort to the use of 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 medicines). ). The cost of ICSI is about $700-1000 more than IVF in Russia and Ukraine, and $3000-5000 more in Israel. The price of artificial insemination ranges from $300 - $500 in Russia and Ukraine, and about $2,000 - $3,500 in Israel. We have given prices for artificial insemination procedures in dollar terms, so that it is convenient to compare, and also easy to convert into the required local currency (rubles, hryvnias, shekels).

There are different methods of artificial insemination.

The goal of each of them is to achieve pregnancy. Fertilization can occur both in the body of a woman and in a laboratory.

Types of artificial insemination

The most commonly used methods of artificial insemination are:

• IVF - fertilization of the egg "in vitro";
• artificial insemination- the introduction of sperm into the uterus.

There are other methods, but most of them have either historical or experimental significance (GIFT, ZIFT and others). Only IVF and artificial insemination have a wide clinical application in most countries.

Intrauterine insemination

According to WHO standards, assisted reproductive technology is not considered. But in Russia, it refers to the methods of artificial insemination, which is indicated in the Order of the Ministry of Health No. 107n.

The essence of the method is that a woman is introduced into the uterus with the help of a catheter, the sperm of a spouse or a donor. At first glance, this type of artificial insemination is no different from the natural way of pregnancy.

But in reality, artificial insemination has a number of advantages, namely:

• Possibility of accumulation and processing of sperm before injection, which helps to overcome the male factor of infertility.
• Sperm is injected directly into the uterus, bypassing the cervical canal, which eliminates the cervical factor of infertility (a form of reduced fertility in which sperm cannot pass the cervical canal due to thickening of the cervical mucus).
• The likelihood of pregnancy increases in case of low sperm motility, because they have to overcome a much shorter distance to the egg.
• The possibility of conceiving a child with the help of donor sperm, if a man has genetic diseases that make his fatherhood impossible (absolute infertility) or dangerous for the child (unfavorable genetic prognosis).
• The possibility of conception of a child by single women using donor sperm.

The advantages of artificial insemination over a more complex method of fertilization such as IVF is the simplicity of the procedure and low cost.

Want to learn more about IVF technologies?

You've come to the right place! IVF is our speciality!

IVF method

The most effective method of artificial insemination today is IVF or in vitro fertilization.

The essence of the method:

1. The body of a woman is stimulated with hormones so that several eggs mature in the ovary at once during one cycle.
2. With the help of ultrasound, the growth of follicles is monitored.
3. On the right day, they are punctured with the extraction of eggs.
4. The cells are fertilized with the sperm of a spouse or a donor.
5. The resulting embryos are then cultured for 3-5 days.
6. The best embryos, one or two, are transferred to the uterus. After that, if successful, pregnancy occurs.
7. If the attempt was unsuccessful, the transfer is repeated in the next cycle.

There are many IVF programs. They differ in the protocol for stimulating superovulation. In addition, IVF uses many additional reproductive technologies.

Among them:

• - manual introduction of sperm into the egg. Used for male factor infertility.
• IMSI is performed as part of ICSI. It involves the preliminary selection of sperm with the best morphological structure under a high magnification of the microscope.
• PICSI is performed as part of ICSI. It involves the selection of a spermatozoon based on an assessment of the ability of male germ cells to interact with hyaluronic acid.
• PGD ​​is a diagnostic procedure aimed at studying the genotype of embryos. Helps to detect chromosomal and genetic abnormalities in time.
• cryopreservation- freezing of germ cells. It makes it possible to save "extra" embryos for their use in the next cycle. It is used in case of failure of the first IVF attempt. It is also used for long-term storage of biomaterial, including donor.
• The use of donor germ cells- is indicated for age-related infertility, absolute infertility, genetic diseases in one of the partners, and is also used by single women.

Surrogate motherhood is considered a separate form of artificial insemination. Bearing a third-party woman's child is used if there are contraindications to pregnancy in the genetic mother.

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

Conventionally, the methods of assisted reproductive medicine are divided into insemination and injections. Inseminations are not expensive, but the chances of successful conception are less, and the list of indications is shorter. In vitro conception is more expensive, but more effective and 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 a conception, but one thing cannot be denied - a medical procedure is often the only way to have children of your own.

Artificial insemination allows you to control and regulate the process of fusion of germ cells. Usually this phrase refers 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 carrying and giving birth to a child. Cardinal measures are usually recommended after 1.5-2 years of infertility therapy (except in cases that are not amenable to treatment).

Artificial insemination is legal in Russia. Official registration of marriage is not required, but if it is, confirmation of the spouse is required. Patients must be over 18 years of age. There are donor cell banks in every country.

Women under 38 years of age before artificial insemination must receive official confirmation of the diagnosis and treatment failure (usually 1.5-2 years). Women older than 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 manipulations are carried out only when the condition is stable.

All methods of artificial insemination are short and normally tolerated by patients. Therefore, it is possible to repeat the procedure without long interruptions.

IVF and its modifications, ICSI, IISM and IISD, donor programs and surrogacy are classified as assisted reproductive technologies. They are resorted to 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 implies the fertilization of the egg in the conditions of the female body, and with IVF and ICSI - outside the body.

Donor programs and surrogacy

In cases where partners have problems directly with germ cells, it is possible to use donor material. All donors undergo a complete medical 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 its double examination with an interval of three months. Before IVF, preimplantation genetic diagnosis is carried out, which reveals genetic pathologies, abnormalities in chromosomes, and possible developmental anomalies.

Intracytoplasmic injections

The injection method is more complicated than insemination, it requires the fulfillment of certain conditions and is divided into several stages. First, a 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 some good eggs.

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

in vitro fertilization

IVF procedure is the most popular method of artificial insemination. In this case, conception occurs outside the woman's body in artificially created conditions. IVF is a fairly young 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 husband's or a donor's sperm. After cell fusion, the embryo is placed in the uterus. Subsequent pregnancy is no different from pregnancy after natural conception. Children born in this way do not suffer from any specific diseases and do not have abnormalities.

Indications for IVF

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

Doctors control the process of egg maturation by controlling the level of hormones. During this period, a woman can lead a normal life, but taking into account the recommendations of doctors on nutrition, physical activity and emotional state.

After hormonal therapy, the stimulation of egg maturation is carried out, 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 materials of the spouses are mixed and placed in an incubator so that a natural combination of cells occurs.

After fertilization, the embryologist analyzes the development of the embryos. The most viable are transferred to the uterus. Usually, several fertilized cells are used to increase the chances of attaching at least one. Therefore, after IVF, twins and triplets are often born. The resulting embryos can be cryopreserved to be used in the future or in the absence of pregnancy after the procedure. In the case of engraftment of several embryos, a part can be removed, but the woman must make such a decision.

Contraindications for IVF

• psychical deviations;
• deformation of the uterus;
• 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 hormone therapy and high cost. Prices start from 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 particular clinic.

Injection of the sperm into the egg

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

ICSI is recommended when IVF and other methods have failed. The procedure is indicated for female and male infertility, even in the most severe cases. According to statistics, as a result of ICSI, pregnancy occurs in every third woman (60-70% of the probability 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 gives hope even in the most severe cases of infertility, especially in males. After a few days, the doctor selects the most viable embryos.

Stimulation of folliculogenesis

The purpose of this event is to form several normal eggs so that doctors have a choice. Hormone regimens are called protocols. They differ for different methods of artificial insemination, 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 is usually started on days 1-2 of the menstrual cycle. The patient is prescribed follicle-stimulating drugs, human chorionic gonadotropin, gonadotropin-releasing hormone agonists or antagonists. A 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 to measure the follicles.

Follicle-stimulating hormone is canceled at an E2 estrogen concentration of 50 mg / l and a follicle size of 16-20 mm. Typically, such indicators are available on the 12-15th day of stimulation. On this day, injections of human chorionic gonadotropin are added. Gonadotropin-releasing is canceled the day before hCG is cancelled. The doctor determines the duration of the course according to the results of ultrasound. 36 hours after the abolition of hCG, cells are collected.

The short protocol also starts on the second day of the cycle. A woman is injected with all three drugs every day, analyzing the growth of follicles every 2-3 days. In the presence of three follicles of 18-20 mm, the drugs are canceled (hCG is administered for another 1-2 days). Eggs are collected 35-36 hours after the last injection.

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 germ cells are taken through similar manipulations.

insemination

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

Indications for insemination

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

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

If no contraindications are identified, preparation can begin. According to indications, doctors can prescribe drug stimulation of ovulation. Sperm is taken in advance (2-3 hours). When donor material is selected, frozen sperm is used.

Sperm is processed, spermatozoa are separated from 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 for insemination

• uterine pathologies that make childbearing impossible;
• ovarian tumor;
• malignant pathologies;
• acute inflammation;
• psychical deviations.

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

Artificial insemination with husband's sperm

The IIMS procedure is recommended in the case when the woman's reproductive system was not subject to pathological changes, there are no adhesions, erosions, convolutions, and the fallopian tubes are passable, but the partner's sperm has insufficient characteristics for natural conception. For sperm, they are processed and endowed with the properties necessary for fertilization. During the procedure, the partner's processed sperm is artificially injected into the uterus.

IISM can be prescribed in case of incompatibility of partners. The reasons for this phenomenon are different, but usually this is an aggressive effect of the flora of the vagina or uterus on spermatozoa. The introduction of sperm directly into the uterus eliminates the contact of the seed with the microflora of the vagina, which greatly increases the chances of successful fertilization. The injection procedure is painless, the embryos are passed through a thin catheter.

For one menstrual cycle, intrauterine insemination can be carried out 2-4 times. It is necessary to undergo an examination and pass tests in order to calculate the most favorable time.

Artificial insemination with donor sperm

The IISD procedure is recommended in the presence of poor indicators of the partner's spermogram. Donor sperm should also be used in the case when the reason for the incompatibility of the spouses is not clear, there is a high risk of a 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 2-4 times per cycle, but the effectiveness of the procedure is 30% more (according to statistics, with ISIS, the chances of success are 40%).

Methods IISM and IISD are recommended for male infertility, sexual disorders, 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 by this method requires special training and the fulfillment of certain conditions. You can place gametes only in passable fallopian tubes and at a strictly selected time. Since only one ovulation occurs per menstrual cycle, GIFT can only be done once a month.

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

GIFT and ZIFT procedures are carried out in a hospital. The doctor uses a laparoscope and an ultrasound scan. If, during the placement of gametes, the mixture is injected from the side of the peritoneum through a small puncture, then the embryo is planted through the cervix. The ZIPT 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 efficiency to standard IVF.

According to statistics, today almost every second couple cannot get pregnant, and therefore they have to resort to such a procedure as artificial insemination. It is impossible to conceive a baby in a natural way for a number of reasons, and the main one is infertility, which is put on most parents. It is worth noting that treating infertility is much more expensive than artificial insemination, and therefore it is better to use this 100% method than to be treated in different ways for a long time, drink pills and not have confidence in the future. There are various methods of how to get pregnant, but each of them should be carried out only under the guidance of a specialist who can provide a competent and individual approach, as well as a guarantee of achieving the goal.

Existing types of fertilization

Types of fertilization, or in other words, the procedure for conceiving a baby, may be different, since it all depends on the physiology of the parents and the presence or absence of certain problems.

Namely, conception can be:

• artificial;
• natural;
• outdoor;
• internal.

If everything is clear with the second point, then there is still a lot of controversy regarding the first point. To be more precise, there are those people who reject insemination and IVF because they consider it an interference with nature, and there are those who have dedicated their lives to researching these ways to help parents become human.

Medical artificial insemination: what is it

The various ways in which an egg is artificially fertilized are generally insemination. During this procedure, sperm is introduced into the lumen of the fallopian tubes or directly into the uterine cavity.

Conception, therefore, is done if:

1. Men have health problems such as impotence, hypospadias, and lack of ejaculation or sperm sluggishness.
2. A woman has pathologies in the development of the cervix.
3. The girl is diagnosed with vaginismus, which cannot be treated.
4. In the cavity of the cervix there is mucus that can disarm sperm.

Before artificial insemination is done, the process of examining the sperm of the man and the female reproductive system is carried out. This is required to accurately identify the cause of infertility.

Insemination is carried out 2-3 times per cycle, and the procedure can be repeated for at least 3 cycles in a row.

If the study yielded a result in the form of a pathology of spermatozoa, for example, their absence or lethargy in their activity, then in this case they are looking for a donor or in other words a person who will fit in all respects to the requests of the parents, will be able to give his seed and at the same time will not have any the right to a future child and even the opportunity to meet him. Sperm is introduced into the uterine cavity using a special syringe, and this helps to bypass all the obstacles and dangers that kill sperm.

How to do artificial insemination

Insemination of females is not a difficult process for modern specialists, but careful preparation is required. First, the body of a man is completely examined, and this should be done a couple of months before the day of the planned conception. A woman, at the expiration of this period, is subjected to stimulation of ovulation, for which special preparations are needed.

As a rule, apply:

• Menopur;
• Gonal-f;
• Puregon.

Only one remedy is used, which must be taken strictly at specific hours. The introduction is carried out intravenously and subcutaneously. The entire process of egg growth is carried out under the supervision of a specialist, through ultrasound and monitoring hormone levels.

The drugs contribute to the maturation of the egg, and not just one, but several at once.

This is what increases the likelihood that 2 people will finally have children. A puncture of the ovarian follicle is mandatory, and if laparoscopy is required, then local anesthesia is needed. The entire diagnostic process is carried out under ultrasound control, which eliminates the possibility of harming the female reproductive system. The sampling needle is inserted through the cavity of the bladder or through the vagina. As soon as the eggs are collected, they are placed in a special thermostat in which they are further cultivated.

Next, the male seed is taken, in which the spermatozoa are artificially separated from the seminal fluid, as well as their processing and placement in the incubator space. After that, they sit down to the egg, and as soon as they are fertilized, they choose the most suitable ones. The rest of the cells are frozen. Throughout this period, a woman needs to take progesterone and estrogen. Due to these hormones, a favorable atmosphere is created for the implantation of zygotes and their adaptation to new conditions of stay. As a rule, 3 zygotes are taken, among which 2 are attached to the uterine cavity, and the rest are simply placed in it. The result of such treatment can be seen after 2 weeks, simply by taking a pregnancy test.

IVF effect: 6 contraindications for the procedure

Stages of artificial insemination at home

There are many specialists who can be contacted to carry out such a procedure as extra corporal insemination, for example, Autleva Susanna Ruslanovna and others, but modern women are interested in why this cannot be done at home? It is worth noting that now it is quite possible to carry out in vitro fertilization at home, and the procedure will resemble the most ordinary sexual intercourse, only without the participation of a man.

To carry out this procedure, you will also need to undergo a preliminary examination to exclude:

• Pathology;
• Diseases;
• Other reasons why natural conception does not occur.

Just as in the clinic, it is required to derive the exact date of conception, for example, by taking an analysis for hormones or a special ovulation test. In order to carry out artificial fertilization and at the same time with your own hands, it is important to remember that sperm activity is only 2 hours. It is impossible to freeze it at home or simply store it in a separate bag, respectively, creating conditions like in a hospital simply will not work.

The main methods of artificial insemination

There are different opinions about whether artificial insemination with a successful result is possible, but it is worth noting that specialists have their own success statistics, since they have their own specific indicators.

In the study of cats and dogs, they were able to carry out fertilization successfully up to 100%.

Why is fertilization called corporate? Because when replanting an egg into the uterus, several zygotes are used at once, which can completely survive everything that will cause the birth of twins or triplets.

Fertilization methods are different, but:

1. They should be carried out under the guidance of a specialist.
2. The process can only be carried out after careful research.
3. The result will be achieved only if all the recommendations of the doctors are followed.

Sperm must be used immediately after ejaculation, and a syringe without a needle is used for injection, and in addition a special vaginal dilator can be used.

It is strictly forbidden to inject sperm directly into the uterine cavity, as it should not penetrate into the sterile cavity. The likelihood that home insemination will be successful is very small, and you should not hope for a positive result too much, so as not to be disappointed later.

Current types of artificial insemination

In general, the fertilization process itself is not too complicated. The seed is placed in the female genital tract. You need to wait until fertilization occurs. The egg is implanted on the uterine cavity, and the natural development of the fetus begins. This method of fertilization eliminates the occurrence of several or, in other words, extra embryos. How quickly a positive result will be achieved directly depends on the concomitant diseases of the chronic type that the parents have.

IVF effect: 6 contraindications for the procedure

In some cases, women have such a pathology as the absence of menstruation at all, and therefore it is first necessary to conduct testing to determine the onset of ovulation or its absence.

As a rule, after fertilization, it is not recommended to have sex, as this can cause rejection of implanted spermatozoa, and the uterus will simply be in shock. This will provoke menstruation, and all procedures will not work. In the period of preparation for fertilization and immediately during and after it, you need to be as careful as possible, and try as best as possible to save the uterus from exposure to bacteria, and the body from viruses. As a rule, fertilization with a successful result makes it possible to pass the pregnancy without complications.

Fertilization by artificial means can be extrapolar, as well as insemination.

Each method counts as:

• Effective;
• in demand;
• Carefully thought out.

It differs from one another in the way in which sperm enters the uterine cavity and how it is recruited. Who needs such fertilization can only be consulted by a specialist, which each center of reproductive medicine possesses. Options to carry out fertilization for free are completely excluded, since the use of expensive equipment and the work of highly qualified doctors are required, which costs far from little.