ARTIFICIAL INSEMINATION BY HUSBAND

INTRODUCTION

Artificial Insemination by Husband (AIH) involves the insertion of semen obtained from the husband which has been washed and placed into the woman’s in order to achieve pregnancy. For men with low sperm quality, insertion of sperm higher up in the reproductive tract reduces the distance they have to swim to get to the egg (oocyte).

It is estimated that tens of thousands of couples seek AIH each year. This figure is increasing rapidly as this facility gains acceptance and publicity. Whenever poor sperm quality is evident, AIH may be employed as a helpful method to provide the infertile couple with their desired family.

Indications for A.I.H. include:

1. difficulties in intercourse but potentially normal sperm production, e.g.
2. anatomical problems;
3. some abnormalities of seminal analysis;
4. when the cervical mucus appears to be "hostile" to sperm penetration

TREATMENT PROCEDURE

A few days before ovulation is due, the woman needs to undergo ultrasound scanning or blood tests which will help to ascertain the time of ovulation. Another indicator may be an alteration in the properties of the cervical mucus. A simple test may be performed and completed by the doctor or the nurse in the surgery.

If, after 3-6 cycles (cycles where artificial insemination was performed), the procedure is still unsuccessful, the treatment may be reviewed and sometimes the woman will be advised to take fertility drugs, hormone tablets or some other suitable medication to enhance her fertility.

Following this, insemination usually occurs once, occasionally twice per cycle around the time of ovulation.

Normally, fresh semen is used in A.I.H. The male partner provides a sample of sperm to the laboratory. This is treated, e.g. washed, and then placed inside the cervix or even into the uterus of the woman.

The actual insemination is quite simple and painless and the woman may attend the surgery alone. However, her partner may also attend the insemination.

Frozen semen may be used. The sperm is stored in "straws" in liquid nitrogen and allowed about 10 minutes to thaw before insemination. The doctor or nurse places the straw containing the sperm into the cervix using a "plunger" to push the sperm out of the straw. The woman then rests for about 20 minutes to aid conception, before the two-week wait to see whether or not a period arrives. Blood tests may be undertaken to monitor the developing pregnancy.

This method is useful when the male partner is routinely likely to be absent at the fertile time of the month for the woman and has stored some sperm with the laboratory, previously.

RESULTS

If AIH is going to be successful, most pregnancies will occur within the first six months of treatment. Using semen frozen and stored from men of "normal" fertility for AI will usually result in a similar pregnancy rate to those using fresh sperm. Couples using AIH for treatment of infertility, will still generally produce poor to moderate results. Factors such as the woman's age may also affect the success of the treatment. Treatment continues until pregnancy occurs or until there is mutual agreement between the client and the doctor, that a different treatment needs to be undertaken.

COUNSELLING

It may be useful to access a counsellor to seek support and clarification on the use of AIH.

Seeking emotional support such as this is not something to be embarrassed about as most couples undergo great stress during this time. We recommend a counselling session prior to commencement on any Assisted Reproductive programme.

RELIGIOUS ASPECTS

Most faiths appear to be flexible in Assisted Reproductive processes. The Roman Catholic Church requires sperm to be collected using a Semen Collection Device (SCD) at normal intercourse and these needs can generally be catered for at most experienced laboratories.