Artificial insemination
Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment for humans, and is a common practice in animal breeding, including cattle and pigs.
Artificial insemination may employ assisted reproductive technology, sperm donation and animal husbandry techniques. Artificial insemination techniques available include intracervical insemination and intrauterine insemination. Where gametes from a third party are used, the procedure may be known as 'assisted insemination
Humans
History
The first recorded case of artificial insemination was by John Hunter in 1790, who helped impregnate a linen draper's wife. The first reported case of artificial insemination by donor occurred in 1884: William H. Pancoast, a professor in Philadelphia, took sperm from his "best looking" student to inseminate an anesthetized woman without her knowledge. The case was reported 25 years later in a medical journal. The sperm bank was developed in Iowa starting in the 1950s in research conducted by University of Iowa medical school researchers Jerome K. Sherman and Raymond Bunge.In 1916, Australian eugenicist Marion Louisa Piddington published a pseudonymous tract titled Via Nuova or Science & Maternity in which she called for a programme of mass artificial insemination for the sweethearts of soldiers who had been killed in World War I. She described this as a "conscription of the virgins" – comparable to the conscription of men for military service – who would receive "artificial insemination from a eugenically-desirable donor". Piddington promoted her scheme for several years in Australia, Britain and the United States under the name of "scientific motherhood", but it was poorly received.
In the United Kingdom, British obstetrician Mary Barton founded one of the first fertility clinics to offer donor insemination in the 1930s, with her husband Bertold Wiesner fathering hundreds of offspring.
In the 1980s, direct intraperitoneal insemination was occasionally used, where doctors injected sperm into the lower abdomen through a surgical hole or incision, with the intention of letting them find the oocyte at the ovary or after entering the genital tract through the ostium of the fallopian tube.
Patients and gamete donors
Artificial insemination is a medical procedure in which sperm is introduced into a woman's reproductive system to achieve pregnancy without sexual intercourse. The sperm used may come from the recipient's partner or from a donor, whose identity may be known or anonymous. Various methods exist to obtain sperm for use in artificial insemination.Originally, artificial insemination was primarily employed to assist heterosexual couples experiencing fertility difficulties. However, advances in reproductive technologies, such as intracytoplasmic sperm injection, have reduced the necessity of AI for many couples. Nevertheless, AI may still be recommended in specific cases. Prior to the procedure, both partners typically undergo medical evaluations to identify and address any physical or reproductive factors that could hinder natural conception. This may include assessing the male's sperm count, motility, and viability, as well as evaluating the female's ovulation and reproductive tract. Certain conditions, such as immune reactions against sperm or cervical issues like scarring, blockage, or thickened cervical mucus, may make artificial insemination a suitable option.
In modern practice, artificial insemination is frequently used by women without a male partner—such as single women or women in same-sex relationships—using donor sperm to achieve pregnancy.
In 2016, an article was published in Seventeen magazine that highlighted the story of Kacie Saxer-Taulbee, a teenager conceived from a sperm donor father. Using her donor's cryobank number in the Donor Sibling Registry, she managed to find other siblings conceived from the same donor. They became known as the "5010ers" and formed a Facebook group to keep in touch.
Barriers for patients and donors
and who is able to receive artificial insemination. Some women who live in a jurisdiction which does not permit artificial insemination in the circumstance in which she finds herself may travel to another jurisdiction which permits it. Compared with natural insemination, artificial insemination can be more expensive and more invasive, and may require professional assistance.Preparations
Timing is critical, as the window and opportunity for fertilization is little more than twelve hours from the release of the ovum. To increase the chance of success, the woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of her cervix. To improve the success rate of artificial insemination, drugs to create a stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth.Sperm can be provided fresh or washed. Washed sperm is required in certain situations. Pre- and post-concentration of motile sperm is counted. Sperm from a sperm bank will be frozen and quarantined for a period, and the donor will be tested before and after production of the sample to ensure that he does not carry a transmissible disease. Sperm from a sperm bank will also be suspended in a semen extender which assists with freezing, storing and shipping.
If sperm is provided by a private donor, either directly or through a sperm agency, it is usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided in this way may be given directly to the recipient woman or her partner, or it may be transported in specially insulated containers. Some donors have their own freezing apparatus to freeze and store their sperm.
Techniques
Semen used is either fresh, raw, or frozen. Where donor sperm is supplied by a sperm bank, it will always be quarantined and frozen, and will need to be thawed before use. The sperm is ideally donated after two or three days of abstinence, without lubrication as the lubricant can inhibit the sperm motility. When an ovum is released, semen is introduced into the woman's vagina, uterus or cervix, depending on the method being used.Sperm is occasionally inserted twice within a 'treatment cycle'.
Intracervical
Intracervical insemination is the method of artificial insemination which most closely mimics the natural ejaculation of semen by the penis into the vagina during sexual intercourse. It is painless and is the simplest and most common method of artificial insemination involving the introduction of unwashed or raw semen into the vagina at the entrance to the cervix, usually by means of a needle-less syringe. The vagina acts as a filter to separate out the sperm from other chemicals in the ejaculate, as with intercourse, so that only sperm pass through the cervix on their way to the uterus.ICI is commonly used in the home, by self-insemination and practitioner insemination. Sperm used in ICI inseminations does not have to be 'washed' to remove seminal fluid so that raw semen from a private donor may be used. Semen supplied by a sperm bank prepared for ICI or IUI use is suitable for ICI. ICI is a popular method of insemination amongst single and lesbian women purchasing donor sperm on-line.
Although ICI is the simplest method of artificial insemination, a meta-analysis has shown no difference in live birth rates compared with IUI. It may also be performed privately by the woman, or, if she has a partner, in the presence of her partner, or by her partner. ICI was previously used in many fertility centers as a method of insemination, but its popularity in this context has waned as other, more reliable methods of insemination have become available.
During ICI, air is expelled from a needleless syringe which is then filled with semen which has been allowed to liquify. A specially designed syringe, wider and with a more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The woman lies on her back and the syringe is inserted into the vagina. Care is optimal when inserting the syringe, so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose and a catheter may be attached to the tip of the syringe to ensure delivery of the semen as close to the entrance to the cervix as possible. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for safety and for the best results, bearing in mind that the purpose of the procedure is to replicate as closely as possible a natural deposit of the semen in the vagina. The syringe may be left in place for several minutes before removal. The woman can bring herself to orgasm so that the cervix 'dips down' into the pool of semen, again replicating closely vaginal intercourse, and this may improve the success rate.
Following insemination, fertile sperm will swim through the cervix into the uterus and from there to the fallopian tubes in a natural way as if the sperm had been deposited in the vagina through intercourse. The woman is therefore advised to lie still for about half-an-hour to assist conception.
One insemination during a cycle is usually sufficient. Additional inseminations during the same cycle may not improve the chances of a pregnancy.
Ordinary sexual lubricants should not be used in the process, but special fertility or 'sperm-friendly' lubricants can be used for increased ease and comfort.
When performed at home without the presence of a professional, aiming the sperm in the vagina at the neck of the cervix may be more difficult to achieve and the effect may be to 'flood' the vagina with semen, rather than to target it specifically at the entrance to the cervix. This procedure is sometimes referred to as 'intravaginal insemination'. Sperm supplied by a sperm bank will be frozen and must be allowed to thaw before insemination. The sealed end of the straw itself must be cut off and the open end of the straw is usually fixed straight on to the tip of the syringe, allowing the contents to be drawn into the syringe. Sperm from more than one straw can generally be used in the same syringe. Where fresh semen is used, this must be allowed to liquefy before inserting it into the syringe, or alternatively, the syringe may be back-loaded.
A conception cap, which is a form of conception device, may be inserted into the vagina following insemination and may be left in place for several hours. Using this method, a woman may go about her usual activities while the cervical cap holds the semen in the vagina close to the entrance to the cervix. Advocates of this method claim that it increases the chances of conception. One advantage with the conception device is that fresh, non-liquefied semen may be used. The man may ejaculate straight into the cap so that his fresh semen can be inserted immediately into the vagina without waiting for it to liquefy, although a collection cup may also be used. Other methods may be used to insert semen into the vagina notably involving different uses of a conception cap. These include a specially designed conception cap with a tube attached which may be inserted empty into the vagina after which liquefied semen is poured into the tube. These methods are designed to ensure that semen is inseminated as close as possible to the cervix and that it is kept in place there to increase the chances of conception.