Inseminations

The insemination is a method of treatment that is commonly used if the failure of a pregnancy verifiably cannot be traced back to andrological reasons. Hence a precondition for this method is the analysis of the partner’s ejaculate to assure normal diagnostic findings regarding the sperm quality (concentration, motility, long term survival, several functional parameters).

Probability to become pregnant
Inseminations can be accomplished in a natural cycle, that means without hormonal treatment or by supporting the follicular development (i.e. in women with irregular cycles) by the application of Clomiphencitrate or Follicle Stimulating Hormone (FSH). In both cases the course of the follicular development is monitored by several ultrasonic examinations and blood controls (determination of Luteinizing Hormone (LH), Estradiol (E2) and Progesterone). When indicated the ovulation is induced by injection of b hCG.
Empirically the pregnancy rate in hormonally stimulated cycles is slightly higher than in natural cycles. On the other hand there is the risk of a development of multiple follicles after hormone application that is that more than 1 or 2 follicles can mature. Thus a higher risk for a multiple pregnancy is given. The most convenient and advisable method for any individual case is considered by the physician together with the patient.
The number of insemination cycles should be limited to 6 as the majority of pregnancies are achieved in the first three cycles. The cumulative pregnancy rate after 3 cycles averages 30 %. However it is depending on many factors like age of the woman, previous surgeries or pretreatments, motility and number of sperms, psychological factors and others. It can be significantly restricted by diseases of the oviduct, endometriosis or PCO.

Sperm preparation and the insemination process
After a liquefaction period of about 20 minutes the partner’s ejaculate is examined for pH-value, color and consistency, number and motility of sperms, its morphology (determination of malformations) and the existence of inflammatory cells.
Using different centrifugation and washing methods (i.e. density gradient or swim-up procedures) it is possible to select the qualitatively best spermatozoa with the highest motility and to separate them from impurities. Using a special catheter these sperms subsequently are injected into the uterus at the time of ovulation or some hours before (see image).