Artificial Insemination Husband (AIH)
This treatment consists of placing the male partner’s sperm, which has been previously selected from a semen sample, inside the woman’s uterus or the cervical channel. The patient’s menstrual cycle has to be monitored in order to detect when ovulation takes place. In this way the cervical channel barrier is avoided on the one hand, and the sperm, which has been selected in the laboratory for its best motility, is placed closer to where it is fertilised on the other.
AIH is a simple and effective procedure with high success rates. The initial sperm quality is decisive in the final outcome as depending on this a larger or smaller number of retrieved motile sperm can be used in the treatment. When after three or four AIH attempts pregnancy does not occur, more precise techniques are recommended, such as In Vitro fertilisation (IVF) or In Vitro fertilisation with intracytoplasmic sperm injection (IVF-ICSI).
AIH procedure
First step (ovulation stimulation and monitoring). To stimulate the ovulation a follicle stimulating hormone (FSH) is used. The cycle is controlled by ultrasound in order to check the follicular development in the ovaries. When the number and size of the follicles is sufficient (with this technique only one has to be developed) its maturity is triggered by use of another hormone called LH (luteinizing hormone).
Second step (semen sample preparation). On the day of the insemination and before the procedure takes place, the male partner presents a semen sample obtained by masturbation to the assisted fertilisation laboratory. It is washed in culture medium and motile sperm are concentrated by means of gradient centrifugation. Once selected, they are dissolved into a small quantity of culture medium. This process attempts to concentrate as much as possible the motile sperm present in the original semen sample and eliminate the immotile ones.
Third step (insemination). After this procedure a very high number of motile sperm (several million) in a very small volume (0.3 ml) is obtained. This sample, called insemination volume, is placed into a small cannula which is introduced inside the uterus on the precise day when ovulation is expected. It is a simple process, generally painless and very similar to any other routine procedure in a gynaecological clinic.
Special cases
Vasectomy. AIH can be carried out when the male partner has undergone a vasectomy and would like to have a child. The sperm is obtained by means of a deferent duct puncture and, if the obtained sample is sufficient, it is prepared to be used in the Artificial Insemination treatment. However, samples obtained via this procedure are normally not large and that is why IVF may be recommended in the end.
Urological pathology. AIH can also be successfully carried out in some rare cases such as when men suffer from retrograde ejaculation (inside the urinary bladder) which may happen after prostate surgery. In this case the spermatzoa are obtained by means of vesicle content centrifugation. AIH can also be undertaken if some urological pathologies such as hypospadias are present. Men who suffer from impotence as a result of paraplegia or tetraplegia have been able to take advantage of this treatment obtaining a semen sample by means of electroejaculation or epididymal puncture.
Cancer. Artificial Insemination can also be prepared in advance when the male partner has to undergo chemotherapy or radiotherapy (both treatments for cancer) during which germinal cells producing sperm are usually altered. In this case several semen samples can be frozen beforehand (cryopreservation) and then thawed and prepared to be used for AIH.
This technique is recommended in ...
Female factors: cervical factor, ovulation dysfunction or when one of the Fallopian tubes is altered.
Male factors: coital factors or a combination of the female and male factors mentioned before.
Mixed factors: sterility reason is unknown as no alteration was detected after carrying out the tests on the couple.