By Andrea Rodrigo BSc, MSc (embryologist), Antonio Forgiarini MD, MSc (gynecologist), Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist), Óscar Oviedo Moreno MD (gynecologist), Aitziber Domingo Bilbao BSc, MSc (embryologist) and Patricia Recuerda Tomás BSc, MSc (embryologist).
Last Update: 09/19/2018

Artificial insemination (AI) is a simple and low cost infertility treatment. It consists in inserting the sperms artificially in the woman’s uterus, so that fertilization occurs and hopefully a successful pregnancy.

It is a painless procedure, and less invasive than other reproductive treatments such as in vitro fertilization (IVF).

In spite of the common belief that it one of the newest technologies, it is estimated that it started to be used as early as the 15th Century, with the first attempts to perform AI on women. It became popular around the early 1970s, though.

The different sections of this article have been assembled into the following table of contents.

How does it work?

For an AI to be properly carried out, the specialist uses an insemination cannula to insert a washed semen sample in the uterine cavity. It is done when the woman is ovulating to boost the chances of achieving a pregnancy.

Egg insemination by the sperm occurs within the Fallopian tubes, as in a natural pregnancy. As a matter of fact, the difference is the way in which the sperms are placed inside the female reproductive system.

Another difference of major importance is related to the AI process in humans, as the patient’s ovulation time is monitored with hormone medications so that an egg is released just when the insemination is about to take place, thereby increasing the odds of success.

In short, the pregnancy success rate of artificial insemination is slightly higher than that obtained through sexual intercourse. It depends, however, on the fertilization potential of the sperm as well as the implantation potential of the embryo(s).

The following are the main steps involved in the process of AI:

  • Ovarian stimulation: Hormones (gonadotropins) are administered in low doses to trigger egg production. Follicle growth is monitored on a regular basis.
  • Ovulation induction: When 1 or 2 follicles have reached the optimum size (18 mm in diameter), ovulation is induced with hCG shots.
  • Sperm preparation: The semen sample is washed by means of sperm capacitation, which removes other cell types and seminal plasma, so that is contains only motile spermatozoa.
  • Insemination: When the woman is ovulating, a small semen sample is placed inside the uterus with an insemination cannula. Anesthesia is not needed.
  • Luteal phase support: Progesterone is administered vaginally to boost the chances for embryo implantation.

For more information about the process followed with this fertility treatment, we recommend you to read the following post: Artificial insemination process.

Types of artificial insemination

Artificial insemination can be classified into two types depending on the origin of the semen sample:

Depending on the precise part of the female reproductive system where the sperm is placed, we can distinguish between the following types of AI:

  • Intratubal insemination: in the Fallopian tubes.
  • Intracervical insemination: in the cervix.
  • Intravaginal insemination: inside the vagina, as in sexual intercourse.
  • Intrafollicular insemination: in the ovarian follicle.
  • Intrauterine insemination: in the uterine cavity.

Intrauterine insemination or IUI is the most common technique, mainly because it has the highest success rates. The others are only used in case there is a problem linked to the canalization of the uterine cervix.

When to do artificial insemination

This assisted reproductive technology (ART) is used in many cases with the sole purpose of having a baby. Fertility problems that can be addressed by means of artificial insemination are different for each type of AI.

Indications of artificial insemination by husband

Artificial insemination by husband is commonly used in the following cases:

  • Female infertility due to cervical disorders
  • Mild-to-moderate endometriosis
  • Menstrual irregularities: in cases of polycystic ovary syndrome or PCOS, anovulation, or problems in the follicular phase.
  • Impossibility to place the semen inside the vagina due to retrograde ejaculation, vaginismus, premature ejaculation, or erectile dysfunction.
  • Mild male fertility problems, i.e. alterations of seminal parameters. However, it is only performed in mild cases because a certain amount of sperm is required to guarantee a minimum success rate of AI.
  • Unexplained infertility: When previous analysis do not show a particular pathology and the patients have normal fertility patterns, then it is advisable to start the IA. Even if a pathology has not previously been detected, it doesn’t mean that it’s not there, but just that it could not be diagnosed in the analysis.
  • Immune infertility: It occurs when there is an incompatibility between the female reproductive system and the semen. It is commonly caused by female antibodies that destroy the sperm. This cause is not very usual and the way in which it works is still unknown.

Indications of donor insemination

As a last resort, donor insemination may be performed as the treatment for couples whose own sperm is non-viable. However, the patient’s own sperm should be the chosen option in the first place.

  • Single women or gay couples.
  • Male genetic diseases that cannot be diagnosed by means of a pre-implantation genetic diagnosis (PGD).
  • Severe male fertility problems: if pregnancy is not achieved after several ICSI cycles and female conditions are favorable.
  • Male sexually-transmitted diseases (STDs): in case after several washings it is not possible to guarantee a virus-free sperm.

In accordance with Dr. Antonio Forgiarini, gynecologist specialized in Reproductive Medicine, technically there exist no differences between AIH and AID. In both, the ovarian cycle of the patient is stimulated, monitoring follicle development until the follicles are mature. In both cases, ovulation is triggered at this moment.

The basic difference between them is the origin of the sperm sample. In AID or donor insemination, as the name suggests, donor sperm is used. Sperm donation is the solution to achieving pregnancy when the husband’s or partner’s sperm is unavailable.

What are the requirements?

Artificial insemination is the first technique of choice when a couple is unable to achieve pregnancy after 12 months trying to conceive without luck. However, a series of requirements should be meet for it to guarantee a minimum chance of success.

If the couple is unable to meet these requirements, other techniques such as in vitro fertilization (IVF) will be applied directly.

The following are the minimum conditions for artificial insemination to be successful:

  • Dismissing any risk of suffering from Hepatitis C, Hepatitis B, HIV, Rubella, Siphilis, or Toxoplasmosis. This step is very important to guarantee that there is no risk of infection to the partner and/or the baby-to-be.
  • Checking the woman’s tubal patency by means of different techniques such as hysterosalpingography (HSG) or laparoscopy. With this techniques you can observe whether the Fallopian tubes are functional or not.
  • Having a minimum sperm count. Once sperm capacitation is done, the results after analyzing the motile sperm concentration or MSC must be above 3 million sperm with progressive motility.

Finally, age also matters, as it has a direct influence on the chances of either success or failure. From age 36 onwards, women have lower chances of getting pregnant. This means that women at 37-38 or more usually go for IVF in the first place.

More information on the following post: Requirements for AI.

Effectiveness and success rates

In general, women are recommended to wait for at least 15 days before taking a pregnancy test in order for false negative results to be avoided. It allows women to find out whether AI has been successful, that is to say, if pregnancy has occurred or not.

Given that it requires little involvement of the specialist, the success rate of AI is lower if we compare it to the statistics of IVF. The rate for artificial insemination with husband’s sperm ranges from 12 to 16%, while the percentage increases to 18-22% with donor sperm.

Most fertility clinics have very similar statistical data when it comes to measuring the pregnancy success rate.

Experts usually refer to the cumulative pregnancy rate of IUI. After conducting several studies, there is evidence that the number of women getting pregnant in the second cycle is higher, taking into account that the average success rate of AI is 14%. on the first attempt.

Taking this phenomenon into account, up to four IUI cycles can be performed before moving on to IVF. With four insemination cycles, the chances of success are as high as 35%.

Benefits and differences with IVF

The main advantage of artificial insemination is that it is a simple procedure. This is very important, since it means that surgery is not required, as in the case of IVF. Also, anesthesia is not necessary, as it does not hurt.

Another important advantage is related to its cost. Since it does not involve a high level of complexity, the price is considerably lower if compared to other treatments that require more sophisticated medical equipment or tools. On the other hand, the protocol followed to induce ovulation is milder than that of IVF, which turns it into a more affordable procedure.

A major difference with IVF is linked to the origin of the oocytes, as only the patient’s own eggs can be used with IUI. Given that fertilization occurs at the laboratory, IVF with donor eggs is another possible option.

Also, even though IUI is an infertility treatment, it is the most similar to the natural process of insemination. Though the semen sample is “artificially” placed inside the uterus, fertilization occurs in a natural way.

If compared to natural pregnancies, the main benefit is that the quality of the semen sample is enhanced thanks to sperm capacitation. Monitoring the day of ovulation helps increasing the chances of getting pregnant as well.

You can find more advantages on the following post: Advantages of artificial insemination.

What can be wrong with AI?

Although the number of risks associated with artificial insemination is low, sometimes complications such as the following can occur:

  • Ovarian Hyperstimulation Syndrome (OHSS): It can be caused by an excessive response of the follicles while on hormone therapy. In artificial insemination, stimulation protocols tend to be mild and monitored by ultrasound, so the risk of developing OHSS is low.
  • Multiple birth: Most cases of multiple pregnancy are due to the stimulation of several follicles, especially in young women. Fertility clinics work very hard on this aspect trying to prevent it, since a twin pregnancy entails numerous risks both during pregnancy and childbirth.
  • Ectopic pregnancy: There is a 4% chance with artificial insemination, while the rate is reduced to 0.8% in natural cycles.
  • Miscarriage: The risk of going through pregnancy loss is higher during early pregnancy. It occurs in 20% of the cases.
  • Infections: They occur rarely, with a rate that reaches 0.07% per AI cycle thanks to strict asepsis and sterility measures. Pelvic inflammations or immune problems may also appear.

As for the potential side effects derived from the process, they are neither severe nor common, although discomfort or a feeling or sickness can arise as a consequence of the fertility drugs administered.

For detailed information about the potential risks, please visit the following article: Risks of AI.

How much does it cost?

The cost of an artificial insemination procedure using the partner’s sperm may vary considerably depending on each clinic. For instance, in Spain the price can range from €600 to more than €1,000.

It should be clear that prices never include the cost of medication. Thus, the price of hormone treatments to stimulate the ovaries as well as progesterone should be added to the initial price.

In case a donor insemination is the chosen option, the cost of the donor sperm should be added to that of AIH. Bearing this in mind, the final price of a donor insemination could be approximately of €900-€1,400 if you are in a European country.

In the UK, the availability and fees of artificial insemination on the NHS varies across the country. However, the costs usually range from around £500 to £1,000 per cycle. It should be taken into account that waiting lists for treatment can be very long in some areas.

The price in the USA is $300-1000, with an average of $550 approximately. It varies from clinic to clinic, though.

Nevertheless, some fertility centers offer discounts and special plans in case you need to start a second AI cycle. Thus, asking for it is highly advisable to get an overall idea of which the quotation should be.

Did you know that we can help you to choose a fertility clinic for your IUI cycle? All you have to do is use "The Calculator", an easy-to-use tool that is capable of filtering the best clinics and tailor an individual report exclusively for you with useful tips that will help you make a well informed decision.

Artificial insemination at home

Many people consider at-home or DIY artificial insemination another type of AI, the truth is that it is not. Given that is an assisted reproductive technology (ART), we cannot consider it as an infertility treatment when it is done at home.

With AI, the pregnancy rate improves due to the preparation of both the male and the female. However, the success rate of at-home artificial insemination is not higher or lower than that reached through sexual intercourse.

The use of DIY artificial insemination kits is common among single mothers and lesbian couples without fertility problems wishing to get pregnant naturally using donor sperm, but without engaging into sexual intercourse with a man.

If you want some tips on how to carry out DIY artificial insemination, here is a step-by-step guide to it: How to do artificial insemination at home.

FAQs from users

How many IUI cycles should you do before moving on to IVF?

By Óscar Oviedo Moreno MD (gynecologist).

In couples with a good prognosis, that is, under the age of 37, with a normal sperm sample, we recommend 4 IUI attempts before moving on to IVF. In the case of single women or donor insemination cycles, up to 6 attempts are recommended. It depends on the clinical history of each patient, though.

Is there any difference between the requirements to undergo artificial insemination by husband (AIH) and artificial insemination by donor (AID)?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

Intrauterine insemination (IUI) or artificial insemination (AIH) involves the placement of washed sperm into a woman’s uterine cavity using a small catheter during a minor office procedure while the woman is awake.

The sperm are processed in the laboratory to obtain the highest numbers of moving sperm in a small volume as well as enhancing their fertilization potential. The IUI catheter deposits the sperm at a location closer to the fallopian tubes in comparison to intercourse. Following the procedure, the woman can resume all normal activity including intercourse with her partner.

Prior to IUI with partner sperm (AIH) and IUI by donor sperm (AID), the evaluation consists of ensuring the woman ovulates, confirming the fallopian tube(s) is/are open, and the sperm analysis is adequate for IUI. All women desiring pregnancy should undergo prenatal bloodwork including proper blood count, thyroid function, vitamin D level, immunity to the German measles (rubella virus) and chicken pox (varicela virus) as well as an updated Pap smear.

Additional recommendations for women desiring pregnancy with donor sperm include the same infectious disease testing as the donor including cytomegalovirus (CMV) antibody testing. If the woman tests negative for CMV then she needs to select a sperm donor who is also CMV negative to avoid the low but potential risk of infection to the baby. We also advise a psychological counseling session as a consent and for education.

Can I become a single mother with artificial insemination?

By Patricia Recuerda Tomás BSc, MSc (embryologist).

Yes, maternity is possible without a male partner. This option can be achieved using donor sperm, based on the physical characteristics of the patient. The success rates of AID are associated with the absence of tubal pathologies and age.

Which one do you recommend in patients with HIV? IUI or IVF?

By Aitziber Domingo Bilbao BSc, MSc (embryologist).

When a man is affected by HIV, the first thing we would do is washing the semen sample, which removes the seminal plasma, so that the sample contains spermatozoa only. Thanks to this technique, we are able to remove the virus from semen samples. After the washing, we examine the sample to detect copies of the virus using the PCR (Polymerase Chain Reaction) test. If the PCR is negative or the number of copies is low, the sample can be used for a fertility treatment. In this cases, we recommend patients to choose ICSI, as a sperm washing affects the sperm count and motility.

Can artificial insemination be done with a turkey baster?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, it is possible. In fact, the turkey baster method for IUI is one of the oldest methods to carry out an artificial insemination at home. The turkey baster is used as the tool for inserting the semen sample into the vagina.

It is useful because it transfers the sperm as close to the area of fertilization as possible. However, nowadays we can find safer tools for DIY artificial insemination, such as syringes.

Some sperm banks around the world include a syringe when you buy a semen sample for at-home insemination. They are used exactly the same as turkey basters, but with the advantage that they are easier to use.

What are the advantages and disadvantages of IUI over IVF?

By Andrea Rodrigo BSc, MSc (embryologist).

The main benefits of IUI are: simplicity of the process, low doses of fertility drugs (mild ovarian stimulation), and the absence of surgery and anesthesia for carrying it out. It does not hurt, the duration time is short, and the cost is lower than IVF.

The cons, however, are linked to the success rates, since they are low if compared to those of IVF. There is also a strong need for meeting all the requirements to be a good candidate for IUI and besides egg donation is not possible in case the patient is unable to use her own eggs.

Is a sperm donor agreement required for donor insemination?

By Andrea Rodrigo BSc, MSc (embryologist).

Sperm donor agreements are contracts between the donor and the person or persons seeking to use his sperm for insemination, without turning to a sperm bank.

They are used with the purpose of clearly identifying the intended parents as the legal parents of the child, and to make it clear that the donor has no legal rights or responsibilities of fatherhood over the child despite being the biological father.

Why does artificial insemination fail?

By Andrea Rodrigo BSc, MSc (embryologist).

Artificial insemination statistics can diminish for a number of reasons: the semen sample was not properly washed, the woman is too old, the dose of fertility medications was too low, etc.

When artificial insemination fails, the first thing that should be done is looking for the cause(s) behind it. If no apparent reason is found, experts recommend to go for a second cycle.

If a pregnancy is not achieved after the fourth attempt, other fertility treatments should be considered, such as in vitro fertilization (IVF), either conventional IVF or with ICSI.

By Andrea Rodrigo BSc, MSc (embryologist).

Firstly, it should be clear that natural insemination is not a fertility treatment, as it is not carried out at a fertility clinic under safety conditions. It is the same as having sexual intercourse, and it carries a series of risks related to the parental rights above all.

Artificial insemination after 40, does it work?

By Andrea Rodrigo BSc, MSc (embryologist).

The odds for pregnancy in women over 35-37 are low. For this reason, AI is not recommended at ages beyond 35.

From age 35 onwards, and especially at 40, a woman’s ovarian reserve drops dramatically, while the chances for the eggs to have chromosomal alterations are higher.

The success rate of donor insemination in women younger than 40 is around 20-22%, while it drops to 13% in women aged 40. In the case of artificial insemination with husband’s sperm, the percentage is 12-14% before age 40, and 9% in women aged 40 or more.

Is artificial insemination after tubal ligation possible?

By Andrea Rodrigo BSc, MSc (embryologist).

No, because the sperm is unable to travel through the Fallopian tubes and reach the egg. If the ability of your eggs is confirmed, pregnancy can be achieved through IVF, as fertilization does not take place inside the female reproductive system, but in the laboratory.

How can sperm be frozen for artificial insemination at home?

By Andrea Rodrigo BSc, MSc (embryologist).

Sperm specimen are not intended for storage in your kitchen freezer, as the required temperature for maintaining sperm viability is far colder than that home freezers can keep.

Some andrology clinics sell specialized kits which are designed to let you manage the process at gime and maintain the necessary temperature for a week or more. These kits also include the necessary sterile tools for semen collection.

Is artificial insemination with gender selection possible?

By Andrea Rodrigo BSc, MSc (embryologist).

In countries where gender or sex selection is allowed (e.g. the United States), choosing the sperm’s gender is possible by means of “sperm sorting”, in which case sex selection for AI would be possible. However, the effectiveness of this technique is low.

Gender selection is usually carried out as a complementary technique with IVF, as PGD (preimplantation genetic diagnosis) is required to analyze the embryos and their chromosomes.

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References

Agarwal S, Mittal S (2004). A randomised prospective trial of intrauterine insemination versus timed intercourse in superovulated cycles with clomiphene. Indian J Med Res; 120: 519– 522.

Allegra A, Marino A, Coffaro F, Scaglione P, Sammartano F, Rizza G, Volpes A (2007). GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial. Hum Reprod; 22: 101 – 108.

Bensdorp AJ, Cohlen BJ, Heineman MJ, Vandekerckhove P (2007). Intra Uterine Insemination for male subfertility. Cochrane Database Syst Rev;Art No.: CD000360, doi:10.1002/14651858.CD00360.pub4

Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C (2007). Semen preparation techniques for intrauterine insemination (Review). Cochrane Database Syst Rev; Art No.: CD004507, doi:10.1002/14651858,CD004507.pub3.

Cantineau AEP, Heineman MJ, Cohlen BJ (2003). Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples. Cochrane Database Syst Rev; Art. No.: CD003854, doi:10.1002/ 14651858.CD003854.

Goldberg JM, Mascha E, Falcone T, Attaran M (1999). Comparison of intrauterine and intracervical insemination with frozen donor sperm: a meta-analysis. Fertil Steril; 72(5):792-5.

Gomez-Polomares JL, Juliia B, Acevedo-Martin B, Martinez-Burgos M, Hernandez ER, Ricciarelli E (2005). Timing ovulation for intrauterine insemination with a GnRH antagonist. Hum Reprod;20:368 – 372

Goverde AJ, Lambalk CB, McDonnell J, Schats R, Homburg R, Vermeiden JPW (2005). Further consideration on natural or mild hyperstimulation cycles for intrauterine insemination treatment: effects on pregnancy and multiple pregnancy rates. Hum Reprod; 20:3141– 3146.

Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llàcer J, Bernabeu R (2004). Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril;81:1308 – 1313.

O'Brien P, Vandekerckhove P (2001). Intra-uterine versus cervical insemination of donor sperm for subfertility (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford: Update Software.

Ragni G, Somigliana E, Vegetti W. (2004) Timing of intrauterine insemination: where are we? Fertil Steril;82:25 – 26.

The ESHRE Capri Workshop Group (2009). Intrauterine insemination. Human Reproduction Update; 15 (3): 265–277.64

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Authors and contributors

 Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information
 Antonio Forgiarini
MD, MSc
Gynecologist
Bachelor's Degree in Medicine from the Università degli Studi di Roma “Tor Vergata”, with specialty in Obstetrics and Gynecology at University Clinical Hospital of Valencia, Spain. Master's Degree in Human Reproduction, and currently works as an OB/GYN specialized in Assisted Procreation at fertility clinics Millet and IMER Valencia. More information
License: 464621719
 Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information
License: ME 78893
 Óscar Oviedo Moreno
Bachelor's Degree in Medicine & Surgery from the University of Caldas (Colombia). Specialist in Internal Medicine by the Pontificia Universidad Javeriana of Bogotá. Degree standardized in Spain in 2003. Specialist in Gynecology & Obstetrics from the Complutense University of Madrid, with residence at Hospital Clínico Universitario San Carlos de Madrid. Expert in Reproductive Medicine and Certification in Obstetric-Gynecologic Ultrasound (levels I, II and III). More information
License: 282858310
 Aitziber Domingo Bilbao
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of the Basque Country. Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid, and Master's Degree in Biomedical Research from the University of the Basque Country. Wide experience as an Embryologist specialized in Assisted Procreation. More information
 Patricia Recuerda Tomás
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of Alcalá de Henares. Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). Extensive experience working at several Assisted Reproduction laboratories. More information
License: 19882M
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One comment

    1. Pauline

      Hello, can anybody help me? I wanna know what happens if you take the hCG medication and then undergo the insemination before 24 hours. I’m reading several webpages about it and all of them say you should wait between 24 to 26 hours to do it, so… I’m worried now. Thanks.