Artificial Insemination Indications – Why & When to Use It?

By BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 01/07/2019

Artificial insemination (AI), in particular Intrauterine Insemination (IUI), the most common type used, is a low cost, simple fertility treatment. However, pregnancy is not achieved in all cases, as one should meet a series of requirements to be referred to this technique.

Depending on the fertility problem and the particularities of each patient, Artificial Insemination by Husband (AIH) or Artificial Insemination by Donor (AID) might be recommended. Find more info throughout this post.

Indications of AIH

The most common indications of Artificial Insemination by Husband (AIH) are:

  • Trouble having complete sexual relations, including problems such as retrograde ejaculation, erectile dysfunction, premature ejaculation (PE)...
  • Mild-to-moderate alterations in seminal parameters like motility, morphology, or sperm concentration (sperm count)
  • Ovarian cycle alterations such as ovulation irregularities
  • Cervical factor or cervix abnormalities that complicate the passage of sperm from the vagina to the uterus
  • Mild-to-moderate endometriosis
  • Unexplained infertility. It occurs when infertility tests, both in the man and the woman, indicate normal parameters and absence of fertility issues but pregnancy does not occur.
  • Immunological infertility. It is caused due to incompatibility between the spermatozoa and the reproductive tract of the female.
  • If there are antisperm antibodies in the cervical mucus, placing the sperm directly into the uterus can prevent the immunological system of the female from attacking the sperm.

A couple may be affected with one or more of these alterations. If both members of the couple are affected, it is a case of infertility of mixed causes, since the inability to achieve pregnancy is due to problems in both the man and the woman.

Indications of AID

This type of artificial insemination is recommended in the following cases:

  • Women who decide to become single mothers by choice (SMC)
  • Lesbian couples
  • Partner's semen of poor quality: severe cases of azoospermia, asthenospermia, oligospermia, etc.
  • The father has a genetic diseases that may be transmitted to offspring and is not detectable using PGD

If sperm quality is too low that it does not allow intrauterine insemination to guarantee a minimum success, you might be referred to In Vitro Fertilization (IVF) using the husband's sperm, except for the cases of secretory azoospermia. In other words, poor sperm quality can be solved using IVF with ICSI (intracytoplasmic sperm injection).

However, if the husband has some kind of religious, moral or medical contraindication for IVF, another option is Artificial Insemination by Donor (AID).

Finally, one should note that, currently, the presence of a Sexually Transmitted Disease (STD) is not a reason to be referred to AID anymore. With a seminal washing, it is possible to remove the pathological agents from the sample and perform an AIH or IVF with the husband's sperm.

Did you know that we can help you to choose a fertility clinic for your IUI cycle? All you have to do is get your Fertility Report now. It is 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.

Who cannot use artificial insemination?

IUI requires a reduced level of human assistance to be performed in comparison with other fertility treatments available nowadays.

Many people opt for IUI just because it is more comfortable and cheaper than other techniques. Nonetheless, if the necessary requirements are not met, it is unlikely that the couple is able to achieve a pregnancy using it.

To be able to undergo artificial insemination, both AIH and AID, the woman has to meet two fundamental requirements:

  • Tubal patency, that is to say, there is no blockage in the passage of sperm through the Fallopian tubes
  • Ovulatory cycles, either naturally or artificially with hormone medications

Thus, for instance, if the woman has her tubes tied, IUI will not be possible in any way, since her tubes are blocked. Simply put, it means that sperm will be unable to meet the egg and fertilize it, so the only treatment option possible will be IVF.

On the other hand, IUI is not indicated in women from 35-37 years old onwards. With age, the ovarian reserve (egg count) diminishes, and the chances for pregnancy drop simultaneously. This does not automatically mean that these women cannot get pregnant using IUI, but in most cases the likelihood is so low that going through it is not worth it. The most recommendable option in these cases is IVF.

As for the male partner, good sperm quality is required. Sperm must be capable of going through the female reproductive tract on their own, reaching the Fallopian tubes, and fertilize the egg.

If the intended father's sperm quality is insufficient, the couple may be referred to IVF or recommended to use donor sperm, which has an excellent quality.

FAQs from users

I have tubal patency in only one tube. Can I become a mother through IUI?

By Andrea Rodrigo BSc, MSc (embryologist).

As long as you have tubal patency in at least one Fallopian tube, the sperm and egg will be able to meet, allowing fertilization. For this reason, pregnancy is possible with IUI in spite of having one of your tubed blocked.

However, it should be noted that the success rates will be lower.

Can you undergo IUI with moderate asthenozoospermia?

By Andrea Rodrigo BSc, MSc (embryologist).

Asthenozoospermia refers to motility issues in the sperm. If the percent of sperm with poor or non-existent motility is high, it is unlikely that sperm are able to swim toward the egg and fertilize it after the insemination. Thus, although it depends on the level of severity of asthenozoospermia, it is better if you go directly for IVF with ICSI.

How is ovulation monitored to determine the best day for insemination?

By Andrea Rodrigo BSc, MSc (embryologist).

To schedule insemination for the optimal moment, that is, for the day of ovulation the woman is prescribed low doses of hormonal medications. This treatment allows you to regulate and control your ovarian cycle. To this end, you doctor monitors the treatment with transvaginal ultrasounds and blood tests to measure estradiol levels.

Suggested for you

Throughout this post, we have made several references to two fundamental requirements that a woman has to meet to guarantee a minimum success chance with IUI. To get more info, read: Requirements to Undergo Intrauterine Insemination (IUI).

If you are considering undergoing intrauterine insemination as your fertility treatment to have a baby, we recommend that you read this post carefully to get an overall idea about the process: How Is At-Home Artificial Insemination Performed Step by Step?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Corson SC, Batzer FF: Homologous artificial insemination. J Reprod Med 26:231, 1981.

Dixon RE, Buttram VC Jr, Schum CW: Artificial insemination using homologous semen: a review of 158 cases. Fertil Steril 27:647, 1976.

Meeken CI: The infertile patient: guidelines for successful workup. Postgrad Med 68:139, 1980.

Nachtigall RD, Faure N, Glass RH: Artificial insemination of husband's sperm. Fertil Steril 32:141, 1979.

Nunley WC Jr, Kitchin JD III, Thiagarajah S: Homologous insemination .. Fertil Steril 30:510, 1978.

Pfeffer WH, Wallach EE, BeckWW, Barrett ATM: Artificial insemination with husband's semen: prognostic factors. Fertil Steril 34:356, 1980.

Scott JZ, Nakamura RM, Mutch J, Davajan V: The cervical factor in infertility: diagnosis and treatment. Fertil Steril 28:1289, 1977.

Speichinger JP, Mattox JH: Homologous artificial insemination and oligospermia. Fertil Steril 27:135, 1976.

FAQs from users: 'I have tubal patency in only one tube. Can I become a mother through IUI?', 'Can you undergo IUI with moderate asthenozoospermia?' and 'How is ovulation monitored to determine the best day for insemination?'.

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Authors and contributors

 Andrea Rodrigo
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 about Andrea Rodrigo
Adapted into english by:
 Sandra Fernández
Sandra Fernández
BA, MA
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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