Artificial insemination is a simple assisted reproduction procedure by which the gynecologist places a semen sample—generally after sperm capacitation—inside the female’s uterus, awaiting for egg fertilization to take place in the Fallopian tubes.
It can be done either using the husband’s sperm or donor sperm. In the latter case, sperm donation may become necessary in the following cases:
- Absence of a male partner (single women and lesbian couples).
- Severe male factor infertility.
- Sexually transmitted diseases, in case the absence of infectious diseases could not be guaranteed after several sperm washing processes.
- When there is risk of gene disorder inheritance from parent to offspring.
In case you turn to donor sperm, you should keep in mind that Greek Law 3305/2005 on Medically Assisted Human Reproduction places particular emphasis on the fact that sperm donors must remain always anonymous; therefore, potential donors will be selected by the fertility clinic. Besides, it limits the number of donations to 10 live births per donor.
Sperm donor requirements
For artificial insemination to be properly carried out, the woman is required to have an adequate tubal patency. Should the Fallopian tubes be blocked, achieving pregnancy would be complicated via artificial insemination despite using high quality donor sperm.
Another basic requirement is that women have a good reserve of eggs remaining in the ovaries, regular menstrual periods, and no type of uterine malformation.
As regards sperm donor requirements, first and foremost the semen sample must present a minimum sperm count. Although specific criteria may differ slightly from lab to lab, as a general rule the motile sperm concentration (MSC) must show at least an amount of 3 million sperm with progressive motility per milliliter of capacitated sperm.
Since it is the spermatozoon which has to fight by itself against the obstacles found within the female reproductive tract to reach the egg and fertilize it, it is crucial that the semen sample shows an elevated sperm quality. It it not only about presenting a high sperm count, but also about presenting a good sperm motility, pH, morphology, etc.
It is also important to point out that the semen sample must overcome an initial sperm cryosurvival rate test. In accordance to Law 3305/2005, using fresh semen samples from sperm donors is forbidden in order to prevent the transmission of sexually transmitted diseases (STDs).
Apart from semen analyses, prospective sperm donors must undergo a thorough medical and psychological screening to make sure they are free from any genetic abnormality likely to be inherited by offspring, as well as their predisposition to put up with the whole sperm donation process.
Firstly, the woman undergoes mild, controlled ovarian stimulation (COS). The goal is to trigger ovulation so that the woman produces between 1 and 2 mature eggs in a single cycle. By doing this, we can increase the pregnancy success rate while at the same time the risk of multiple births is controlled.
In cases of international patients who choose Greece as their destination for artificial insemination, some fertility centers may allow them to start with the ovarian stimulation phase in their country of origin and then travel to the Hellenic Republic a few days before being inseminated. Nonetheless, this is not always possible, as many gynecologists have a preference for monitoring themselves the ovarian response a woman is experiencing in order to evaluate how the treatment develops more closely.
Once the follicles—small “sacs” containing eggs—have reached the adequate size, women are administered an hCG shot. This is done in order to trigger ovulation within 36 hours after being applied. Thus, the insemination per se will be scheduled for this precise moment, thereby increasing the chances for the union between the egg and the sperm to take place.
The same day when ovulation and subsequently insemination are scheduled, the semen sample of the donor will be defrosted and washed via sperm capacitation. The aim of this technique is to gather only those sperm presenting the best seminal parameters.
After being capacitated, the semen sample will be aspirated by means of needle aspiration. Then, the next step will be inserting and placing it inside the woman’s uterine fundus, all within a simple and painless process. After 15 minutes, women can continue with their normal lifestyle and take a pregnancy test between 15-17 days later.