Artificial Insemination (AI) Using Ovulation Induction

By MD, PhD, MSc (gynecologist), BSc, MSc (embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 04/14/2020

In an artificial insemination (AI) process, it is necessary to perform controlled ovarian stimulation to allow follicular development and ovulation of one or two mature eggs.

This is achieved through hormonal medication in lower doses than those used for in vitro fertilization (IVF). The drugs used have various trade names and the vast majority contain gonadotropins such as FSH and LH or compounds such as clomiphene citrate.

The guidelines for administering hormone medication depend on the characteristics of each patient and can be modified as treatment progresses and ultrasound checks are performed.

What is controlled ovarian stimulation?

In a normal menstrual cycle, a woman develops a follicle in her ovary inside which an egg grows. At the time of ovulation, it is released into the fallopian tubes, where the encounter with the sperm and fertilization takes place.

Fertility specialists aim to control the menstrual cycle in such a way as to ensure the maturation of one or more eggs. In addition, ovulation is induced at a specific time to coincide with insemination with the male's semen.

Therefore, artificial insemination treatment consists of two parts in which the drugs used are different:

Controlled ovulation induction
exogenous menstrual cycle hormones (FSH and LH) are administered to trigger follicular development.
Ovulation induction
the hCG hormone induces ovulation 36 hours after it is injected. At this time it takes place artificial intrauterine insemination.

For AI, the sperm used can be from the woman's partner or from an anonymous donor. In both cases, sperm training will be done to prepare the semen before it is introduced into the uterus.

Dosage and days of treatment

The goal of AI stimulation is to achieve one or at most two mature eggs that can be fertilized in the tubes. Therefore, ovarian stimulation is gentle compared to that done in IVF, where multiple follicular development is intended to be achieved.

The hormone doses in an AI are low and are administered by injections that the woman gives herself according to medical recommendations.

The stimulation process usually lasts between 8 and 14 days. The injections start on day 2 or 3 of the beginning of the menstrual cycle, taking as the beginning of the cycle the day that menstruation arrives.

The gynecologist controls the maturation process of the follicles with periodic transvaginal ultrasounds and blood estradiol analysis.

The monitoring of the stimulation aims to control the number of follicles in each of the ovaries, schedule the time of insemination and measure the thickness of the endometrium.

The proper size of the follicles that have to reach 18 millimeters in diameter, at which time the hCG hormone is administered to trigger ovulation.

In case the follicular development does not take place as expected, the gynecologist can modify the hormonal dose and/or the days of treatment.

Patient Characteristics

Several aspects are taken into account to determine the most appropriate medication pattern for each woman, of which we highlight:

  • Patient Characteristics
  • Morphology of the ovaries
  • Body mass
  • Hormone analysis
  • Response to stimulation in previous cycles

In assisted reproduction, it is not possible to standardize the process of ovarian stimulation, but it is necessary to make a personalized treatment for each patient.

Medication for artificial insemination

The types of drugs for controlled ovarian stimulation in AI are diverse and have different mechanisms of action. In addition, each type of drug has many brand names with very different prices.

Below, we will comment on the most used ones today:

GnRH analogues
serve for ovarian suppression, that is, they inhibit the endogenous sex hormones of the menstrual cycle. They can be applied with a short or a long treatment and the most used are Cetrotide, Procrin, Decapeptyl and Orgalutran.
These are the exogenous hormones that cause follicular development itself and those that must be administered in low doses. The drugs that contain them are Gonal, Menopur and Puregon among others.
Clomiphene citrate
is used in women with ovulatory problems such as polycystic ovary syndrome (PCOS). It stimulates follicular development and also causes ovulation. One of the most widely used drugs is Omifin.
Hormone hCG
consists of a single injection given 34-36 hours before AI to induce ovulation. The most famous drug is Ovitrelle.

It should be noted that all of these drugs must be used under medical supervision in a fertility treatment.

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.

Risks of controlled ovarian stimulation

The main drawback that can arise from hormonal medication in an AI is ovarian hyperstimulation syndrome (OHSS).

OHSS occurs, when the ovaries respond abnormally highly to the hormones used in stimulation. This can lead to increased permeability of blood vessels and promote the accumulation of fluid in the peritoneal cavity of the abdomen, which causes great pain.

The risk of suffering this symptom in an artificial insemination treatment is low since the stimulation is very mild. In addition, the monitoring and control carried out makes it possible to anticipate a high response and therefore to stop the medication pattern before this alteration takes place.

Other disadvantages of controlled ovarian stimulation are the side effects it causes, such as abdominal swelling, headache, breast discomfort, etc. However, these pass in a few days and are of no great importance.

FAQs from users

How many days does ovarian stimulation last in an artificial insemination?

By Carmen Ochoa Marieta MD, PhD, MSc (gynecologist).

Although it depends on the type of cycles a woman has and her response to ovarian stimulation, it is usually 10-12 days.

Is there a risk of multiple pregnancy using artificial insemination?

By Zaira Salvador BSc, MSc (embryologist).

With ovarian stimulation, the number of eggs that can be fertilized by sperm is increased in order to increase the probability of pregnancy. Therefore, there is a greater risk of multiple pregnancy compared to what happens in a natural cycle.

To reduce this risk, it is important that ovarian stimulation is moderate, preventing the development and ovulation of more follicles than desired.

Is letrozole used for ovarian stimulation?

By Zaira Salvador BSc, MSc (embryologist).

Letrozole is a drug that increases the secretion of GnRH in the brain and this causes the release of more FSH and LH. Therefore, it does cause a stimulation in the ovary.

This type of drug, like clomiphene citrate, is used in women with anovulatory problems in both artificial insemination and scheduled intercourse. In both cases, it is necessary to inject Ovitrelle to trigger ovulation.

Suggested for you

If you want to know what medications are used for ovarian induction, we recommend you this post: What medications are used for ovarian stimulation?

For more information about artificial insemination and what the treatment consists of, you can access our specialized page on this subject: What is intrauterine artificial insemination?

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Authors and contributors

 Carmen Ochoa Marieta
Carmen Ochoa Marieta
MD, PhD, MSc
Bachelor's Degree in Medicine from the Basque Country University. PhD in Medicine & Surgery from the University of Murcia. Currently, she is the director of the Assisted Reproduction Unit of Centro de Estudios para la Reproducción (CER SANTANDER) in Santander, Spain, as well as the director of the Diagnostic Unit of Human Assisted Reproduction in Bilbao. More information about Carmen Ochoa Marieta
License: 484805626
 Neus Ferrando Gilabert
Neus Ferrando Gilabert
BSc, MSc
Bachelor's Degree in Biology from the University of Valencia (UV). Postgraduate Course in Biotechnology of Human Assisted Reproduction from the Miguel Hernández University of Elche (UMH). Experience managing Embryology and Andrology Labs at Centro Médico Manzanera (Logroño, Spain). More information about Neus Ferrando Gilabert
 Zaira Salvador
Zaira Salvador
BSc, MSc
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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