What Is Artificial Insemination (AI)? – Process, Cost & Types

By (embryologist), (gynecologist), (embryologist), (patient care), (embryologist), (embryologist) and (psychologist).
Last Update: 12/30/2021

Artificial insemination (AI) is a simple and low-cost assisted reproductive technique by which sperm are introduced unnaturally into the woman's uterus. The objective is to produce fertilization and achieve pregnancy.

It is a painless and much less invasive procedure than other reproductive techniques such as in-vitro fertilization (IVF). Depending on the origin of the semen sample used, we distinguish two types:

  • Homologous artificial insemination (HAI) or conjugal artificial insemination (CAI), i.e. using a sample from the couple. The probability of pregnancy in this case is close to 15-25%.
  • Heterologous or donor artificial insemination (DAI), with bank sperm. The success rate is 20-30%.

The price of this treatment may vary between different clinics and depends on the needs of each patient or couple, but usually ranges between 1000$-2500$ per cycle.

Provided bellow is an index with the 14 points we are going to expand on in this article.

How does it work?

Artificial insemination consists of depositing a previously processed semen sample inside the uterus.

To carry it out, the specialist introduces a cannula into the uterine cavity transvaginally and in an ultrasound-guided manner, that is to say, controlled by ultrasound. It is performed during the woman's ovulatory period in order to increase the chances of success.

The fertilization of the egg by the sperm takes place in the fallopian tubes, just as it happens when pregnancy is achieved naturally. The differences are the way in which the sperm is introduced into the female reproductive organ and that the best sperm have been previously selected from the sample.

Another important difference is that, in the AI process, the woman's ovulation time is monitored by ultrasound to coincide with the insemination and thus increase the probability of success.

In addition, hormonal medication is usually administered to the patient to stimulate follicular growth, which also increases the pregnancy rate.

Therefore, the probability of pregnancy is slightly higher than that derived from sexual intercourse, although it still depends fundamentally on the fertilizing capacity of the sperm and the implantation capacity of the embryo generated after fertilization.

AI treatment step by step

The main steps of the artificial insemination process are outlined below:

  • 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 a 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 of trying to conceive without luck. However, a series of requirements should be met 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, Syphilis, 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 a 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 to increase the chances of getting pregnant as well.

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

Problems, risks and side effects

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 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 donor insemination could be approximate of €900-€1,400 if you are in a European country.

In the UK, the availability and fees of artificial insemination on the NHS vary 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 $600-3000, with an average of $1500 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 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.

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 in 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

Is there a risk of ectopic pregnancy in an AI?

By Héctor Iván Izquierdo Urdinola M.D. (gynecologist).

An ectopic pregnancy is nothing more than a gestation that nests inappropriately in the fallopian tubes, which implies a medical emergency that may require surgical treatment, in addition to having consequences on the reproductive health of women.

This is due to the fact that the fallopian tubes -of much smaller diameter and resistance than the uterus- are not prepared to host a pregnancy and, with the development of the embryo in this area, a rupture of this tissue, which has a lot of blood supply, can be generated. This would trigger a hemorrhage that could pose a great risk to the woman.

Artificial insemination is a simple and minimally invasive assisted reproduction treatment, which can be ideal when the causes of reproductive problems are due to the male factor. In this treatment, the sperm -previously prepared- is basically introduced into the uterus in order to promote pregnancy. In most cases, the woman is also usually given medication to help promote ovulation.

All assisted reproduction treatments carry a slightly increased risk of ectopic pregnancy, and artificial insemination is no exception. The causes for this type of pregnancy are not entirely clear, but the most widely accepted are the following: firstly, the fact of injecting the sperm directly into the uterus could affect the peristalsis of the tubes (movement of the tubes that moves the ovum from the ovary to the uterus), causing it to function inadequately and not be able to transport the fertilized ovum to the uterus. The other cause may be that there is a pathology in the tubes that partially occludes them, enough to allow the passage of the sperm, but subsequently does not allow the passage of the fertilized embryo.

Can I become a single mother with artificial insemination?

By Patricia Recuerda Tomás B.Sc., M.Sc. (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.

If I am a single mother, is it better to resort to artificial insemination or in vitro fertilization? What is the difference?

By Rebeca Reus BSc, MSc (embryologist).

Each case must be evaluated on a case-by-case basis, but normally, in cases of single women who do not show any signs of sterility, the technique of choice is artificial insemination.. This is because it is more comfortable for the patient and more economical, since fertilization occurs in the woman rather than in the laboratory and less hormonal medication is needed.

In cases where there is some indication that it will not be possible to achieve gestation through artificial insemination, in vitro fertilization (IVF) will be chosen. For example, if the woman has blocked fallopian tubes or low ovarian reserve, IVF is preferable.

What are the advantages and disadvantages of IUI over IVF?

By Andrea Rodrigo B.Sc., M.Sc. (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.

Are pregnancy symptoms after artificial insemination the same as if pregnancy is achieved naturally?

By Rebeca Reus BSc, MSc (embryologist).

Yes, they are very similar. However, in the case of artificial insemination, there may be some additional symptoms derived from the hormonal mediation necessary for ovarian stimulation.

After artificial insemination, is it possible to have sexual intercourse?

By Rebeca Reus BSc, MSc (embryologist).

Yes, as long as they do not hurt or have been contraindicated by the specialist. In fact, some experts recommend it because they argue that it increases the chances of achieving pregnancy.

Is artificial insemination with gender selection possible?

By Andrea Rodrigo B.Sc., M.Sc. (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.

If you are interested in the AI process and want to learn more about the requirements for it to be more successful, be sure to visit this article: Requirements for an AI.

On the other hand, as we have already mentioned, the success of AI does not increase after the fourth attempt. In this case, the ideal would be to resort to IVF. If you need information about this fertility treatment, we recommend you to visit this article: In vitro fertilization (IVF): What is it and how much does it cost?

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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

FAQs from users: 'Is there a risk of ectopic pregnancy in an AI?', 'Can I become a single mother with artificial insemination?', 'Can artificial insemination be done with a turkey baster?', 'If I am a single mother, is it better to resort to artificial insemination or in vitro fertilization? What is the difference?', 'What are the advantages and disadvantages of IUI over IVF?', 'Why does artificial insemination fail?', 'Are pregnancy symptoms after artificial insemination the same as if pregnancy is achieved naturally?', 'After artificial insemination, is it possible to have sexual intercourse?' and 'Is artificial insemination with gender selection possible?'.

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Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
B.Sc., M.Sc.
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
 Héctor Iván Izquierdo Urdinola
Héctor Iván Izquierdo Urdinola
M.D.
Gynecologist
Dr. Izquierdo has a degree in Medicine and Surgery from the Universidad del Valle. In addition, he has a course in basic psychosomatic care by the Institute of Psychotherapy and Psychoanalysis of the University of Würzburg, a Master in Assisted Human Reproduction by the University of Salamanca and the title of Gynecologist and Obstetrician by the Government of Upper Bavaria, Germany. More information about Héctor Iván Izquierdo Urdinola
Member number: 03-0312760
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Montserrat Villalobos Plumé
Montserrat Villalobos Plumé
B.Sc., M.Sc.
Patient care
Degree in Biology from the University of Granada and Master's Degree in Assisted Human Reproduction from the University of Salamanca, with an internship in the embryology and andrology laboratory of the Hospital Clínico Universitario de Valladolid (HCUV). More information about Montserrat Villalobos Plumé
 Patricia Recuerda Tomás
Patricia Recuerda Tomás
B.Sc., M.Sc.
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 about Patricia Recuerda Tomás
License: 19882M
 Rebeca Reus
Rebeca Reus
BSc, MSc
Embryologist
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
Adapted into english by:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
B.Sc., M.Sc.
Psychologist
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman
Member number: CV16874

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