Artificial Insemination Indications – Why & When to Use It?

By BSc, MSc (embryologist), MD, MSc (gynecologist), (embryologist) and (invitra staff).
Last Update: 11/11/2019

Artificial insemination (AI) is a low-cost, low-complexity assisted reproductive technique. Normally, it is indicated when it is difficult for the sperm to reach the uterus naturally.

However, this technique does not always make it possible to achieve pregnancy, as a number of essential requirements must be met. For this reason, you might wonder when artificial insemination should be performed.

Depending on the infertility problem and the circumstances of each patient, conjugal AI or donor AI will be indicated. In this article we are going to explain in detail the cases in which each of the types of artificial insemination is recommended.

Indications of AIH

Artificial insemination with husband’s sperm (AIH) is a procedure in ART in which the spouse's own sperm is used. It is recommended when the woman is less than 35-37 years old.

The same couple may be involved in one or more of the situations discussed below. If both members of the couple are affected, this is a case of sterility of mixed origin, as the inability to achieve pregnancy is caused by both male and female problems.

Sterility of female origin

The AIH is indicated in cases where the problem is due to sterility on the part of the woman, as long as the cause is:

Cervical Factor
alterations in the quality of mucus from the cervix that prevent sperm from reaching the uterus or fallopian tubes, as it acts as a barrier.
Uterine Factor
anomalies in the anatomy or functioning of the uterus, such as uterine malformations, uterine fibroids, endometriosis, intrauterine adhesions, etc.
Vaginism
involuntary contraction of the muscles of the vagina, which prevents the deposit of semen.
Ovulatory dysfunction
there are irregularities in ovulation such as anovulation, polycystic ovary syndrome (PCOS), etc.

Sterility of male origin

Artificial insemination by husband is also indicated in cases where the problem is caused by the man, as in:

  • Alterations in sperm quality that can be observed after a seminogram in a man. It refers to a reduction in the quality, quantity and morphology of spermatozoa.
  • Inability to deposit semen in the vagina, which may be due to premature ejaculation, psychogenic impotence, hypospadias, or retrograde ejaculation.
  • Cases of oligoastenoteratozoospermia:seminal samples with low quantity, problems of mobility and morphology of the spermatozoa.

Sterility of unknown origin

Sterility of unknown origin is that form of sterility that occurs when fertility tests in the couple (both man and woman) indicate normal results, but even so, pregnancy is not achieved.

On the one hand, the woman has regular menstrual cycles and a uterus with normal morphology. In addition, it lacks polyps or fibroids, that is to say, it has no uterine alterations.

On the other hand, the male has no anomaly and his seminogram shows values within the normal range, so his sperm quality is good in relation to morphology, quantity, mobility, etc.

Immunological sterility

The AIH is recommended when there is some immunological alteration that can be due to the presence of antispermatozoid antibodies (ASA), which affects the motility of the spermatozoid, the penetration in the cervical mucus or even the interaction between the gametes (ovum and spermatozoid).

If these ASA antibodies are present in the cervical mucus, the solution would be to deposit the spouse's semen directly in the uterus. This prevents the defenses of the woman's vagina from attacking.

Indications of AID

In artificial insemination with donor (AID), as its name suggests, semen from an anonymous donor is used and is indicated in the cases discussed below.

Absence of male partner

In cases where there is no male partner and there is a desire to achieve pregnancy, an artificial insemination with donor sperm can be performed. These include single women who choose to become mothers or female couples.

To do so, they must meet the following requirements:

  • For women without a male partner who do not appear to have fertility problems, the age limit is 40 years instead of less than 35-37 years as was the case in AIH.
  • No history of genital infections and pelvic surgery.
  • Not having endometriosis type III or type IV, that is, moderate or severe endometriosis respectively.

With male partner without the possibility of sperm contribution

In the case of couples between a man and a woman, artificial insemination with donor sperm may have to be used due to various factors. These are detailed below:

  • Severe male infertility such as a secretory azoospermia. In this case, no sperm appear in the semen and fertilization cannot take place.
  • History of genetic disease in the male and lack of treatment with preimplantation genetic diagnosis (PGD).
  • Sexually transmitted disease in the male after several sperm washings. This means that in seropositive patients (affected by HIV, Hepatitis B...) it is necessary to perform sperm washings. This separates the sperm from the other components of the semen and reduces the risk of transmission to the mother and baby. If, after the molecular tests to check the successive washes, viral load is still identified, insemination with donor semen is used.
  • Rh incompatibility of the couple. This occurs when the mother is Rh negative and the father is Rh positive. If the fetus inherits the Rh-positive from the father, maternal and fetal blood contact will produce maternal antibodies (defenses). This has negative consequences on the pregnancy, as it can lead to misscarriages. The mother is normally isoimmunized so that there is no problem, but in certain cases a solution is still not possible and AID is used.

When not to perform artificial insemination

Artificial insemination is the assisted reproduction technique that requires less intervention by the specialist. Many people opt for it because it is more comfortable and economical. However, if the necessary requirements are not met, there may not be a chance of achieving pregnancy through this method.

In order to do an artificial insemination, both by husband and donor, it is necessary for the woman to comply the following:

  • Having permeable tubes, i.e. the passage through them is not blocked. This can be checked by laparoscopy or hysterosalpingography (HSG).
  • Being able to ovulate, either spontaneously or through hormonal medication.
  • Age of the woman less than 35-37 years. This is because with age, the ovarian reserve decreases and the likelihood of pregnancy is reduced. It does not mean that it will be impossible for these women to get pregnant by this method, but the chances often are so low that it is not worth it. In these cases in vitro fertilization is recommended.

Thus, if, for example, it is a woman who has had a tubal ligation, under no circumstances may she undergo artificial insemination, either with semen from her spouse or from a donor. The reason for this is that her fallopian tubes are blocked and sperm will never be able to meet the egg to fertilize it, so she does not meet one of the basic requirements for artificial insemination. The solution in this case would be to carry out an in vitro fertilization treatment.

In relation to the masculine part, it is necessary that the semen has a good quality so that the spermatozoa are able to cross by themselves the whole feminine reproductive system, reach the fallopian tubes and fertilize the ovum.

If the seminal quality of the future father is not adequate, the possibilities would be to carry out in vitro fertilization (IVF), or to use donor sperm with excellent sperm 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

In this article we have referred to the two fundamental requirements that the patient must meet to guarantee a minimum of success in an artificial insemination. For other necessary conditions, click here: Basic requirements for artificial intrauterine insemination.

If you are considering artificial insemination as an assisted reproduction treatment to have a child, we recommend that you carefully read the following article to understand the process in detail: How is an artificial insemination done 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
 Laura García de Miguel
Laura García de Miguel
MD, MSc
Gynecologist
Bachelor of Medicine and Surgery from the Autonomous University of Barcelona, with specialization in Obstetrics & Gynecology at Sant Joan de Déu University Hospital. Master's Degree in Human Reproduction from the Complutense University of Madrid. Currently, she is the Medical Director of Clínica Tambre in Madrid, Spain. More information about Laura García de Miguel
License: 280843059
 Marta Barranquero Gómez
Marta Barranquero Gómez
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
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English edition of inviTRA. More information about Romina Packan

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