How successful is artificial insemination?

By (embryologist), (gynecologist), (gynecologist), (embryologist), (gynecologist), (embryologist) and (psychologist).
Last Update: 02/10/2022

Artificial insemination (AI) is one of the simplest assisted reproduction treatments, so its success rates are not very high, especially in the first attempt.

Even so, all women and couples who meet the requirements for artificial insemination have a chance of achieving pregnancy.

In addition, the success rate of AI increases after the first attempt, so that the woman could become pregnant in the second, third, or fourth cycle. This is known as the cumulative success rate.

Provided below is an index with the 8 points we are going to expand on in this article.

Does artificial insemination work?

The AI ​​treatment is a small help to the natural process of conception since it simply consists of depositing the sperm from the man in the woman's uterus, but they are the ones that have to travel through the fallopian tubes to reach the uterus. egg and fertilize it.

For this reason, artificial insemination is only recommended in mild cases of infertility, when the woman is young and her ovarian reserve is not yet compromised.

Thanks to artificial insemination, 4,984 babies were born in Spain in 2019, according to the latest data published by the Spanish Fertility Society (SEF).

AI is also usually the first technique indicated when the couple comes to a fertility clinic, whenever possible and when there is a chance of success, as it is the simplest and most economical treatment.

Basic requirements

In order to carry out artificial insemination, it is necessary for both the woman and the man to undergo some fertility tests to ensure that they meet the following requirements:

  • Good seminal quality. The male has a good amount of motile spermatozoa.
  • The woman must be able to ovulate, either spontaneously or induced with hormonal medication.
  • The fallopian tubes must be patent.

If these 3 basic requirements are met, artificial insemination can be the definitive solution to the reproductive problem.

For more detailed information about this, you can continue reading here: Basic requirements for intrauterine artificial insemination.

AI success factors

Despite everything that has been said so far, not all people who meet the AI ​​requirements will be able to get pregnant with this fertility treatment.

The success of artificial insemination depends on many other factors related to the couple or the treatment. We comment on them below:

Age of the woman
a woman's reproductive capacity decreases over time until its definitive end in what we know as menopause. As we approach this period, the quantity and quality of the eggs are reduced. That is why, from the age of 35-37, the chances of pregnancy through artificial insemination are low.
Cause of infertility
for AI to be successful, the sperm must have sufficient capacity to travel through the female reproductive tract, swim to the egg and penetrate it for fertilization to occur. embryo. Therefore, if there are serious fertility problems in women or men, such as severe endometriosis or oligoasthenozoospermia, it will be difficult for natural fertilization to take place.
Origin of the male gamete
since donor sperm is of very high quality, women who undergo donor artificial insemination (DAI) will have a higher chance of achieving pregnancy.< /dd>

Ovarian stimulation protocol
It is important to analyze the situation of each woman and personalize the hormonal treatment that she will receive to stimulate ovarian development and ovulation. A very strong stimulation can cause too many follicles to mature, which can be counterproductive since the quality of the ovules could be affected, as well as increasing the probability of a multiple pregnancy.
Endometrial receptivity
The endometrium is the layer of the uterus where the implantation of the embryo and the beginning of pregnancy take place. For this to happen, the endometrium must be receptive, that is, in good condition to receive the embryo. It is essential that the endometrium has a trilaminar appearance (three parallel layers are seen on ultrasound) and an approximate thickness of 8-10 mm. If the endometrium does not have the proper qualities for implantation, it will not occur and artificial insemination will fail.

Success rates

It is important to know that there are different ways of expressing the success of an assisted reproduction treatment, as we discuss below:

Pregnancy rate
percentage of women with a positive pregnancy test after AI.
Cumulative pregnancy rate
percentage of pregnancies after two, three or more attempts. Typically, the AI's cumulative pregnancy rate increases up to 4 attempts.
Delivery rate
percentage of women who achieve full-term pregnancy and the birth of one or more babies. In this case, it does not refer to whether the baby is born alive or dead, or with some malformation, pathology or disease.
Live birth rate
percentage of women who achieve the birth of a live and healthy baby after AI.

For all this, the live birth rate is the most important. However, the SEF only provides data on the pregnancy rate and the delivery rate for each type of AI, so these are the percentages that we will provide below (National Activity Registry 2019-SEF Registry).

Conjugal artificial insemination

According to the latest report published by the SEF with the results obtained by Spanish centers in 2017, artificial insemination with partner semen (IAC) has the following success rates depending on the age of the woman:

Women <35 years old
pregnancy rate of 12.8% and delivery rate of 10.5% per cycle.
Women 35-39 years old
pregnancy rate of 13.0% and delivery rate of 10% per cycle.
Women ≥ 40 years old
pregnancy rate of 10.3% and delivery rate of 6.5% per cycle.

It is very likely that the woman will not get pregnant in the first artificial insemination. However, the cumulative rate of IAC after four attempts reaches up to 60%, so the couple could achieve pregnancy on the second, third or fourth attempt.

Artificial donor insemination

In case of having to resort to the semen of an anonymous donor to do the artificial insemination, the probability that the woman has to become pregnant and give birth to a baby depending on her age is the following:

Women <35 years old
pregnancy rate of 21.8% and delivery rate of 17.6% per cycle.
Women 35-39 years old
pregnancy rate of 18% and delivery rate of 13.1% per cycle.
Women ≥ 40 years old
pregnancy rate of 11.2% and delivery rate of 7.3% per cycle.

As in the previous case, the IAD has a cumulative pregnancy rate that can reach up to 80% after four attempts.

Number of AI attempts

As we have pointed out, specialists recommend a maximum number of 4 artificial insemination attempts before moving on to other more complex treatments.

Numerous studies have shown that, after the fourth artificial insemination treatment, the pregnancy rate does not improve and, therefore, it makes no sense to continue applying this method. In this case, it will be necessary to go on to in vitro fertilization (IVF) processes.

However, there is an exception in the case of single women and couples of homosexual women, who may be indicated up to a maximum of 6 IAD attempts.

The reason is that these women, in principle, do not present any infertility problem, only the absence of a male partner.

Pregnancy test

After about 15 days of beta-waiting, the pregnancy test will make it possible to discover whether or not artificial insemination has been successful. It is based on measuring the beta-hCG hormone, released by the embryo after implantation.

To avoid errors in the result, it is recommended not to do the pregnancy test before 15 days have passed since the AI, since there would be the possibility of obtaining a false negative due to not having enough beta-hCG.

On the other hand, the blood pregnancy test is more specific than the urine test and leads to fewer errors. In any case, we will not have definitive confirmation of the pregnancy until we see the gestational sac and the embryo in the ultrasound at week 6 or 7.

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.

FAQs from users

What can be done after three unsuccessful DAIs?

By Gustavo Daniel Carti M.D. (gynecologist).

After having performed three unsuccessful DAI cycles and having ruled out active tubal and endometrial pathology, constituting an entity without apparent cause, it is advisable to opt for in vitro fertilization (IVF). This reproductive option will provide accurate information on the quality of the eggs, fertilization and embryo evolution.

Is there any concrete symptom indicating that artificial insemination has been successful?

By Paloma de la Fuente Vaquero M.D., Ph.D., M.Sc. (gynecologist).

No, the symptoms are the general ones of any pregnancy and usually appear approximately 15 days after insemination. Among the most common are nausea or vomiting, fatigue, sleep ... but do not differ from those produced by a natural pregnancy.

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

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

Artificial insemination after 40, does it work?

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

The odds for pregnancy in women over 35-37 are low. For this reason, AI is not recommended at ages beyond 35.

From age 35 onwards, and especially at 40, a woman's ovarian reserve drops dramatically, while the chances for the eggs to have chromosomal alterations are higher.

The success rate of donor insemination in women younger than 40 is around 20-22%, while it drops to 13% in women aged 40. In the case of artificial insemination with husband's sperm, the percentage is 12-14% before age 40, and 9% in women aged 40 or more.

Can I get pregnant through IUI with endometriosis?

By Sara Salgado B.Sc., M.Sc. (embryologist).

It depends on the location and how expanded the endometriosis is. If it is a mild-to-moderate case of endometriosis, then pregnancy could be achieved with this technique.

On the contrary, in the most severe cases, it is likely that the Fallopian tubes are blocked due to this condition, in which case the sperm would not be able to meet the egg. Also, it might have affected the endometrial lining, reducing the embryo's possibilities of attaching to it.

Should I move on to IVF after three failed IUI attempts?

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

Although studies indicate an increase in pregnancy chances after the fourth attempt with artificial insemination, depending on the case, it is possible that, after three failed IUI attempts, your doctor refers you to IVF. This depends on each situation as well as on aspects such as the causes of infertility, the woman's age, the causes that led to failure of previous IUI attempts, etc.

Does IUI work in women with polycystic ovaries?

By Sara Salgado B.Sc., M.Sc. (embryologist).

Yes, polycystic ovaries can cause infertility problems due to alterations in ovulation. However, with a mild ovarian stimulation cycle, normal menstrual cycles can be recovered and pregnancy achieved, either naturally or by IUI.

Can you choose the gender of the unborn child with IUI?

By Sara Salgado B.Sc., M.Sc. (embryologist).

No. Since fertilization and subsequent embryo development occur inside the female's body, the embryos cannot be manipulated to examine their genetic content. So, in short, choosing the gender of the baby is not possible.

Throughout this post, we have seen that the chances of pregnancy vary, amongst other reasons, depending on the type of insemination carried out: whether it is an AIH or an AID. Also, the cost of these types of AI is different, as you can read here: How Much Does Artificial Insemination Cost?

Also, we have made special emphasis on the importance of opting for Intrauterine Insemination (IUI) only in those cases where it is indicated. Otherwise, achieving satisfactory results would be highly unlikely. Want to learn more about the main indications? Click here: Artificial Insemination Indications – Why & When to Use It?

We make a great effort to provide you with the highest quality information.

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References

Berg U, Brucker C, Berg FD. Effect of motile sperm count after swim-up on outcome of intrauterine insemination. Fertil Steril 1997; 67:747–50.

Buxaderas R. (s.f.) Guía 14: Ciclos de inseminación artificial conyugal. Servicio de Medicina de la Reproducción Departamento de Obstetricia, Ginecología y Reproducción Hospital Universitario Quirón Dexeus, Barcelona.

Caballero Peregrín P, Núñez Calonge R, García Enguídanos A. (s.f.) Guía 15: Ciclos de inseminación artificial con semen de donante. Clínica Tambre. Madrid.

DiMarzo SJ, Kennedy JF, Young PE, Hebert SA, Rosenberg DC, Villaneuva B. Effect of controlled ovarian hyperstimulation on pregnancy rates after intrauterine insemination. Am J Obstet Gynecol 1992; 166:1607–13.

Karlstrom P-O, Bergh T, Lundkvist O. A prospective randomized trial of artificial insemination versus intercourse in cycles stimulated with human menopausal gonadotropin or clomiphene citrate. Fertil Steril 1993:59;554–9.

Khan JA, Sunde A, Von During V, Sordal T, Molne K. Intrauterine insemination. Ann NY Acad Sci 1991;626:452–60.

Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod 1996;11:1892–6.

Plosker SM, Jacobson W, Amato P. Predicting and optimizing success in an intrauterine insemination programme. Hum Reprod 1994;9:2014–21.

FAQs from users: 'What can be done after three unsuccessful DAIs?', 'Is there any concrete symptom indicating that artificial insemination has been successful?', 'I have tubal patency in only one tube. Can I become a mother through IUI?', 'Artificial insemination after 40, does it work?', 'Can I get pregnant through IUI with endometriosis?', 'Should I move on to IVF after three failed IUI attempts?', 'Does IUI work in women with polycystic ovaries?' and 'Can you choose the gender of the unborn child with IUI?'.

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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
 Gorka Barrenetxea Ziarrusta
Gorka Barrenetxea Ziarrusta
M.D., Ph.D.
Gynecologist
Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta
License: 484806591
 Gustavo Daniel  Carti
Gustavo Daniel Carti
M.D.
Gynecologist
Dr. Gustavo Daniel Carti has a degree in medicine and specialized in obstetrics and gynecology from the University of Buenos Aires. More information about Gustavo Daniel Carti
Licence number: 07/0711274
 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
 Paloma de la Fuente Vaquero
Paloma de la Fuente Vaquero
M.D., Ph.D., M.Sc.
Gynecologist
Bachelor's Degree in Medicine from the Complutense University of Madrid, with a Master's Degree in Human Reproduction and a Doctorate in Medicine and Surgery from the University of Seville. Member of the Spanish Fertility Society (SEF) and the Spanish Society of Gynecology and Obstetrics (SEGO), she performs as a gynecologist specializing in assisted reproduction in the clinic IVI Sevilla. More information about Paloma de la Fuente Vaquero
License: 4117294
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
Embryologist
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:
 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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