Artificial insemination with donor sperm (aid)

Artificial insemination with donor sperm consists of placing sperm obtained from a sperm bank inside the uterus. It is a simple and effective technique because it closely resembles nature and because the semen sample presents the optimum conditions of both quality and quantity of sperm.

1 Indications for aid..

  • Absence of a partner.
  • Lesbian couples
  • Severe male factor such as secretory azoospermia (negative testicular biopsy)
  • Genetic cause. In cases where the man is carrying a serious genetic disease that can be transmitted to offspring and when the pre-implantation genetic diagnosis is not possible.
  • Infectious diseases of the male with positive sperm washings.
  • Failures in previous assisted reproduction techniques with patients’ own gametes and in the absence of a female factor causing sterility.

Requirements for aid

To perform an AID, just as for an AIH, there should be bilateral tubal permeability, which may be shown by hysterosalpingography, hysterosalpingosonography or tubal laparoscopic chromopertubation.i

Under special considerations, performing an AID in patients with only one permeable Fallopian tube could be accepted (then proceeding to cancel the cycle in the event of follicular development on the side of the tubal obstruction), or even perform the technique without certifying the tubal permeability in women with no history of infertility or previous abdominal surgery or genital infections, as well as in the case of homosexual couples, or women without a partner.

Control and stimulation of the ovaries.

The ovaries are stimulated by the administration of hormones (follicle stimulating FSH and, in some cases, luteinizing hormone (LH) and follicle growth is monitored by hormonal analyses (by determination of levels of estradiol, progesterone and LH) and ultrasound, to verify that the number and size of follicles is appropriate (only one follicle is needed for this technique). It is then, when by means of administering recombinant hCG, which mimics the action of the LH that naturally causes ovulation, that the egg is released.

Types of aid cycles at eugin:

  1. Stimulation cycle: This is the most common. It consists of performing a controlled ovarian stimulation, with the administration of hormonal medication (FSH or FSH + LH) administered subcutaneously at low doses, usually from day 3 of the cycle, to help follicular development and maximize the chances of success and thus monitor the cycle better.
  2. Natural cycle It consists of monitoring (using ultrasound and hormone analyses) the natural cycle of the patient without stimulation. When there is evidence of the presence of at least one dominant follicle, the ovulation discharge is programmed. Such cycles can be useful especially in younger patients (35 years) with regular cycles and no history of infertility, above all when you want to avoid the risk of multiple pregnancy. It should be borne in mind that many scientific studies show slightly lower success rates compared to stimulated cycles. ii.ii.

3 Obtaining the semen sample

The semen sample is collected from a donor who has undergone a comprehensive medical study (semen analysis, blood and urine analysis, general examination, study of sexually transmitted diseases and psychological examination) to ensure the quality of their sperm and rule out any pathology. All donors are of adult age and sign a consent and anonymity form with regard to their donation. The semen is frozen before use to verify that there are no STDs. The selection of the specific donor for each patient is made based on the physical characteristics of same.

Should you get pregnant, and subject to availability of samples in the sperm bank, at EUGIN we can reserve a semen sample from the donor for a possible second pregnancy, or for the partner’s pregnancy (in the case of homosexual couples).

Insemination.

A single insemination between 36 and 42 hours the ovulation discharge is performediii.

On the day of ovulation the sperm sample from the sperm bank is loaded into a cannula and then inserted into the uterusiv. After this, a rest period of 10 minutes is recommended and the patient can then carry out her normal everyday activitiesv.

As for the number of inseminations carried out, at Eugin we perform a single insemination. The reason is twofold. In the first place, there is no scientific evidence to support the fact doing 2-3 inseminations increases the pregnancy rate and, secondly, at Eugin a hormonal analysis and ultrasound check is done at each verification stage during stimulation. That is, we can delimit with quite a high degree of accuracy the time of ovulation to perform the synchronization with the insemination.

After the AID, low-dose vaginal progesterone is prescribed to help the luteal support phase, at least until the time of the pregnancy test.

The pregnancy test is performed 2 weeks after insemination and, if the result is negative, it can be done again with the next menstrual cycle.

Bibliography

i Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessement. Fertil Steril. 2011 Jun;95(7):2171-9
ii Veltman-Verhulst SM, Cohlen BJ, Hughes E, Heineman MJ. Intra-uterineinsemination for unexplainedsubfertility.Cochrane Database Syst Rev. 2012 Sep 12;9
iii Polyzos, N, Tzioras S, Spyridon S, Mauri D and Tatsioni A, Double versus single intrauterine insemination for unexplained infertility: a meta-analysis of randomized trials. Fertil Steruil 2010: 94 (4):1261-1266
iv Goldberg JM, MashanE, Falcone T et al. Comparison of intrauterine and intracervical insemination with frozen donor sperm: a meta-analysis. Fertil Steril 1999;72:792-795
v Custers IM, Flierman PA, Maas P, Cox T et al. Immobilisation versus immediate mobilisation after intrauterine insemination:randomised controlled trial. BMJ. 2009; 339

Last Updated: November 2017