One of the initial treatments that can be applied to a group of couples who have difficulty conceiving naturally is insemination treatment (Intrauterine Insemination-IUI). Roughly, the method involves providing egg development with medications or naturally, and injections that will cause ovulation, and then, after a certain period of time, the sperm given by the man is prepared in the laboratory and injected into the uterus.
Which Couples Are Suitable for Insemination Treatment?
Just like pregnancies that occur naturally, insemination also requires open and healthy tubes. The meeting of the egg and sperm occurs through the tubes. In women who have had one tube removed or whose tube is closed without any additional problems (enlargement, hydrosalpinx, etc.), insemination is possible if the remaining tube is healthy. In addition to the tubes, there should be no serious problems with the uterus.
The man’s sperm must also be above a certain level. The sperm injected into the uterus must reach the egg through the tubes and fertilize it. Therefore, sperm with very low numbers, shapes and mobility are not suitable for insemination treatment.
The woman’s age and ovarian reserve are also important. Although the chance of pregnancy with insemination is not zero, if the woman is over 37 and her ovarian reserve has decreased, it is a more logical choice to go directly to in vitro fertilization treatments.
What is the Chance of Success of Insemination?
In scientific publications, pregnancy rates vary between 11-15 percent per insemination. A group of publications also report that the pregnancy rate in the first, second or third attempt after a total of 3 insemination treatments in correctly selected couples is 35-40 percent.
Today, when in vitro fertilization treatment is widely and successfully used, young couples may find these rates very low. The same confusion also exists among infertility doctors. While there are views that argue that insemination should definitely be tried persistently, there are also doctors who find pregnancy rates insufficient and directly recommend in vitro fertilization.
I apply insemination treatment in my own clinical practice and I think it is a good intermediate treatment. Because it is cheap, easy to apply and apply, and not tiring. However, it is necessary not to insist on this treatment. When the second insemination treatment also results in a negative result, some couples can be very worn out, especially mentally. Considering that these couples are young, do not have serious problems and have a high chance with in vitro fertilization treatment, I believe that it is necessary to select the couples who will be inseminated several times well and to inform them in detail and to include them in the treatment decisions.
How is Insemination Performed?
Egg development monitoring can be done without medication, or Clomiphene Citrate and Letrozole tablets or hormone-containing injections can be used. The aim is to ensure the development of one or more follicles. If medication is used, this treatment should be followed very carefully, and when there is a large number of follicle development, treatment should be considered to be canceled. Otherwise, there is a risk of ovarian overstimulation syndrome or multiple pregnancy (quintuplets, ten!).
When the follicles reach the appropriate size, ovulation-inducing injections (cracking needle) are administered. After this injection, insemination is performed twice in the 24th and 48th hours or once in the 36th hour. It is not necessary to strictly comply with these time intervals.
On the day of insemination, the man gives sperm by masturbation, this sperm is subjected to laboratory procedures in approximately 1 hour and a concentrated sperm sample of 0.5 cc is obtained. This sample is simply and painlessly injected into the woman’s uterus and the treatment is completed. The woman should be given a single dose of antibiotics on the same day. Progesterone-containing medications can also be used after insemination treatment. A pregnancy test is performed on the blood 14 days after the procedure.
