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reproductive medicine
Insemination
Intrauterine insemination is a procedure in which the sperm are washed, concentrated, and placed directly inside the woman’s uterine cavity using a thin catheter. In this way, a significantly higher number of spermatozoa can reach the fallopian tubes where fertilization occurs, in contrast to regular sexual intercourse, when only a small part of the sperm achieve this.
Insemination is a treatment of choice when the following conditions are met:
- Insemination is indicated in couples with unexplained infertility who have been trying to conceive for at least a year. This treatment can be applied for 3 to 6 months at most in women with spontaneous ovulation.
- To perform insemination, it is necessary that the male partner has normal semen analysis results or only slightly lowered sperm motility and morphology.
What to expect when you have an IUI Procedure?
How to book an appointment?Your fertility consultant will inform you on which day of your menstrual cycle you should visit for an examination. The appointment is made via the hospital call centre.
NB! Day 1 of your period is counted the first day of full flow. If full flow settles in the afternoon or the evening, the following day is counted as day 1.
To monitor the follicle growth, you will need to visit the hospital for regular ultrasound scans up to the moment when the dominant follicles reach a size indicating impending ovulation.
Your fertility consultant will inform you when the insemination will be performed and when you have to receive the injection for the final maturation of the oocytes. This injection can be applied at the clinic; our midwives and nurses can do this for you. If you wish, though, you can take the medication with you and have it administered at another clinic or medical office of your choice.
Before the procedure, both you and your partner need to have negative test results for HIV, Syphilis, and Hepatitis B and C. Test results are valid for three months before the insemination date.
It is necessary that you have filled in and signed the informed consent form for the procedure; you will receive it at the manipulations office at the hospital (first glass-door office next to consultant’s office 1 in the main foyer).
After your last examination before the insemination, you should book your appointment for the procedure. You can do this at the Registrations desk, observing the timing guidance by your doctor.
Blood tests for Hepatitis B and C, Syphilis and HIV; no earlier than three months before the procedure.
An essential condition is that your partner has to have two to five days of sexual abstinence before the procedure. On the day of the insemination, he will be asked to come first to the hospital (typically between 8:00 and 8:30 in the morning) to provide the semen. Semen is collected by masturbation in specially dedicated collection rooms next to the Andrology lab.
NB! The following has to be observed before semen collection:
- Empty bladder;
- Mandatory washing of hands and genitals;
Semen is collected in a sterile cup and is handed over to a biologist in the Andrology lab. There the material is processed and prepared for the procedure. A small aliquot of the semen is taken to test sperm viability after processing.
The male partner’s sperm is used for intrauterine insemination in most cases. Sometimes, however, donor insemination is necessary, using the sperm of an anonymous donor. In Bulgaria, special legislation is in force, regulating the use of donor gametes.
Check Ordinance 28 for activities in assisted reproduction.
The procedure is performed in Office No. 7 (Procedures office right next to the main hospital entrance). Insemination is entirely painless and feels like a regular gynaecological exam. Its duration is a couple of minutes, after which you will remain in the lying position on the gynaecological chair for about 15 minutes more. Your doctor may assign you additional therapy for the period until the pregnancy test.
You can do a urinary pregnancy test (dipstick) on day 15 after the procedure and a blood test – between days 11 and 14. You have to inform us about the result (positive or negative) and book an appointment for a consultation with your treating consultant.
What are contraindications to insemination?
Intrauterine insemination should not be applied in women with blocked fallopian tubes. Therefore tubal patency should be checked first by an X-ray procedure called hysterosalpingography (HSG).
Intrauterine insemination has very low success rates in women over 40 years of age, as well as in younger women with elevated basal levels of follicle-stimulating hormone (FSH) (measured on day 3 of the menstrual cycle), or in women with other indicators of diminished ovarian reserve.
Risks and advantages
It is important to note that IUI has low success rates in the following cases:
- When the female partner is more than 40 years old;
- When the eggs are few or of poor quality;
- When the sperm has poor quality parameters;
- In women with moderate to severe endometriosis;
- In women with tubal damage or pelvic adhesions.
Success rates are slightly higher in women with no spontaneous ovulation (anovulatory) who have been stimulated by medication before the insemination, as it is the absence of spontaneous ovulation that is the cause of infertility.
Chances for pregnancy are higher when the stimulation before insemination was done by gonadotropin injections than by pills (note that the risk of multiple pregnancies is also higher). This is because the injection medications induce the maturation of more eggs than the pills, and more mature follicles and, in turn, eggs retrieved, raise the chances for successful conception.
A potential backside is that the gonadotropin injections raise the odds of twins and higher-order multiples.
Intrauterine insemination is not recommended for more than four to six cycles.
Complications after intrauterine insemination are individual, but it is only very rare that infection or uterine cramping can occur if the standard requirements for the procedure have not been met.
Attention!
Please note that according to medical standards and the requirements for strict control, the semen for insemination can only be processed at adequately equipped and licensed laboratories.
‘Ordinary’ insemination offered at some clinics involves depositing unprocessed semen inside the vagina –mock intercourse. Such dubious procedures carry risks of infection and allergic shock and the development of immunological incompatibility with your partner.
Our advice is: when you are offered insemination, do inquire how, where, in what conditions and who will be processing the semen. Something else – insemination should only be performed after tubal patency has been checked and confirmed.
See also
In Vitro Fertilisation (IVF, ICSI/ IMSI)
Specialised tests
Specialised procedures
Nadezhda Donor program
