Artificial insemination

Page last reviewed: 13/07/2011

Artificial insemination is a treatment for infertility, when a couple cannot conceive a baby. It involves directly inserting sperm into a woman's womb.

When is artificial insemination used?

Artificial insemination can help a couple conceive if:

  • there is a problem with the man's sperm or he has erectile dysfunction or premature ejaculation 
  • there is no obvious reason why the couple cannot conceive (unexplained infertility) 
  • the woman has ovulation problems or mild endometriosis, when cells usually found in the lining of the womb grow in other parts of the reproductive system, such as the fallopian tubes, ovaries or vagina

Women without a male partner, such as women in same-sex partnerships, have also used artificial insemination to become pregnant.

See Artificial insemination - why it is used for more information.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is the technique used for artificial insemination, and it has a good record of success.

Figures from the UK Human Fertilisation and Embryology Authority (HFEA) in 2006 found that IUI has a success rate of around 15% for each cycle of treatment. However, a number of factors can affect this. See Artificial insemination - results for more information.

In IUI, a man provides a sample of sperm, which is then "washed" and filtered using special techniques. This ensures that only the highest-quality sperm is used for the procedure.

During the procedure, the concentrated sperm is passed directly into the woman's womb through a thin tube called a catheter.

See Artificial insemination - how it is performed for more information.

Sperm donation

If the male partner cannot produce any healthy sperm, frozen sperm from a donor can be used.

Some couples obtain donated sperm from someone they know. However, in most cases, sperm is obtained from an unknown.

 

Donor
A donor is a person (living or dead) who donates blood, an organ or other body parts to another person in need.

Fallopian tubes
Fallopian tubes (also called oviducts or uterine tubes) are the two tubes that connect the uterus to the ovaries in the female reproductive system.

Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

Uterus (womb)
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).

Useful Links

 

Infertility

It is estimated that one couple in six is affected by infertility. If you and your partner have not conceived after one year of trying, see your GP.

It is best for both partners to see their GP because fertility problems can affect the man or woman. Sometimes, both partners are affected.

Your GP can give you advice about what to do next, and they will also carry out an initial assessment to investigate what may be causing your fertility problems.

Page last reviewed: 13/07/2011

Artificial insemination can be used to treat couples who can produce healthy eggs and sperm but, due to a health condition or for an unknown reason, cannot get pregnant through sexual intercourse.

Some of the reasons why couples have artificial insemination are explained below.

If a man cannot produce any healthy sperm, sperm from a donor can be used. Donor sperm may also be used if a woman wants to raise a child by herself or if a woman is in a same-sex relationship and wants to get pregnant. 

Men

Artificial insemination may be recommended if a man has:

  • fertility problems  
  • erectile dysfunction (impotence)
  • premature ejaculation 
  • infertility caused by a medical treatment

Fertility problems

The most common cause of male infertility is abnormal semen. Semen is the fluid that contains sperm and which is ejaculated during sex. Abnormal semen accounts for three-quarters of male infertility cases. Reasons for abnormal semen include:  

  • decreased number of sperm - the man has a very low sperm count or no sperm at all
  • decreased sperm motility - this means it is more difficult for sperm to swim to the egg
  • abnormal sperm - sperm can sometimes be an abnormal shape, making it harder for them to move and fertilise an egg

See the Health A-Z topic about Infertility - causes for more information about the causes of infertility in men.

For intrauterine insemination (IUI) to work, the semen must be of sufficient quality before it is placed in the woman's womb. For example, the semen may need to contain a certain number of sperm. Different clinics may use different criteria to determine the quality of sperm.

Erectile dysfunction

Erectile dysfunction is when a man cannot get or keep an erection during sex. It often has both physical and psychological causes. For example, a physical cause could be that the blood vessels leading to the penis are narrowed. Psychological causes could include anxiety and depression.

See the A-Z topic about erectile dysfunction for more information.

Premature ejaculation

Ejaculation is where semen is squirted out of the penis during an orgasm. Premature ejaculation is where a man ejaculates too quickly. If a man ejaculates before his penis is inside his partner's vagina, it can affect fertility.

See the A-Z topic about Ejaculation problems for more information.

Medical treatment

Several medical treatments can cause infertility in men, including:

  • chemotherapy- a treatment for cancer that uses powerful medication
  • radiotherapy- a treatment for cancer that uses high-energy radiation
  • orchidectomy - a surgical procedure to remove one or both testicles, sometimes used to treat testicular cancer

If a man needs to have one of these treatments and wants to have a child, he may have the option of freezing a sample of sperm so that it can be used at a later date.

Women

Artificial insemination may be recommended if a woman has:

  • ovulation problems 
  • endometriosis

Ovulation problems

Infertility in women can be caused by problems with ovulation, the monthly release of an egg from the ovaries. Some ovulation problems prevent any eggs from being released, while others cause an egg to be released during some cycles but not others.

Ovulation problems can occur as a result of conditions such as:

  • premature ovarian failure - where the ovaries stop working before a woman is 40 years of age 
  • polycystic ovary syndrome (PCOS) - a condition that makes it more difficult for the ovaries to produce an egg

See the A-Z topic about Infertility - causes for more information about the causes of ovulation problems in women.

Endometriosis

Endometriosis is a condition where cells that usually only grow on the lining of the womb grow in other parts of the reproductive system, such as the fallopian tubes or ovaries.

The condition causes heavy and sometimes painful periods and, in a small number of women, it can lead to infertility.

IUI is often used in women with minimal to mild endometriosis who are having problems getting pregnant.

The severity of endometriosis is assessed by measuring the amount of tissue growing outside the womb. In minimal to mild endometriosis, only small patches of tissue are present outside the womb.

IUI is not recommended for women who have more severe symptoms of endometriosis. This is because severe cases of endometriosis can result in the womb becoming scarred, which means that IUI is unlikely to be successful.

See the A-Z topic about Endometriosis for more information about the condition.

Unexplained infertility

IUI can be an effective treatment for couples who cannot conceive a child but where there is no obvious medical reason why this is the case.

IUI is much less expensive than in vitro fertilisation (IVF). IVF is a technique where an egg is surgically removed from the ovaries and is fertilised outside the body.

Fallopian tubes
Fallopian tubes (also called oviducts or uterine tubes) are the two tubes that connect the uterus to the ovaries in the female reproductive system.

Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females. 

Testicles (testes)
The testicles are part of the male reproductive system. They produce sperm and are located in the scrotum (a loose bag of skin) hanging down behind the penis.

Uterus (womb)
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Page last reviewed: 13/07/2011

Before having intrauterine insemination (IUI), a couple's fertility will need to be assessed to find out why they are having difficulty conceiving and to determine whether artificial insemination is suitable.

Assessing a woman's fallopian tubes

For a woman to have IUI, her fallopian tubes must be open and healthy. The fallopian tubes connect the ovaries to the womb. Eggs are released from the ovaries into the fallopian tubes each month, and this is where fertilisation takes place. If there is a problem with the fallopian tubes, it may prevent IUI from working.

Checking that the fallopian tubes are open and healthy is sometimes called a tubal patency test. The fallopian tubes can be assessed using one of two methods:

  • laparoscopy
  • hysterosalpingogram

Laparoscopy

A laparoscopy involves making a small cut in the lower abdomen. A thin, tubular microscope called a laparoscope will be used to look more closely at the womb, fallopian tubes and ovaries. A dye may be injected through the neck of the womb into the fallopian tubes to highlight any blockages.

A laparoscopy is usually only used if it is very likely that there is a problem, for example if a woman has had pelvic inflammatory disease (PID). PID is an infection that can damage and scar the fallopian tubes.

Hysterosalpingogram

A hysterosalpingogram is a type of X-ray that is taken of the womb and fallopian tubes after a special dye has been injected. This will help detect any abnormalities or defects, such as tumours or scar tissue. 

The timing of IUI

To maximise the chances of success, a cycle of IUI should be carried out just after ovulation. Ovulation is when one or more eggs are released from the ovaries into the fallopian tubes.

It is difficult to predict exactly when ovulation will occur, but in most women it usually happens 10 to 16 days before the start of their period. The menstrual cycle begins on the first day of a period (day one). Ovulation occurs some time after the period, which is followed by the next period 10 to 16 days later.

IUI is usually carried out between day 12 and day 16 of the menstrual cycle.

Women may be given an ovulation prediction kit (OPK) to work out the date of ovulation with greater accuracy. An OPK is a simple testing device that can detect hormones that are released during ovulation in urine or saliva. Alternatively, a woman may have blood or urine tests to find out when she is about to ovulate.

If a woman is using fertility medication to encourage ovulation, an ultrasound scan may be used to check the development of the eggs. An ultrasound scan uses high-frequency soundwaves to create an image of the inside of the body. See Artificial insemination - how it is performed for more information about fertility medication.

When an egg is mature, the woman may be given an injection of hormones to stimulate the egg's release from the ovary.

Fallopian tubes
Fallopian tubes (also called oviducts or uterine tubes) are the two tubes that connect the uterus to the ovaries in the female reproductive system.

Hormones
Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

Uterus (womb)
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Page last reviewed: 13/07/2011

Intrauterine insemination (IUI) is the technique used to carry out artificial insemination. 

IUI using a partner's sperm

If a couple decides to have IUI using their own sperm, the man will be asked to provide a sperm sample at the fertility clinic. The sperm sample will usually be taken on the same day that IUI treatment takes place.

To obtain the sperm sample, the man will be asked to masturbate into a specimen cup. He may be asked not to have sexual intercourse or masturbate for two days before the sample is taken because this could affect the sperm sample's quality.

After a sample has been provided, it will be "washed" and filtered using special equipment to remove any dead sperm and impurities. The faster-moving sperm will be kept and any slow-moving sperm will be removed. This produces a concentrated sample of healthy sperm.

A special instrument called a speculum is inserted into the woman's vagina to keep the walls of the vagina open. A thin, flexible tube called a catheter is then placed inside the vagina and guided into the womb. This process is mostly painless, although some women may experience mild cramping, similar to period pains. The sperm sample will then be passed through the catheter and into the womb.

The process usually takes no more than 10 minutes, and the couple should be able to go home shortly after the process has been completed.

IUI using a donor's sperm

Choosing to use donated sperm can be a difficult decision, and a couple may be advised to have counselling before going ahead. Talking through the decision with a professional counsellor may help a couple decide if it is the right choice for them. 

If a couple decides to have IUI using the sperm of a donor, the procedure used is the same as above. However, instead of using the male partner's sperm, a sample of frozen sperm from a donor will be thawed out, "washed" and then inserted into the woman's womb.

All donated sperm is carefully checked for:

infections, such as HIV, hepatitis B and hepatitis C

  • genetic and hereditary disorders, such as sickle-cell anaemia and cystic fibrosis, which could affect the health of a child

The fertility clinic can provide information about the physical characteristics of available donors, such as their ethnicity, physical build and hair and eye colour. This will enable a couple to try and match a potential donor's characteristics with their own. 

Fertility medication

In the past, women who had IUI were also given medication to stimulate ovulation. However, nowadays the routine use of fertility medication is not usually recommended. This is because these types of medication increase the possibility of multiple births, such as twins or triplets (see Artificial insemination - risks for more information).

Wherever possible, fertility clinics try to avoid multiple births as there is an increased risk of complications associated with this type of pregnancy. The one circumstance where fertility medication is recommended is if a woman has symptoms of endometriosis, a condition where small pieces of the womb lining are found outside the womb.

Uterus (womb)
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).

Page last reviewed: 13/07/2011

Multiple births

There is an increased risk of a multiple birth, such as twins, if a woman has intrauterine insemination (IUI) in combination with fertility medication. In IUI cycles combined with follicle-stimulating hormone (FSH), a fertility hormone that increases the number of eggs produced, multiple pregnancy rates range from 10-40%. 

Multiple births are associated with an increased risk of:

  • miscarriage - the loss of the pregnancy during the first 23 weeks 
  • gestational diabetes - a type of diabetes that affects women during pregnancy
  • low birth weight - babies born weighing under 2.5kg (5.5lbs)
  • premature birth - babies born before week 37 of pregnancy

The risk of death for premature babies during the first week of the birth is five times higher for twins and nine times higher for triplets than for single babies.

Ovarian hyperstimulation syndrome (OHSS)

Ovarian hyperstimulation syndrome (OHSS) is an uncommon but potentially serious complication that can occur when a woman uses fertility medication during a cycle of IUI treatment.

For reasons that are not fully understood, the ovaries of some women become swollen after the use of fertility medication. In most cases, the swelling is mild and causes symptoms of:

  • bloating 
  • mild to moderate abdominal pain 
  • occasional nausea and vomiting

OHSS is severe in an estimated 3% of cases where fertility medication is used. Severe OHSS can cause symptoms including:

  • chest pain 
  • dehydration 
  • shortness of breath

Mild cases of OHSS can be treated at home. Drinking plenty of water and taking paracetamol to help relieve the painful symptoms is recommended.

Severe cases of OHSS require admission to hospital so that the normal functions of the body can be supported until the swelling subsides.

The symptoms of OHSS usually develop four or five days after the initial use of fertility medication. Women should contact their fertility clinic as soon as possible if they think they may have OHSS.

Hormones
Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

Page last reviewed: 13/07/2011

Figures from the UK Human Fertilisation and Embryology Authority (HFEA) in 2006 suggest that intrauterine insemination (IUI) has a success rate of around 15% for each cycle of treatment. This estimate is based on women under 35 years of age using donor sperm.

More recent research suggests lower success rates. For example, one study found that when IUI was combined with clomifene citrate, a medicine to encourage ovulation, pregnancy rates were 7%. When IUI was combined with follicle-stimulating hormone (FSH), a fertility hormone that increases the number of eggs that are produced, the pregnancy rate was 12%. Of these, 13% were multiple births.

Multiple births increase the health risks for both the mother and babies.

Another study compared the birth rate between couples having IUI, couples taking clomifene citrate and couples who received no treatment. It found that live birth rates between the three groups were not significantly different.

The National Institute for Health and Clinical Excellence (NICE) in the UK does not recommend using fertility medication with IUI. This is because, although it increases pregnancy rates, it also increases the risk of having a multiple birth.

Factors affecting success

As with most other types of fertility treatment, the younger a woman is, the greater her chance of having a successful pregnancy. Other factors than can affect the success of IUI include: 

  • the possible causes of female infertility
  • the length of time that a couple has had fertility problems 
  • the man's sperm count and sperm quality
  • technical aspects of IUI, such as working out the time of ovulation correctly

NICE recommends that a couple try up to six cycles of IUI treatment. If they do not get pregnant within six cycles of treatment, it is unlikely that further IUI treatment will be successful. In this case, a couple should consider trying other types of fertility treatment, such as in in vitro fertilisation (IVF).

Hormones
Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

Ovulation
Ovulation is when an egg is released from a woman's ovaries.

Page last reviewed: 13/07/2011

Intra-cervical insemination is used for couples who have a physical problem with sperm reaching the correct place.

Intrauterine insemination (IUI) is often used if the female partner has cervical mucus that rejects sperm. It may also be used in cases of unexplained infertility and to overcome some male fertility problems. It is uncommon for pregnancy rates to improve unless fertility drugs are used before IUI. The male partner is also required to have a semen assessment prior to treatment to determine whether the sperm are suitable for the IUI technique.

Sperm analysis looks at the sperm count, whether the sperm are formed normally and able to move freely, sperm survival over a period of time and the presence of anti-sperm antibodies. For IUI to be successful, there needs to be at least five million healthy sperm.

Insemination with sperm from a donor may be used if the male partner has no sperm, very poor sperm, or risks passing on an inherited disease. Men who donate sperm must be screened for hepatitis, and sexually transmitted infections (STIs) such as HIV. Checks for HIV require the sperm to be frozen and quarantined for at least six months.

Many clinics try to match the characteristics of men who donate sperm with the couple receiving treatment. Physical characteristics such as hair and eye colour, build and height may be matched with the male partner. However, this is reliant upon a large bank of sperm donations.

You should discuss what treatment is available with your GP, as it will depend on what your fertility problem is and whether artificial insemination is likely to be suitable and successful.

Glossary

Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Donor
A donor is a person (living or dead) who donates blood, an organ or other body parts to another person in need.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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