Insemination: days after it, preparation, test,pain after discharge

Every year the problem of infertility becomes more urgent, as
female and male. Get pregnant “on the go” is not obtained from
all couples, which is associated with an increase in the incidence of
environmental degradation, frantic pace of life. Artificial
insemination is one of the ways out of this situation. Notсмотря на ее
low efficiency (from 15 – 20 to 30% of pregnancies after
carrying out the procedure), it has a number of advantages, an important one
which is a low price (compared to IVF).

Artificial инсеминация: что это, виды

ATнутриматочной инсеминацией или искусственной инсеминацией
called the procedure for introducing sperm (husband or donor) into the genital
пути женщины для наступления of pregnancy. This medical
manipulation refers to assisted reproductive technology
and held in the conditions of the clinic, after the completion of the procedure
a woman goes home. Artificial инсеминация начала
about 200 years ago, for the first time in Russia, the AI ​​method was
Shorokhova applied in the 25th year of the last century. More widely given
The technology began to be applied in the 1950s and 1960s.

ATарианты проведения ИИ

The method of artificial insemination includes 2 options:

Homologous method

AT данном случае искусственное осеменение проводится спермой
husband Used to perform the procedure as freshly received.
sperm, just before its introduction, and
cryopreserved. Cryopreservation of husband’s sperm is performed
before sterilizing a man, before starting a course of treatment
cytostatics and the eve of irradiation.

Heterologous method

Artificial инсеминация проводится спермой донора по
absolute and relative medical indications. Not допускается
mixing the donor and spouse sperm, since the chances of fertilization
the husband’s sperm cell will not increase, and donor quality
sperm will deteriorate. Before conducting AI donor sperm perform
test for the penetration of sperm husband and donor in the cervical mucus. AT
case of significant differences in penetration
sperm husband and donor, the question of AI is solved in favor of the donor.

According to the technique of artificial insemination procedure
divided by:

ATнутришеечную (подвид – влагалищная)

This is the simplest procedure, performed without special technical requirements.
difficulties. ATнутришеечная ИИ по технике проведения максимально
corresponds to the natural sexual intercourse. Special preparation before
No manipulation is required. Artificial insemination
held freshly purified sperm (no later than three hours
before the procedure) and cryopreserved sperm. The essence
vaginal method consists in the introduction of sperm into the vagina
women, and intracervical (intra cervical) – as close as possible
to the cervix.

ATнутриматочную

This method of sperm injection is more effective than
intracervical insemination. The technical essence is
introduction into the uterine cavity through the cervical canal specifically
подготовленной и очищенной sperm If in the uterus to enter fresh and
untreated seminal fluid, it may be reduced or
development of an allergic reaction that will not only significantly reduce
the chances of fertilization, but also carries a threat to the patient’s life.

ATнутритрубную

Before the procedure, the sperm undergo special training.
Then the seminal fluid is injected into the fallopian tube, from the side
which ovulation occurred. Proven efficiency
intratubal insemination no higher than intrauterine.

ATнутриматочную интраперитонеальную

Notкоторое количество обработанной спермы соединяют с несколькими
milliliters of mobility enhancing fluid
sperm. Then the resulting solution (approximately 10 ml) is injected
in the uterine cavity under pressure. AT результате, сперматозоиды с
liquid almost immediately get into the pipe and from there into the abdominal
cavity. The chances of fertilization of an egg that is in this
moment in the abdominal cavity is much higher than with natural
intercourse. This method of AI is used when not installed
the cause of infertility and in case of ineffectiveness of intracervical and
intrauterine insemination.

AI preparation

Before insemination, the woman (the recipient) is trained
мужчины (мужа или донора) и самой sperm A married couple should
pass a full examination, and if any
diseases of their treatment (for example, genital infections). Also spouses
All recommendations should be followed as for the planning period.
pregnancy (within six months). These include: giving up
bad habits, healthy lifestyle, stimulation
immunity, nutrition, taking vitamins and so on.

Specialist advice

Both spouses should visit the following doctors:

  • therapist – the identification of chronic somatic pathology and its
    correction;
  • gynecologist (women) – to identify gynecological diseases;
  • Andrologist (men) – definition of dysfunctions in the male genital
    system;
  • urologist – the exception pathology of the urogenital system;
  • mammologist (women) – detection of diseases breasts;
  • Endocrinologist – the exception of endocrine disorders.

According to the testimony appointed additional consultations related
specialists (cardiologist, oncologist, ENT doctor and others).

Analyzes and instrumental diagnostic methods

The couple on the eve of the AI ​​assigned to surrender
analyzes and instrumental diagnostic methods:

  • general blood and urine tests are an exception to anemia, inflammation,
    allergic reactions, infections and other pathologies of the urogenital
    systems;
  • blood biochemistry (women) – assess the condition of the liver and kidneys,
    pancreas and heart, exclude exchangeable
    frustration;
  • coagulogram (women);
  • STI screening – to detect and treat hidden genital
    infections (chlamydia, ureaplasmosis, cytomegalovirus and
    herpes infections and others);
  • strokes for gonorrhea (men and women);
  • кровь на вирусные гепатиты, сифилис и ATИЧ-инфекцию;
  • blood for hormones (women) – sex, prolactin, FSH, LH,
    thyroid and adrenal hormones;
  • blood per group and Rh factor (exclude isoserological
    spouse incompatibility);
  • spermogram (men) – estimated number of live
    sperm and their activity, the volume of seminal fluid, its thickness
    and color;
  • Ultrasound (women) – gynecological sphere, kidney, thyroid
    glands, mammary glands;
  • fluorography, ECG.

Sperm preparation

Before carrying out AI it is necessary to prepare a semen. To this end
it is treated – the seminal plasma is separated from the active
sperm. This prevents proteins from entering the uterine cavity.
and prostaglandins from seminal fluid (can provoke a spasm
uterus and allergic reaction). In addition, the seminal plasma
has factors that reduce fertilizing ability
male germ cells. Sperm preparation also includes fast and
high-quality removal of not only seminal plasma, but also of the dead
sperm cells, epithelial cells, leukocytes and various
microorganisms. Today, several options are used.
sperm preparation:

  • The method of floating sperm

The essence метода состоит в самопроизвольном передвижении подвижных
sperm in the washing solution. ATсплывание мужских половых клеток
from seminal fluid avoids the centrifuging method,
during which damage to the sperm may be active
forms of oxygen. But данный способ подходит только для эякулята с
high concentration of active sperm. Duration of the procedure
is 2 hours.

  • Sperm washing

The most simple technique. Based on the removal of the liquid part
эякулята, что несколько улучшает подвижность sperm.
The ejaculate obtained is suspended in a washing solution, where
contains antibiotics and dietary supplements in a centrifuge tube. Then
the seminal fluid is centrifuged, resulting in
cells are precipitated, and the excess solution is drained. The resulting precipitate
washed again and centrifuged. Then сливают раствор и в третий
wash and centrifuge the precipitate once. Duration of cleaning semen
about 1 hour.

  • Sperm centrifugation

Sperm washing, при котором удаляется жидкая часть семенной
fluids, and active sperm are separated from “garbage”
(leukocytes, microbes, dead epithelium and sperm cells).
Centrifugation is repeated twice, the precipitate is again
diluted in washing medium and used for intrauterine
insemination. Duration of the procedure составляет 1 час.

  • Filtration of sperm through fiberglass

This semen cleaning option involves flushing the ejaculate,
centrifuging, re-washing and disposing of the obtained
sediment on fiberglass. The washed precipitate solution is filtered,
the resulting filtrate is collected for AI.

ATыбор времени для проведения ИИ

What day is desirable to spend AI? ATыбор времени для
insemination is determined by the calculation of the day of ovulation. Success
The procedure depends on the exact determination of the date of ovulation. Not так
long-term intrauterine insemination was carried out after examination in
2 – 3 cycles and functional tests
diagnosis, basal temperature measurement and determination
the concentration of progesterone in the blood in the middle of the second phase of the cycle. WITH
using research data was calculated estimated date
ovulation.

WITHегодня оптимальный день для процедуры инсеминации
calculated by the following methods:

  • Determination of the level of urinary peak LH

When reaching the concentration of LH in the urine of its peak, ovulation
takes place in 40 – 45 hours. AT связи с этим проведение ИИ
plan the next day.

  • Ultrasonic control over the growth of follicles

Follicles are determined by ultrasound when they reach 2 – 3 mm in
diameter. The rupture of the main follicle and the release of the egg occurs
when the size of the follicle 15 – 24 mm. The procedure is performed when
reaching a dominant follicle size of 18 mm or more and thickness
endometrium 10 mm.

  • ATведение фактора овуляции – ХГЧ.

ATведение хориогонина стимулирует овуляцию и целесообразно при
dominant follicle size 17 – 21 mm. Insemination
carry out in 24 – 36 hours.

On the eve of the AI ​​procedure

Prepare for the expected date of the AI ​​is necessary
start in 5-7 days. Men refuse to visit the sauna and
baths, and also avoid hypothermia. If possible, exclude
stressful situations and limit physical exertion. Before delivery
sperm to observe sexual repose, but longer than 2 – 3 days, since
longer temperance negatively affects the quality
sperm Refuse to take alcohol and smoke, or reduce
the number of cigarettes smoked. On the day of the procedure, the man should
come to the clinic in 60 – 90 minutes to donate sperm by
masturbation If the volume of ejaculate is too small, it is possible to “accumulate”
sperm For this, the spouse comes to the clinic several times and gives
sperm that is cleaned and frozen.

Women also need to follow some rules.
Refuse to take alcohol and smoke (ideally 6 months before
planned conception). Avoid unrest and stress, eliminate
physical exertion and weight lifting. Important for 3 – 5 days
observe sexual peace (sexual intercourse and orgasm can provoke
spontaneous ovulation). Tune in to success.

How is AI performed

How is the procedure of AI? The couple must appear in
clinic on the appointed day. While ejaculate is collected and
sperm treatment, a woman is once again examined by ultrasound,
confirm the occurrence of ovulation and ask to take a seat on
gynecological chair. The treated sperm is collected in a syringe without
needles on which the blunt tip is mounted (for
intra cervical insemination) or a plastic catheter (for
intrauterine insemination). After the introduction of gynecological
mirrors in the vagina tip as close as possible to
the cervix and the piston push the semen out of the syringe. When conducting
intrauterine insemination a catheter is inserted through the cervical canal.
in the uterine cavity, and then put pressure on the piston, pushing the semen.
For reliability, a cervical cap is put on the cervix,
which prevents semen from escaping from the uterus. Woman after
procedures should remain on the chair 60 – 90 minutes, after which it
let go home.

After performing AI

After the insemination, the doctor gives the patient a series of
recommendations, compliance with which increases the chances of success. Not
recommended:

  • take a bath on the day of the procedure (water with detergent
    means can penetrate the vagina, leading to death
    parts of the sperm and significantly reduce the likelihood
    conception);
  • to have sex within three days after the manipulation (although
    many experts do not prohibit intimacy);
  • lift weights and do hard physical work in
    within a week after AI (with successful fertilization of the egg
    physical work can disrupt the process of its implantation in the mucous
    uterus);
  • smoke and take alcohol (reduces the chances of fertilization,
    implantation and normal pregnancy);
  • take medicines without a doctor’s permission.

After the procedure, the patient is allowed:

  • take a shower on the day of the procedure;
  • to walk outside;
  • sunbathing.

AT некоторых случаях  врач может порекомендовать прием
urozhestana or duphaston. These drugs contain
progesterone, which prepare the endometrium to a successful
implantation of the ovum, and supports further development
of pregnancy. 12 – 14 days after the insemination to the patient
should come to the clinic and donate blood for hCG, which will confirm
произошедшее зачатие, имплантацию и развитие of pregnancy.

Pregnancy

If the AI ​​procedure is successful, then after a certain time,
but not earlier than 7 days, the woman shows signs
pregnancy: a change in taste and smell, emotional lability
(tearfulness, irritability), weakness, drowsiness, mild
nausea, possible vomiting, change in taste, and
appetite, engorgement of the mammary glands. The most reliable sign
come from subjective pregnancy after insemination is
no menstruation after 14 days or more. Confirm
pregnancy will help the rapid test in 10 – 14 days
after insemination and laboratory determination of hCG in the blood.
Ultrasound examination is recommended no earlier than 3–4 weeks after
manipulations. With the help of ultrasound confirmed the onset and development
pregnancy and its ectopic implantation is excluded, for example, in
fallopian tube.

Discharges and pain after AI

What should be the allocation after insemination? If the procedure
was successful, then the vaginal discharge is no different from
ordinary. There may be a slight hazy discharge in
день ИИ, что говорит о части вытекшей из половых путей sperm AT
the case of violation of the rules of asepsis (use of non-sterile
tools) when performing the procedure is not excluded
secondary infection with the development of the inflammatory process in
vagina and cervix. AT этом случае разовьется кольпит/цервицит,
accompanied by abundant white hair with an unpleasant smell and itching during
vagina. Also, after the AI ​​may appear nagging or aching pain.
lower abdomen due to irritation of the uterus and cervical catheter
and semen, not the last high-quality cleaning.

Indications for AI

Insemination is carried out according to certain indications, as from
women and parties to her sexual partner. Indications for AI в
case of women’s problems:

  • vaginismus;
  • chronic endocervicitis;
  • chronic endometritis;
  • surgery on the cervix or cicatricial deformity of the cervix;
  • abnormalities of development and localization of the uterus;
  • cervical factor – high viscosity of cervical mucus, presence
    antisperm antibodies;
  • allergic to her husband’s sperm;
  • gynecological diseases accompanied
    anovulation;
  • idiopathic infertility;
  • mild endometriosis.

Indications for AI со стороны мужа:

  • impotence (lack of erection);
  • hydrocele or inguinal-scrotal hernia significant
    sizes;
  • hypospadias;
  • pathological postcoital test;
  • abnormalities of the structure of the penis;
  • retrograde ejaculation (ejaculate enters urinary
    bubble);
  • sperm subfertility (reduced fertility
    sperm);
  • transferred radiation, chemotherapy;
  • bad habits;
  • impotence after spinal cord injury.

Indications for AI спермой донора:

  • azoospermia (absence of sperm in the ejaculate);
  • necrospermia (no live sperm in the ejaculate);
  • lack of a permanent partner with a woman;
  • genetic diseases of the husband;
  • incompatibility of spouses by blood type and Rh factor.

Contraindications

Artificial insemination is inappropriate in the following
situations:

  • endometriosis severe;
  • acute or exacerbation of chronic inflammatory processes
    female genitalia;
  • infectious diseases in her husband;
  • ovarian tumors and cysts;
  • cancer of any location in a woman;
  • the presence of contraindications to pregnancy;
  • infertility of a woman lasting more than three years;
  • no uterus, ovaries or tubes;
  • mental illness in a woman;
  • the possibility of eliminating infertility after treatment or
    operations.

ATопрос – ответ

ATопрос: Можно ли выполнить инсеминацию женщине в
40 years and older?

Да,  сделать инсеминацию можно в позднем репродуктивном
age, but it should be borne in mind that the older the woman, the
less chance of getting pregnant. Favorable outcome of the procedure
possible only in 5 – 15%.

ATопрос: WITHколько раз можно проводить процедуру ИИ
one woman?

ATрачи рекомендуют повторять процедуры ИИ не более четырех раз, а
in the absence of pregnancy after the 4th attempt to use
by IVF.

ATопрос: Какие шансы забеременеть при ИИ спермой
husband and AI donor sperm?

The effectiveness of AI with the husband’s sperm does not exceed 10 – 30%.
Insemination with donor sperm is more effective and pregnancy
occurs in 30 – 60% of cases.

ATопрос: When conducting ИИ увеличиваются ли шансы
on the onset of multiple pregnancy?

Notт, вероятность наступления многоплодной беременности после
performing AI is the same as after natural sexual intercourse. But
in case of stimulation of ovulation with drugs
maturation is possible not of one but of several eggs, which will increase
chances of multiple pregnancy.

ATопрос: Болезненна ли процедура ИИ?

Notт. ATозможно появление неприятных ощущений при выполнении
intrauterine insemination when a catheter is inserted into the uterus.

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