What to do before an Artificial Insemination treatment?
After the first informative appointment and the recapitulation of all the patients’ clinical data, the next steps to follow are:
It should be performed during the first days of menstruation. The uterus and ovaries are visualized by ultrasound, counting the number of antral follicles in the ovaries.
It is performed between the second and fourth day of the menstrual cycle (FSH, LH, 17 b-Estradiol and prolactin). This analysis may coincide with the date of the gynecological examination. It can also be provided by the patient if it has been performed within the last 3 months.
All patients should have a complete serology work-up (both female and male) which should at least include HBsAg, anti-HBs, anti-HC, rubella and syphilis. In certain cases, and knowing the patient’s personal and family medical history, a complete blood count and biochemistry will be performed. It can be provided by the patient if it is up to date (less than 1 year) and in case of underlying pathology, if indicated, the number of analyses can be increased.
It is a necessary test to know if the patient’s fallopian tubes are permeable or not. It is performed between days 8 and 12 of the cycle and is essential to maximize the chances of pregnancy prior to treatment.
Seminogram and EMR
A semen sample from the couple is analyzed to count the total number of spermatozoa, the number of motile spermatozoa, their morphology and the study of other variables that may be relevant. In addition, a Mobile Sperm Retrieval (MSR) is performed, which consists of capacitating the sample and analyzing the amount of spermatozoa retrieved; this allows us to know the behavior of the sample and to choose the most appropriate capacitation technique for the day of insemination.
Male analytical tests
The basic study consists of complete serologies (HBsAg, anti-HBs, anti-HC, rubella and lues) and blood group and Rh. In case of an important underlying pathology that could be related to the subfertility process, further analysis and even a consultation with the urology team of the ERGO Clinic is offered.
How is the Artificial Insemination treatment?
Once the results of the previous phases indicate that the most appropriate technique to perform is still artificial insemination, the patient should contact the ERGO Clinic on the first day of the period in order to confirm the hormonal treatment regimen and dosage (gonadotropins) to be followed. Its administration is very simple (subcutaneous injections), and the patient can do it at home, but our nurse will explain everything necessary to do it correctly. Even if the patient requires it, she can be pricked by our nurse whenever she needs it.
As a general rule, treatment will begin on the third day of menstruation. At this time we will tell you the day you should go to the gynecologist or sonographer, which will take place approximately 4-5 days after starting hormone treatment. During this visit, a vaginal ultrasound will be performed to control the ovarian response and a blood test for hormone determination. Depending on the results, we will let you know the date of your next check-up.
When one or two follicles are observed to be optimally developed (approximately 18 mm in diameter), ovulation is triggered, generally with the hormone hCG, and insemination is scheduled. If follicular growth is not observed after several days with correctly administered medication, the stimulation is cancelled and new options are reconsidered. If the response is excessive (i.e. 3 or more developed follicles), the medical team of the ERGO Clinic also recommends cancellation, as the risk of risky multiple pregnancy (3 or more fetuses) is very high and carries many obstetric risks for both the mother and the fetuses. In any case, it is agreed with the patient.
This is the process of preparing the semen sample so that it is concentrated in motile spermatozoa and does not contain other cell types or seminal plasma. If the patient is going to use her partner’s sperm, he must come to the ERGO Clinic one hour before the scheduled insemination time. In case of using donor sperm or frozen sample, it is not necessary to come before the indicated time.
As the laboratory team already has the information from the previously performed EMR, they will train this sample with the most appropriate technique.
What about after insemination?
After the insemination, the patient can return home the same day by any means of transportation (car, train, plane) and continue to lead a normal life until the pregnancy test, which will take place 15 days later.
Remember that you will always have at your disposal our psychology team specialized in supporting couples in assisted reproduction treatments.
On the day of the insemination, the nurse, together with the progesterone regimen and the rest of the instructions given to the patient, will hand over the form for the pregnancy test to be performed at the ERGO Clinic. On the indicated day, the patient can come to the clinic at any time between 8 am and 8 pm, without the need to be fasting, and can lead a completely normal life. Our nurse will draw some blood and the patient will be able to go perfectly. We will have the results later in the day, and the medical team will call you to inform you of the β-hCG value.
If the test tells us that you are pregnant… Congratulations! The whole team will share with you that great moment, but we will also give you the basic instructions that you must follow from then on, such as medication guidelines, precautions in your daily life and, above all, we will give you the appointment for the ultrasound control for clinical pregnancy confirmation. It will be approximately 3 weeks after the result of the test, since it is at that time when you can visualize with guarantees the fetal heartbeat of your little one.
If, on the other hand, the result is not what we expected, don’t worry, we will not leave you alone in this hard moment. We will give you an appointment with the medical team for the date you want, and there we will solve all the doubts you may have, we will analyze with you what could have happened and above all what options there are to help you achieve your dream.
When is Artificial Insemination indicated?
- Mild seminogram alterations (moderate oligos or asthenos)
- Coital difficulties (e.g. vaginismus)
- Cervical mucus alterations
- Mild endometriosis
- Ovulatory alterations
- Infertility of unknown origin
Can donor sperm be used?
Yes, if necessary, our patients can request a sample from a sperm donor. This donor is selected by the medical staff of the ERGO Clinic in accordance with the provisions of Law 14/2006 on Assisted Reproduction, taking into account the maximum possible phenotypic and immunological similarity with the patient. (You can find more information in our Donors section).
If you have any doubts, remember that our first visits are completely free of charge. Ask for an appointment and we will be happy to help you.