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Artificial insemination

Having a baby is the dream of millions of couples around the world, and when it is not fulfilled after a period of more than twelve months of having frequent sexual intercourse and without contraceptive protection, an infertility problem is suspected.

Currently, fertility rates are in decline around the world, especially in industrialized countries, where the population is projected to decline dramatically over the next 50 years, and while much of the population chooses to delay the arrival of children, there is another percentage suffering from infertility problems.

 

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According to the National Population Council (CONAPO), in a 2019 study, 1.4 million Mexicans require some assisted reproduction technique since it is estimated that 17% of women of reproductive age suffer from infertility. And while men are also known to suffer from this condition, there is not enough data to estimate a percentage.

In the United States, the fertility rate has declined in recent years; a report conducted in 2017 revealed that the fertility rate nationwide was 1,765 per thousand women : the lowest number of births in 30 years, which represented 16% less than the level needed for the population to be replaced, which is 2,100 births per thousand women. Only two states reported a rate above the replacement level: South Dakota, with a rate of 2,227; and Utah, with a rate of 2,120.

It is a fact that fertility rates decrease in the United States, only between 2007 and 2017 the rate fell by 12% in rural counties, 16% in suburban counties and 18% in metropolitan counties. In particular, the state of California has had a 2.2 to 1.5 decline in its fertility rate, especially in Latin women and even fertility rates among teens have declined considerably.

Fertility Table in the United States from 2007 to 2015

 

Estados   2007  2008  2009​  2010  2011  2012  2013  2014  2015 
Utah  2.62  2.59  2.47  2.45  2.38  2.37  2.34  2.33  2.29 
South Dakota 2.14  2.35  2.28  2.27  2.25  2.27  2.27  2.27  2.27 
North Dakota 2.12  2.13  2.12  2.04  2.08  2.12  2.14  2.24  2.16 
Alaska  2.32  2.40  2.27  2.35  2.28  2.19  2.22  2.19  2.17 
Nebraska  2.29  2.29  2.27  2.14  2.11  2.12  2.12  2.16  2.15 
Idaho  2.48  2.47  2.27  2.24  2.15  2.19  2.13  2.15  2.13 
Texas  2.39  2.36  2.29  2.16  2.07  2.08  2.07  2.09  2.07 
Kansas  2.27  2.24  2.19  2.16  2.09  2.12  2.04  2.05  2.05 
Oklahoma  2.22  2.20  2.15  2.11  2.04  2.04  2.04  2.03  2.00 
Iowa  2.14  2.10  2.07  2.01  1.97  1.99  2.00  2.02  2.01 
Hawái  2.28  2.33  2.23  2.15  2.11  2.10  2.08  2.00  1.97 
Wyoming  2.28  2.28  2.14  2.04  1.98  1.99  1.99  1.99  2.01 
Arizona  2.42  2.31  2.11  2.07  2.00  2.00  1.97  1.97  1.92 
Arkansas  2.20  2.16  2.07  2.00  2.00  1.97  1.94  1.97  1.98 
Kentucky  2.08  2.05  2.00  1.97  1.94  1.95  1.95  1.96  1.95 
Luisiana  2.16  2.07  2.02  1.95  1.91  1.92  1.93  1.96  1.96 
Montana  2.08  2.08  1.89  1.99  1.96  1.96  1.97  1.95  1.96 
Minnesota  2.15  2.10  2.04  1.96  1.95  1.94  1.94  1.94  1.93 
Indiana  2.11  2.09  2.02  1.97  1.95  1.93  1.92  1.93  1.93 
New Mexico  2.26  2.23  2.14  2.06  2.00  1.98  1.93  1.91  1.90 
Misisipi  2.28  2.20  2.06  1.96  1.94  1.89  1.88  1.89  1.87 
Ohio  2.00  1.98  1.93  1.90  1.88  1.89  1.88  1.88  1.87 
Misuri  2.07  2.05  1.96  1.94  1.92  1.89  1.88  1.87  1.86 
Nevada  2.42  2.31  2.12  1.96  1.91  1.87  1.86  1.87  1.86 
Georgia  2.25  2.17  2.05  1.96  1.93  1.88  1.86  1.87  1.85 
Tennessee  2.10  2.07  1.95  1.88  1.87  1.87  1.85  1.87  1.85 
Wisconsin  2.01  1.99  1.95  1.89  1.87  1.86  1.84  1.85  1.85 
Washington  2.02  2.04  1.97  1.91  1.89  1.88  1.84  1.85  1.82 
California  2.20  2.15  2.05  1.95  1.90  1.89  1.84  1.84  1.79 
Míchigan  1.91  1.87  1.85  1.85  1.84  1.82  1.83  1.83  1.81 
North Carolina  2.14  2.12  2.01  1.91  1.86  1.84  1.82  1.83  1.82 
Alabama  2.07  2.06  1.95  1.87  1.84  1.81  1.79  1.83  1.83 
Maryland  2.05  2.03  1.95  1.89  1.85  1.83  1.79  1.82  1.80 
West Virginia 1.92  1.90  1.86  1.83  1.84  1.85  1.86  1.81  1.78 
Virginia  2.06  2.02  1.94  1.88  1.85  1.84  1.81  1.81  1.80 
New Jersey 2.09  2.05  2.00  1.90  1.88  1.85  1.81  1.81  1.80 
Illinois  2.04  1.99  1.94  1.88  1.84  1.82  1.79  1.81  1.81 
South Carolina 2.14  2.12  1.99  1.88  1.84  1.82  1.80  1.80  1.79 
Delaware  2.12  2.11  1.99  1.94  1.90  1.85  1.79  1.79  1.81 
Colorado  2.09  2.05  1.98  1.92  1.85  1.83  1.79  1.77  1.75 
Florida  2.11  2.05  1.92  1.83  1.80  1.77  1.77  1.77  1.77 
Pensylvania  1.95  1.93  1.85  1.81  1.80  1.78  1.75  1.76  1.74 
Nueva York  1.92  1.88  1.87  1.81  1.79  1.77  1.73  1.73  1.71 
Oregón  1.97  1.95  1.84  1.79  1.76  1.74  1.73  1.72  1.70 
Maine  1.78  1.73  1.72  1.70  1.67  1.68  1.67  1.66  1.64 
Connecticut  1.92  1.87  1.80  1.72  1.71  1.66  1.63  1.63  1.61 
Vermont  1.71  1.67  1.62  1.66  1.63  1.61  1.59  1.63  1.58 
New Hampshire 1.75  1.71  1.67  1.67  1.67  1.61  1.60  1.58  1.59 
Massachusetts 1.79  1.77  1.71  1.67  1.67  1.63  1.60  1.58  1.55 
Rhode Island 1.75  1.73  1.67  1.63  1.60  1.59  1.57  1.56  1.58 
Columbia District 1.75  1.79  1.73  1.65  1.64  1.61  1.53  1.52  1.48 
United States 2.12  2.08  2.00  1.93  1.89  1.88  1.86  1.86  1.84 

 

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This infertility is due to an evolutionary phenomenon, both, from a biological and social point of view. Since more and more women delay motherhood for after their 35 years, an added factor to diseases such as; polycystic ovary, endometriosis, diabetes mellitus, among others which cause fertility problems.

Facing this situation, couples are increasingly approaching assisted reproduction clinics looking for methods that help them fulfill their dream of having a baby out of their love. Below we will tell you everything you want to know about artificial insemination, join us to read.

 

What is artificial insemination?

Artificial insemination is an assisted reproduction method of low complexity, whose purpose is to deposit spermatozoa, previously treated inside the woman´s cervix with the use of high specialty instruments.

This technique is performed after the patient’s menstrual cycle has been monitored as the semen deposit must be performed at the time the egg is released. Since it is a copulation replacement, women can resort to treatment even if they do not have a male partner, and just go to a sperm bank to have anonymous sperm donors.

 

Fertility problems that can be fixed

  • Female sterility due to cervical factor. The cervix communicates the vagina with the uterus, it is the duct through which a baby is born by vaginal delivery, and its function in fertility is to let the sperm pass through to fertilize the egg. Therefore, an alteration in the cervix leads to a sterility problem due to cervical factor, which affects between 5 and 10% of couples; the alterations are anatomical or functional and both prevent the sperms path to the uterus and fallopian tubes.
  • Mild or moderate endometriosis. This chronic benign disease affects 10 to 15% of reproductive age women, and consists of the abnormal growth of endometrial tissue outside the uterine cavity. In addition to causing infertility, it causes a lot of discomfort to women, especially when the growth occurs in the pelvic cavity or invades other organs such as the intestine.
  • Alterations in the ovulatory cycle. This situation is common in women suffering from polycystic ovary, anovulation or problems in the follicular phase. As there is no egg available, fertilization cannot occur.
  • Inability to deposit semen in the vagina. This situation can occur due to cases of retrograde or premature ejaculation, vaginismus or sexual impotence.
  • Mild male factor. It is a slight alteration in the seminal parameters, however a minimum of sperm is required to be successful in an artificial insemination treatment with samples from the couple; otherwise, you can resort to a sperm bank or other alternatives.
  • Sterility of unknown origin. It is currently known that infertility is a multifactorial problem: 30% is due to female causes, 30% to negative causes, in 20% both have alterations, and in the remaining 20% the reasons are unknown. That means, results of the usual tests are within normal parameters, so it is not known what is the cause that prevents pregnancy.
  • Sterility of immunological cause. This situation is very rare and the mechanism by which it works is unknown. It consists of the manufacture of female antibodies that destroy sperm.

 

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Artificial insemination types

Artificial insemination types

  • Homologous or conjugal artificial insemination (IAC). The couple’s sperm is used, with a success rate of 15 to 25%.
  • Heterologous or donor artificial insemination (IAD). A sperm bank is used to obtain the sample, with a success rate of 20 to 30%

 

Artificial insemination process

  • Ovarian stimulation. Stage that lasts between 10 and 12 days in which the patient must administer the hormonal drug daily in the dose indicated by the specialist, in order to stimulate the ovary in a controlled way, so that more than one egg matures, which is normal.
  • Follicular preparation/control. For AI only one to two follicles are required, unlike IVF, in which more than 5 may be required; inside these follicles the eggs develop, although sometimes they are empty. The specialist controls the maturation of the follicles by means of a transvaginal ultrasound and when they reach a size of 16 to 18 millimeters ovulation is induced by the hormone hCG, whose role is the egg release by the follicles into the fallopian tubes, waiting for the sperm to be fertilized.
  • Semen preparation sample. The semen sample is obtained through masturbation after a period of sexual abstinence of between 3 and 5 days, in order to process through sperm training to obtain quality sperm, eliminating immobile, dead sperm and seminal plasma. This process is carried out on the day on which the AI is carried out in case it is homologated; if you are a heterologist, the semen sample must have been frozen for a minimum period of six months, and thawed on the same day of insemination.
  • Insemination. The doctor will introduce the cannula loaded with sperm from the vagina to the cervix and monitor the process through an abdominal ultrasound, allowing the specialist to avoid tearing the patient’s uterine walls as this could affect the implantation of the embryo. It is not a painful process, but it is a bit uncomfortable: similar to a gynecological check-up or a cytology.

 

Considerations before and after the procedure

Before the procedure

About 30 days prior to the AI, the specialist will give the hormonal medications to the patient to control her ovulation and facilitate the process, although this may not be done if her cycle is regular.

On the intervention day, if the semen sample will be taken, the couple must arrive two hours before the procedure but if it is frozen, they will arrive at the indicated time. While it is not necessary fasting for the procedure, it is recommended to have a light meal, without a lot of fluids and also important to arrive previously showered.

After the procedure

Once the insemination is done, the patient should rest for 15 to 30 minutes, and then she can continue with her normal life, with the indication of not making excessive efforts, carrying a lot of weight or having too much stress.

It is important to be patient and wait for the date the specialist tells you to take the pregnancy test. This period is 12 to 15 days for the blood for the beta-hCG hormone test which indicates if the implantation took place. Doing the test ahead of time can give false results.

 

Frequently asked questions

How do I know if I am a candidate?

Candidates for artificial insemination should be in good general health, have permeable fallopian tubes, and be ovulating on the day of the procedure. It is recommended as a treatment option for women with endometriosis, with a hostile cervical condition, when their partner has little or low sperm quality, or if they do not have a male partner.

Semen origin?

Semen can be obtained from the partner, a sperm bank, or a donor, a patient´s relative or friend; it is then processed in the laboratory in order to select the best quality spermatozoa.

How long does it take?

The procedure lasts between 10 to 15 minutes, depending on the characteristics of the patient’s cervix. In case the cervix is closed it may take longer.
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After artificial insemination, can you have sex?

While the specialist will give you indications after the procedure, in general there are no problems in having sex after the AI; in fact, the uterine contractions that occur during orgasm help sperm advance to the fallopian tubes.

Can I be a single mother by artificial insemination?

Yes, in fact it is increasingly common for single women or women with same-sex partners to resort to this technique to start a family with a child of their own.

Are In Vitro Insemination (IVF) and artificial insemination the same thing?

No. The difference lies in the technique; AI seeks to reduce the distance between the egg and the sperm so that there is fertilization in a natural environment, while in IVF the egg is joined with the sperm in a laboratory, so fertilized embryos are transferred to the uterus that evolve to give rise to pregnancy.

How much does an artificial insemination cost?

It depends on the type of treatment that the patient requires, as well as the place where it is performed. In general, AI techniques are cheaper than other assisted reproduction treatments such as IVF, and it is important that the couple considers that the cost does not include medication, nor the use of samples from a sperm bank.

What are the chances of getting pregnant at the first artificial insemination?

The success rate of AI depends on factors such as the woman’s age, her lifestyle (alcohol and tobacco consumption decrease the chance of getting pregnant), overweight, obesity, diseases and problems with cervical mucus.
In general, the success rate of AI is 15 to 20% per cycle, and after four attempts a cumulative rate of 45 to 50% can be achieved.

 

Are there risks in artificial insemination?

While problems associated with AI are rare, the following may occur:

  • Ovarian hyperstimulation syndrome. It is a consequence of hormonal medication in which the female organism has an excessive response, but the risk of it occurring is low since the patient is monitored by transvaginal ultrasound.
  • Multiple pregnancy. The stimulation of the follicles carries the risk of multiple pregnancies in young people, however the procedures are oriented in the prevention of this case, which involves risks during pregnancy and childbirth.
  • Ectopic pregnancy. All assisted reproduction procedures carry an ectopic pregnancy risk, that is, nesting in the fallopian tubes, which involves surgical treatment to interrupt gestation.
  • Infections. They are rare since assisted reproduction clinics have asepsis strict protocols and instruments and facilities sterility, but there is always a small chance of them occurring.

 

Where to approach?

If you live in Tijuana, or you live in North America and you are looking for a more accessible option than in your country to get pregnant, come to The Fertility Center clinic, where we have highly trained specialists, with high specialty medical equipment, and high success rates with procedures like embryo freezing, so that you fulfill your dream of being a mother.

We will gladly assist yo! Call the following phone numbers: 664 231 1020 and 858 8674090, send us an email to hello@thefertilitycentermexico.com or through our contact form.

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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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