Artificial Insemination with Partner’s Sperm (AIH)

What is AIH?

Artificial insemination with partner's sperm (AIH) is a technique involving the placement of a male partner's sperm sample into the patient's uterus. Post-collection, sperm undergo laboratory processing and selection, retaining only the 'best' to enhance fertilization chances. This assisted fertilization technique minimizes the distance between egg and sperm, facilitating gamete fusion without egg retrieval.

Artificial insemination is indicated for:

• Unexplained infertility;
• Cervical or tubal factors (anatomical and/or functional alterations of the cervix, cervical mucus, or one or both fallopian tubes);
• Mild to moderate alterations in certain seminal fluid parameters hindering sperm's reach to the uterus;
• Coital difficulties or impediments to sexual intercourse (e.g., vaginismus, vasectomy, recurrent impotence);

AIH compensates for male sperm abnormalities; sample preparation separates viable, motile sperm from inferior ones.

AIH is also used if the male partner experiences:

• Retrograde ejaculation (into the bladder) due to prostate surgery;
• Certain genital tract diseases, such as hypospadias, hindering intercourse;

Regarding women, AIH is indicated with:

• Mild endometriosis;
• Ovulatory dysfunction;
• Immunological factors (e.g., anti-sperm antibodies);

AIH eligibility requires at least one open fallopian tube and the man meeting minimum sperm parameters. AIH is also applicable to serodiscordant couples (HIV, Hepatitis B and C). If the man is a carrier, a sperm wash is performed.

Treatments: Intrauterine Insemination (IUI)

If conception fails after 12-24 months of targeted intercourse, investigating the cause is necessary.

Before AIH, the doctor interviews both patients, reviews medical histories, and orders tests to rule out hormonal dysfunctions, uterine and tubal pathologies, and seminal fluid abnormalities.

If conditions are unmanageable via pharmacological and/or surgical intervention, or procreation is improbable, medically assisted procreation may be indicated.

Based on infertility causes, the ART center specialist recommends AIH or a more suitable procedure.

Ovulation Triggering in AIH: How does it work?

AIH can be performed on a spontaneous cycle or with ovulation stimulation, starting on day 2 or 3 of the menstrual cycle.

The goal is to stimulate the ovaries to produce multiple follicles and mature 2-3 eggs, increasing the chances of fertilization.

Ultrasound monitoring adjusts medication dosage to optimize ovarian response. Follicle size and uterine lining thickness predict ovulation timing.

Generally, when two or three follicles reach ~18mm, human chorionic gonadotropin (hCG) injection triggers ovulation, determining the optimal insemination time.

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AIH Sperm Collection and Preparation

Seminal fluid for AIH is obtained via masturbation after 2-5 days of abstinence (to increase sperm count) or vas deferens puncture.

The sample undergoes laboratory preparation—selecting and concentrating motile sperm in a sufficient volume.

Artificial Insemination: How does it work?

Insemination is scheduled 36 hours post-hCG. The prepared partner's seminal fluid is introduced into the patient's reproductive system (uterine cavity, cervical canal, or tubes) via a catheter. The process is simple, painless, and similar to a gynecological exam.

A plasma hCG assay 14 days post-insemination confirms pregnancy.

How long to wait between two artificial inseminations?

The time between AIH procedures depends on the patient's health, previous treatment results, and fertility goals. Generally, fertility specialists recommend waiting at least one complete menstrual cycle.

This allows the woman's body to recover and prepare for the next cycle, enabling better ovulation monitoring and treatment adjustment for maximized success.

The frequency varies depending on the couple's situation. Multiple cycles may be needed, or success may occur on the first attempt.

Close collaboration with a fertility specialist determines the appropriate timing and frequency.

In conclusion, the recommended delay is at least one menstrual cycle, but frequency varies and should be determined with a fertility specialist. With proper advice and collaboration, many couples successfully conceive via AIH.

What to do after artificial insemination?

AIH is usually complication-free and painless. Post-insemination risks are limited, but response to ovulation-inducing medications should be monitored via ovarian ultrasounds and/or hormone tests.

If excessive follicle development occurs, treatment should be stopped to prevent:

• Multiple pregnancy;
• Ovarian hyperstimulation syndrome;

Other AIH-associated risks include:

• Miscarriage;
• Ectopic pregnancies;

Possible complications:

• Infections;
• Allergies to seminal wash components;
• Immunological reactions (anti-sperm antibodies);

What is the success rate of artificial insemination?

The success rate depends on factors like the woman's age, sperm quality, and number of ovarian follicles. The average success rate per cycle is 10-15%, but this varies considerably. Success can be achieved on the first attempt or after several attempts. Maintaining a healthy lifestyle, following the doctor's instructions, and managing stress enhance chances of success.

Artificial Insemination Results

AIH has good results; the probability of pregnancy is 10-15% per cycle.

Success rates vary based on:

• Causes of infertility;
• Couple's age;
• Seminal fluid characteristics;
• Type of pharmacological stimulation;

If conception fails after 3-4 AIH cycles, reassessment and consideration of more advanced procedures like in-vitro fertilization (IVF) are recommended.