Artificial insemination is a great opportunity for many childless couples to become pregnant despite fertility problems. Doctors support the sperm and ovum on their way to each other. Which Assisted Reproduction Technique (ART) is best suited depends on the individual situation of the couple. Get an overview of the methods, chances of success and risks of artificial insemination here.
The term artificial insemination conceals a number of fertility treatments. In principle, reproductive medicine helps a little in assisted reproduction so that the egg and sperm can find each other more easily and merge successfully.
The following three methods of artificial insemination exist:
Except for the semen transfer, artificial insemination is saturated outside the female body. Thus, sperm and egg must first be removed from the body and processed accordingly.
In many cases, a cycle monitoring takes place before artificial insemination. This means that doctors scrutinize the processes in the female body for a menstrual cycle. This usually requires three to four ultrasound appointments and blood samples. On the one hand, cycle monitoring serves to detect the cause of unwanted childlessness. On the other hand, the findings help the doctor to find the right treatment for a couple and if, for example, a hormone treatment is necessary.
The course of an artificial insemination depends on the organic causes of infertility (infertility). Only after a precise diagnosis, the doctor can decide which procedure is best.
Even if every reproduction technique goes a bit differently in detail, the following steps can be distinguished.
To help with fertilization, the doctors need sperm. There are different methods for removal. Which one is chosen depends on the extent to which there are disorders in the man. Basically possible are:
TESE and MESA are shorthand for two surgical procedures used in men with a deficient spermogram. With these surgical procedures, sperm from either the testes (TESE) or epididymis (MESA) can be harvested for ICSI (Intracytoplasmic Sperm Injection). Learn here which operation helps when and how it is ordered to the success of TESE and MESA.
Since the beginning of the 1990s, men with a poor spermiogram can be helped: Thanks to the ICSI, in principle only one fertile sperm cell is needed for successful fertilization. To detect these, the two techniques promise TESE and MESA. Because in about half of all apparently infertile men can be found in the testes still areas with spermatogenic activity.
The procedures are small operations on the testicles or epididymis. MESA stands for microsurgical epididymal spermatozoa aspiration, ie epididymal puncture, and TESE for testicular spermatozoa extraction, ie an extended testicular biopsy.
A tissue-sparing minimally invasive variant is the Mirko-TESE (microsurgical extraction of testicular tubular segments), which is preferably used in small testes. Following a TESE or MESA, artificial insemination (ICSI) can be performed.
In MESA, the epididymides are punctured with a fine needle (cannula) and the epididymal fluid is assayed for active mature sperm (epididymal spermatozoa). The procedure is performed under general anesthesia and with the aid of a surgical microscope. It is a bit more expensive than the testicular sperm extraction. Subsequently, the semen sample is stored by cryopreservation and processed shortly before the ICSI.
In TESE, testicular tissue is removed from one or both sides and examined. The surgery is outpatient and under local anesthesia or general anesthesia. About a small, about one to two centimeters long skin incision on the scrotum (scrotum), the surgeon exposes the testicles.
Subsequently, at least three small tissue samples are obtained and examined immediately in the laboratory. The further procedure depends on the laboratory results. If necessary, further biopsies are necessary. If active and fertile sperm are contained, the tissue is frozen. Only before the ICSI you can thaw the sample and remove the sperm. After completion of the TESE, the wound is closed with self-dissolving sutures and a compression bandage is applied to the scrotum. Afterwards, the patient has to take a few days off and abstain from sex for one to two weeks.
In order to have mature eggs for artificial insemination, hormone therapy is sometimes necessary. After the doctor examines the ovaries and determines the hormone levels, one of two hormonal methods can stimulate egg maturation:
The standard procedure is the short protocol, which begins with the onset of the menstrual period. From the second or third day of the cycle, the patient injects the stimulating hormone (FSH, FSH / LH, HMG) daily under the skin of the abdominal wall via an injection syringe or is helped by her partner. A second hormone suppresses premature ovulation (so-called antagonists) and is also injected.
In the long protocol, natural ovulation is hormonally suppressed before the actual stimulation. For this purpose, the responsible hormone, the so-called "gonadotropin releasing hormone" (GnRH) from the pituitary gland is blocked by medication (administration of a GnRH agonist). This can be done as a depot or daily syringe or via a nasal spray. It takes up to two weeks for the controlled stimulation of egg maturation to begin. This procedure is used less and less frequently. During the hormone administration for oocyte stimulation, the doctor also monitors the growth and maturity of the follicles in both protocols by ultrasound and hormone analysis.
The following possibilities of egg retrieval (puncture) exist:
After external artificial insemination (ICSI, IVF) the insertion of the fertilized eggs into the uterus (transfer) is the most important step on the way to pregnancy. If this happens within three days of fertilization, it is called embryo transfer. With a liberal interpretation of the Embryo Protection Act, it is possible to cultivate several fertilized ova. However, after a culture period of up to six days, only a maximum of two embryos may be transferred. Surplus but viable embryos can be frozen (cryopreserved) and non-developable embryonic stages discarded. However, there is no clear legal certainty for this frequently practiced German middle ground.
At what point the transfer should best happen is individually different.
If more eggs are available, it may be useful to wait a little longer. By developing new nutrient solutions, the oocytes can continue to grow outside the female body for up to six days.
If the cells divide after fertilization, blastomeres develop from the oocytes within the first three days, which then reach the stage of the blastocyst on the fifth day. Only 30 to 50 percent of all fertilized cells make it here. If the transfer occurs five to six days after fertilization, it is called blastocyst transfer.
Chances that these cell structures implant in the uterus, are usually better, because the lack of time or a defective development can be detected early and unsuitable cells are not even used. In the direct comparison of the pregnancy rates of embryo and blastocyst transfer, however, there are hardly any differences.
Artificial insemination helps couples who have a fertility disorder (male infertility, female infertility) or lesbian couples to a child. Even cancer patients before chemo- or radiotherapy, the artificial insemination offers opportunities for a later desire to have children.
Best regulated is artificial insemination in Germany for married heterosexual couples. In addition to a solid partnership, you must meet additional requirements, for example:
For the anonymous sperm donation is in Germany a solid partnership, at best, with marriage certificate, duty. Women without partners have little chance of artificial insemination. Single women with a desire to have children will find it difficult to find a doctor or a sperm bank to perform artificial insemination. Reason are legal gray areas. For single women from Germany, therefore, countries like Denmark, where anonymous sperm donation is allowed, are attractive or they try a so-called home or self-insemination.
Not all couples have artificial insemination success. Sometimes it is a rocky road with failures, setbacks, mentally and physically burdening. Artificial insemination is also reaching its limits.
Artificial insemination does not work indefinitely. The best chances, women have to 35. Thereafter, the pregnancy rate decreases rapidly with artificial insemination and goes in women over 45 against zero. The reason for this is the quality of the eggs, which decreases with age. The older the woman, the higher the risk of miscarriages and birth defects. If the trend towards late family formation persists and egg donation is banned, freezing egg and sperm cells at a young age (social freezing) could become more important.
Whether artificial insemination is successful depends on individual factors such as the fertility disorder, age, mental stress and the method used. The birth rate per treatment cycle can therefore only roughly be estimated for each technique and varies between 10 and 20 percent depending on the method.
If there is no pregnancy after several fertilization attempts, it is depressing and difficult for the couple to accept. But also medicine is sometimes limited - physically, methodically and from the law side. Not everything that is technically possible is allowed in Germany.
The Embryo Protection Act regulates in this country, which methods and interventions the doctor may perform. It should avoid a commercial and unethical use. According to the law, the embryo is a fertilized, developable egg. A pregnancy with a surrogate mother, with foreign egg cells (egg donation), sperm deceased spouse and a sex selection in sperm (except for serious genetic hereditary diseases) is not allowed for artificial insemination in Germany.
Risks and complications are also present in artificial insemination. The following problems can occur:
Multiple pregnancies due to artificial insemination: Twins are not uncommon, as usually two embryos are used. In addition: Twins tend to premature and caesarean delivery.
Slightly increased rate of miscarriage (mostly due to the older age of women)
In spite of all the risks and complications, artificial insemination offers, of course, the biggest advantage: the chance of fulfilling the longed-for wish to have children despite a fertility disorder, cancer or homosexual partnership.
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