When a couple that cannot conceive seek help from a fertility specialist, two of the choices that are usually offered are sperm insemination and in vitro fertilisation. The dilemma that the couples faces is whether to undergo sperm insemination first or opt directly for IVF. If the couple decides to try insemination first, how many attempts are sufficient before moving to IVF?
The relationship between cost and success is something that concerns couples and may affect their choice. Sperm insemination is a low-cost choice, with a price almost six times less than IVF. A great number of couples that visit our Centre choose insemination as the first line of treatment not only due to the low cost but also due to the milder hormonal stimulation needed and less psychological and physical discomfort.
Sperm insemination as a first choice of treatment may aid couples with:
- mild / moderate endometriosis
- mild / moderate oligoasthenospermia
The above indications cover around 65% of subfertile couples.
Sperm insemination and IVF:
The routine sperm insemination method is performed with 1ml of processed sperm that is placed in the uterus through a catheter and from there it travels to the fertilisation areas. Our new insemination method: intrauterine tuboperitoneal insemination (IUTPI) is performed with 10ml of inseminate, which contains the processed sperm sample. The cervix is sealed using the suitable DNB cervical clamp, the sample is inserted into the uterus and due to the increased volume of the inseminate the spermatozoa are pushed quickly to the fallopian tubes and the pouch of Douglas, where they will meet and fertilise the oocytes without losing their dynamic.
If the sperm sample is of low concentration, it is possible to combine 2 or even 3 samples (collected a few days before the insemination) in order to increase the number of spermatozoa inseminated. This technique is called sperm pooling.
Processing the sperm sample prior to the insemination is necessary for the removal of substances that are present in the sample and may affect the viability of the spermatozoa and the concentration of quick and normal spermatozoa.
The World Health Organisation (WHO) suggests 4 to 6 insemination attempts before the couple moves to IVF. IVF is a more expensive choice (almost 6 times the insemination cost) and is directly suitable for couples with with blocked or missing fallopian tubes, severe endometriosis, over six failed insemination attempts or those with severe oligoasthenospermia.
Insemination and ovulation inductions
Sperm insemination is possible with no hormonal induction of the ovaries. The success rates, however, in this case are quite around, around 15%. On the other hand, a mild hormonal stimuation may increase the success rates to 28-30%.
The success of the procedure depends on the woman’s age, the quality of the sperm sample and the response of the ovaries in the hormonal stimulation. According to the American Society for Reproductive Medicine, the success rates of routine insemination, with 1ml of inseminate is 20% per cycle. With our new method the success rates reach 30%.
For ICSI and IVF the success rates may go up to 65% in women less that 35 years of age and when the embryo transfer is performed on the 5th day developed at the blastocyst stage, 36% in women between the age of 36 to 40 years old and 25% in women between the years of 41 and 45 and always with blastocyst transfer.