Infertility Treatments > Insemination > Husband Therapeutic

Inseminations can be used under several different circumstances. Parameters have been very well defined as to what constitutes a normal semen analysis. What options have a reasonable chance of success if the sperm count is compromised have also been well defined. We know, for example, that approximately ten million sperm are needed for inseminations to have a reasonable chance of success. Significantly lower sperm counts dictate consideration of more aggressive alternatives such as IVF and perhaps even ICSI. The first indication for inseminations is, therefore. compromised sperm counts. Inseminations also allow us to monitor the sperm count and be sure that continued attempts with insemination are warranted.

Inseminations are also indicated if there is, for some reason, decreased cervical mucus production. This can occur if there has been prior treatment of cervical dysplasia such as a LEEP procedure or laser therapy. Decreased cervical mucus production is also encountered frequently in women treated with clomiphene. (We, howeveer, do not use clomiphene except in very unusual circumstances.)

If anti-sperm antibodies are present, insemination is a good alternative. The vast majority of the antibodies to the sperm are prodcued by the cervix and expressed in the cervical mucus. Insemination bypasses the cervix, making anti-sperm antibodies a non-issue.

Perhaps most importantly,intercourse-on-demand gets old very quickly. The stress of "having to have sex" at specfied times on specified days takes a toll on the individuals and, sometimes, on the marriage itself. We therefore, often recommend inseminations as a means of obviating this issue. Most couples find insemination much less stressful than intercourse-on-demand.

Inseminations are more successful than is timed intercourse. This has been clearly shown in several studies. It has also been shown that two inseminations are more successful than one if the problem is a somewhat compromised sperm count, and the optimal timing seems to be 18 and 42 hours after hCG administration (to trigger ovulation). If the problem is endometriosis or unexplained infertility, one insemination has a success rate that is as good as two. Therefore, most commonly under these conditions we will recommend one insemination.

Our approach is this: If we are using ovulation induction, and if there are no other mitigating factors, we will often allow a couple to try to conceive with timed intercourse in the first cycle of ovulation induction. If that initial attempt is unsuccessful and we are going to attempt it again, we suggest inseminations as a means of improving the likelihood of success. If logistically feasible, we prefer to do two inseminations with timing as noted above. If two inseminations are not feasible, we do one at about 30-32 hours after hCG administration.

© 2005 Jarrett Fertility Group