Types of Artificial Insemination
1.) Insemination
Insemination involves injecting prepared motile sperm into the uterus, cervix, or oviduct using a syringe or soft catheter. Insemination may be recommended for patients with poor sperm quality or quantity and cervical disease. The success rate of this fertility treatment is 10-25%.
If the injection is made with a catheter through the cervical canal directly into the uterus, it is called intrauterine insemination (IUI). To avoid severe allergic reactions, only purified sperm can be used in this method. For this purpose, dead sperm and other cells are removed from the ejaculate and the remaining live sperm are frozen with a preservative to ensure optimal ph. On the day of ovulation, the sperm are then transferred directly into the woman's uterus.
In intracervical insemination (ICI), sperm containing all the ejaculate and natural fluids are injected high into the woman's vagina near the uterine cervix. Only the most motile sperm pass through the cervical mucus into the uterus, similar to natural intercourse.
In intratubal insemination (ITI), the sperm are injected directly into the fallopian tube. This allows them to travel a shorter distance to the uterus. Just as in intrauterine insemination (IUI), the sperm are prepared and purified beforehand.
Depending on the sperm donor, we speak of homologous or heterologous insemination. In homologous insemination, the sperm of the patient's partner is used; in heterologous insemination, the sperm of a donor is used.
Please note that sperm donation is prohibited by law in Turkey.
2.) In Vitro Fertilization (IVF)
In vitro fertilization, or IVF for short, is the best-known method of artificial insemination. Here, fertilization takes place in a special test tube.
On July 25, 1978, Louise Brown was born, the world's first baby conceived through artificial insemination. The date is considered the birth of IVF.
IVF is preceded by medication for the woman. First, the woman's natural ovulation is suppressed. After about 14 days, the egg maturation is stimulated by administering the appropriate hormones. This takes place over a period of about 11 days, during which the blood values and the size and maturity of the eggs are regularly checked by ultrasound.
As soon as enough eggs have matured, ovulation is induced with a hormone injection.
The eggs are then removed from the follicles through the vagina. This is done on an outpatient basis.
The eggs are placed in a test tube in a nutrient solution together with the partner's sperm. After about 16 to 20 hours, it is possible to see whether fertilization has taken place or not.
If fertilization has been successful, 3 to 5 days after egg collection the embryos are transferred through the vagina into the uterus. The number of embryos that can be transferred is regulated by law, please see "What you should know before treatment in Istanbul, Turkey" for details.
If the embryo implants in the uterus and pregnancy begins, this can be detected by measuring the pregnancy hormone HCG in the blood approximately 14 days after the transfer.
One month after embryo transfer, ultrasound is used to determine whether the embryo is alive and whether it is a singleton or multiple pregnancy.
The success rate of IVF treatment is 25-30%.
3.) Intracytoplasmic Sperm Injection (ICSI)
Just like IVF, ICSI involves fertilization in a test tube, this method is considered a variant of IVF. The difference between the two procedures is the fertilization procedure of the egg.
The preparation of the woman is the same. After the mature eggs of the women are collected, spermatozoa are obtained from the male partner either from the ejaculate or surgically from the testicles or epididymis.
One of these sperm cells is injected directly into the woman's egg in the laboratory. The ICSI method is also checked after approximately 16 to 20 hours to determine whether fertilization has taken place or not.
This method is often used when there are too few sperm cells in the male partner's ejaculate, the sperm motility is too low or he is leading under an obstruction of the spermatic ducts.
The success rate of ICSI is about 25%.
4.) Intratubal gamete transfer (GIFT)
Intratubal gamete transfer, also known as GIFT for short, is a mixture of insemination and in vitro fertilization.
This method is used when the causes of infertility are unclear or in cases of endometriosis. When there is endometriosis, tissue similar to endometrium is deposited outside the uterus.
In this method, too, the woman is prepared for the procedure with hormone therapy. After ovulation of the mature eggs has been induced, they are retrieved.
Then the eggs and the sperm are transferred separately into the oviduct. This is done either with the help of a catheter through the cervix or through the abdominal wall.
The actual fertilization of the eggs takes place in the oviduct. The egg then migrates naturally to the uterus and nests there.
The success rate is about 20%.