How Does Artificial Insemination Work?

Artificial insemination is a procedure that places sperm into the cervix or uterus around the time of ovulation in hopes of becoming pregnant. Infertility is the most common reason people use artificial insemination.

Other reasons include being in a same-sex relationship, having a transgender partner, or being single and wanting to have a child. There are different types of artificial insemination with varying costs.

This article discusses artificial insemination, including the types, costs, and alternatives.

Goal of Artificial Insemination

Artificial insemination sometimes is a first step for someone who may be interested in getting pregnant. Artificial insemination increases the chances of pregnancy by placing semen or concentrated sperm into the vagina, cervix, or uterus. The procedure is done as close to ovulation as possible to increase the chances of fertilization.

About 20% of heterosexual women in the United States cannot get pregnant after one year of trying. Nearly half of those infertility cases are due to male factors, which includes problems such as a low sperm count, low motility (inefficient movement of sperm), abnormally shaped sperm.

Types

During natural conception, sperm travel from the vagina, through the cervix (opening of the uterus), into the uterus, and up the fallopian tubes, where egg fertilization occurs. Artificial insemination is often the first intervention to assist in conception if traditional methods (intercourse) haven't resulted in pregnancy. The different types of artificial insemination include:

• Intracervical insemination (ICI): A trained healthcare provider performs ICI in a clinic. The semen is injected directly into the cervix using a syringe and tubing. The semen does not need to be washed (seminal fluid removed) before this procedure.
• Intrauterine insemination (IUI): A trained healthcare provider places sperm into the uterine cavity using a syringe and catheter. Sperm washing is done to remove and other substances, and to concentrate the sperm in the sample to be placed in the uterus. IUI was slightly more effective than ICI, with a pregnancy rate of 40.6% vs. 37.9% after six cycles.
• Home insemination: Fresh sperm from a donor or frozen sperm from a sperm bank is placed into the vagina at the cervical os using a syringe, cervical cap, or menstrual cup. Home kits are available if using fresh sperm. If you order frozen sperm, a kit will be provided.
  

Process

Artificial insemination is a low-risk and noninvasive procedure conducted in a clinic or the comfort of your home. However, there are key considerations when performing artificial insemination.

Ovulation

Whether having artificial insemination in a clinic or your home, an essential factor is ovulation. Many people undergoing artificial insemination will take medications that help induce ovulation. These medications can cause more than one egg to be released, which can result in more than one embryo developing and implanting. These medications are also used for people who do not ovulate on their own.

The following classes of drugs are often used to induce ovulation during artificial insemination:

• Clomid (clomiphene citrate)
• Aromatase inhibitors
• Gonadotropins

Monitoring for signs of ovulation is essential to successful artificial insemination. You can check for ovulation by tracking your menstrual cycle (ovulation occurs between days 12 and 14 of a 28-day cycle), using an at-home urine test that predicts ovulation, and assessing your cervical mucus, which becomes thinner and slippery during ovulation.

Timing of Insemination

Artificial insemination usually occurs close to the time of ovulation so the sperm is in the fallopian tube, ready to fertilize the egg. Healthy sperm can live for several days in the female reproductive tract.

The Procedure

If artificial insemination occurs in a clinic, a healthcare provider will place a speculum into the vagina to visualize the cervix. A sperm-filled syringe with tubing attached will be placed in either the cervix or uterine cavity, where the contents of the syringe will be emptied. It takes a few minutes and could be mildly uncomfortable. Some people may experience cramping or light bleeding.

At-home artificial insemination is performed in a recumbent position (lying down) with a pillow under the hips. You or your partner will use a syringe or cervical cap (or menstrual cup) to deliver the sperm into the vagina at the cervix level. If the sperm is frozen, allow it to thaw for 15 minutes before the procedure.

Success Rates

It can take several rounds of artificial insemination to become pregnant. Factors that affect successful artificial insemination include:

• Maternal and paternal age
• The health of the sperm
• Condition of the female reproductive organs (blocked fallopian tube, endometriosis, etc.)
• Use of ovulation-inducing medications
  

If you are wondering what your specific success rate with artificial insemination is right for you, speak with a healthcare provider or a fertility specialist.

Risks

Although artificial insemination is usually a low-risk procedure, people can experience the following risks:

• Infection of reproductive organs
• Increased number of eggs released by the ovary
• Multiple pregnancies (twins, triplets)

Estimated Cost and Insurance Coverage

Due to limited fertility coverage by private insurance and Medicaid, artificial insemination can cost thousands of dollars out of pocket, especially when numerous rounds may be needed. Many insurance companies don't consider fertility treatment medically necessary, and some states are not mandated to cover infertility services.

Check with your insurance company, state law, and local family planning organizations to help calculate the cost of artificial insemination in your area. Generally, the average price of one round of IUI is $300-$3,000.

In Vitro Fertilization vs. Artificial Insemination

In vitro fertilization (IVF) is an alternative to artificial insemination. During IVF, the egg or eggs are removed from the ovaries and fertilized by the sperm in a lab to create embryos. An embryo can be transferred into the uterus several days later, or it can be frozen and saved for future use. Healthy embryos that are not put in the uterus can be frozen for future use. IVF is much more expensive than artificial insemination and is often used for male infertility issues or tubal factor infertility.

Summary

Artificial insemination is a noninvasive procedure that places sperm directly into the cervix or uterus, increasing the odds of pregnancy. There are several types of artificial insemination, some of which must be done by a trained healthcare provider. Home artificial insemination is also available.

Artificial insemination costs vary based on insurance coverage and your state. Although infertility is the most common reason for artificial insemination, this procedure is a valuable fertility option for LGBTQ+ families. Invitro fertilization is an alternative to artificial insemination.