Insemination with partner sperm

Insemination with the partner’s sperm, i.e. the sperm are injected directly into the uterus, may enhance the chances of pregnancy in couples with unexplained infertility, slightly to moderately reduced sperm quality or irregular ovulation.

In order to achieve pregnancy after insemination, there must be passage through the fallopian tubes in order for the sperm cells to swim up into the fallopian tubes, following which fertilization can take place in the outer layer of the fallopian tube.

If you are not quite sure that your fallopian tubes are intact, we will perform hysterosalpingo contrast ultrasonography to evaluate the tubal passage patency.

Insemination with partner’s sperm may also increase the pregnancy success rate in couples where the male’s sperm quality is slightly to moderately reduced.

If the sperm quality is heavily reduced, pregnancy can only be achieved using in vitro fertilization, where the eggs are either fertilized naturally (IVF, moderately reduced sperm quality) or by Intra Cytoplasmic Sperm Injection (ICSI, severely reduced sperm quality) or with sperm from a donor (in case of no sperm production at all).

Insemination treatment means:

Stimulating the development of more than one egg.
By subjecting the female to hormone therapy with hormone tablets (Pergotime) and possible hormone injections, 2-3 mature eggs develop in the ovaries compared to the one egg the female normally produces.

Optimization of sperm quality
Sperm quality improves by purifying the sperm, i.e. the most motile sperm capable of fertilizing are concentrated (sperm are separated from semen).

Reducing the distance the sperms have to travel.
By inseminating the sperm directly into the cavity of the uterus and thereby reducing the distance the sperm cells have to move, the number of sperm cells around the egg is increased at the site of fertilization in the fallopian tubes.

Optimum timing of ovulation
Insemination is made approximately 36 hours after pre-administered ovulation injection, so that insemination is performed within the period when fertility chances are the highest.

During this first, non-binding consultation, we will take case notes, inform you about the treatment, and talk to you about your wishes for the treatment.

If you have previously undergone insemination treatment in another fertility clinic, either a public or private one, it would be helpful if you could obtain a copy of the previous case notes and bring it to our talk. We will carry out an ultrasound scan of the uterus and ovaries, and subsequently draw up a plan for the treatment.

If the semen quality has not been examined before or it is long time since the last time, we will advise that a new semen analysis is performed in our laboratory.

Registering for treatment

When your menstrual period starts (fresh bleeding), you must call the clinic at tel +45 7624 5020 all weekdays between 09.15-12.00 and 12.30-2.30 p.m. and make an appointment for an ultrasound scan of the ovaries which is performed on Cycle Day 10 in a normal cycle of 28 days. If your cycle is shorter or longer, we will adjust the scan schedule to the duration of your cycle.

If your menstrual period starts during the weekend, please call us one of the first days of the upcoming week.

Hormone therapy in connection with insemination
You will either be given or receive by mail a prescription for Pergotime tablets and hormone injections (Gonal F, Menopur or Puregon).

You must take 50mg Pergotime tablets, 1 tablet x 2 daily for 5 days from Period Day 3 – 7.

You must administer hormone injection son Cycle Day 8 and 9. If you have not tried this before, we will instruct you in injection techniques on you Cycle Day 8, which is the first day when you will have to administer the injection.

If it is difficult for you to get Pergotime for Cycle Day 3, you can start on Cycle Day 4 instead and postpone the entire hormonal therapy by one day. This will not change the treatment result.

Ultrasound scan

On Cycle Day 10 (or cycle day 8, 9 or 11  dependent on your cycle length), we will perform an ultrasound scan to assess the number and size of the follicles.

Sometimes it turns out that you will have to come to one or a few extra control visits before the follicles have the right size.

When the follicles have the right size of approximately 17-20 mm, the ovulating hormone Ovitrelle will be injected. Ovulation normally occurs approximately 36 hours later and during this period, insemination will be performed.

Side effects

The Pergotime tables may have side effects in the form of hot flushes, headache, nervousness, insomnia and fatigue and in very rare instances blurred vision. All these symptoms disappear once you stop taking the medication.

FSH (Gonal-f, Menopur and Puregon) may give you the feeling of a bloated stomach, abdominal pressure and headache.

Ovitrelle may give pregnancy symptoms such as fatigue and nausea.

The semen sample

The semen sample can be produced in the privacy of your home or at the clinic. We should receive the semen sample no more than 1 hour after the production and it should be kept warm during transportation (under your clothes near the skin surface). It is important that the man did not have ejaculation 2 days before the semen sample is produced. You will receive a semen sample cup at the clinic. The semen sample should be delivered to the clinic 1,5 hours before the insemination.

Insemination procedure

The insemination procedure includes the purified sperm to be injected into the uterus using a thin catheter. This is a painless procedure, and often you will feel nothing at all. It is a good idea to come to the clinic with a filled bladder as it facilitates the insertion of the catheter into the uterus.

Pregnancy test

The pregnancy test is taken from your early morning urine approximately 16 days after insemination using the pregnancy test kit you are given here at the clinic. Please call us at the clinic and notify us of the result. If the pregnancy test is positive, you will be given an appointment for an ultrasound scan approximately 3-4 weeks later. The pregnancy test must always be taken, even though you have experienced a menstrual bleeding, as it is not unusual in a pregnancy. This will normally require additional scans.

If the pregnancy test is negative, you may resume treatment immediately.

The pregnancy success rate of insemination treatment is approximately 15% per treatment.

Problematic pregnancies

If you become pregnant, the risk of a miscarriage is approximately 15%  (same risk as in pregnancies achieved naturally). Ectopic pregnancy will occur in approximately 2% . The risk of a twin pregnancy will be approximately 5-10%.

Risks in connection with insemination

A successful insemination using partner sperm is defined as one resulting in one healthy child at a time. Twins and triplets are considered as risks.

In connection with the hormone stimulation procedure performed prior to insemination, some females, especially young females, experience hyperstimulation of the ovaries where they produce more than the two-three follicles that are necessary for successful insemination.

According to the National Board of Health’s guidelines, we are not allowed to inseminate if there are more than three follicles. In these cases, we must try to find an acceptable solution for you, including:

1. Discontinue the procedure and treatment.
Hormone therapy and ovulation injections are discontinued. Price for discontinued treatment: DKK 1200.

2. Follicle reduction.
The surplus follicles are reduced to the desired 2-3. This is done just before the insemination. A thin catheter is inserted through the wall of the vagina and into the ovaries and the surplus follicles are aspirated. Following this, insemination is carried out in a standard fashion.
Price for follicle reduction and insemination, please look at the pricelist.

3. Conversion to IVF  
Here, we make use of the more than three follicles (often 5-6) that have been produced and use them for IVF treatment instead. Hormone injections are administered a few days more in order for the follicles to remain intact. At the same time, Orgalutran is administered. This is a hormone minimizing the risk of spontaneous ovulation prior to egg retrieval which will often take place a few days after the scan. Another 2-3 days later, the 1-2 fertilized eggs are transferred to the uterus.
Price for conversion to IVF is half the price for IVF-treatment (please look at the pricelist)