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Husband Insemination

HUSBAND INSEMINATION

Hirsutism is the excessive growth of long. coarse hair on the face, chest, lower abdomen, back. upper arms. or upper legs of women. This hair grows in a pattern similar to that found in men. Besides causing cosmetic distress, hirsutism may signal the presence of polycystic ovarian syndrome (PCOS). a hormonal disorder discussed further in the econd half of this section. A hormone imbalance or a hormone-producing tumor may also cause hirsutism. Understanding the causes of this excessive hair growth helps women put hirsutism into its proper perspective as a medical disorder, rather than an unattractive flaw in their physical appearance. Unfortunately, many women do not feel comfortable seeking treatment for hirsutism although it is very common and often improves with medical management. Prompt attention is important, because delaying treatment of hirsutism and/or PCOS makes the treatment more difficult.

WHEN is HI NEEDED?

Women undergoing ovulation induction are the primary recipients of HI, because timing the insemination with ovulation is very important. The procedure is also indicated when the male has prior proven fertility, but conditions such as poor sperm/cervical mucus interaction or a problem with the female’s cervix prevent the sperm from entering the uterus from the vagina. In some cases, men with excessively low sperm counts, decreased sperm motility. or abnormal sperm morphology have benefited from HI, but success rates in these cases are generally low.

HI may be indicated for couples who are infertile because of impotence or an ejaculatory disorder. One such disorder is the male’s inability to ejaculate inside the vagina, a problem caused by several conditions. Retrograde ejaculation, a disorder that causes the ejaculate (semen) to be released backward into the bladder at male climax is one such indication. This condition is found in men with a history of diabetes or trauma or surgery to the bladder neck, or may be a side effect of certain medications. Retrograde ejaculation may also be experienced by men suffering from paraplegia. Retrieving the retrograde ejaculate from the urine may allow sperm to be obtained for insemination. Additionally, the physician may suggest HI if the male partner has severe hypospadias or drug-induced erectile dysfunction.

Men who wish to store their sperm for future use before having a vasectomy testicular surgery, or radiation/chemotherapy treatment for cancer may also plan to participate in HI.

THE EVALUATION

In order to decide whether to undergo HI, it is important to determine the cause of the fertility problem(s) and whether or not the male’s sperm is suitable for insemination The physician will take a detailed medical history from both partners, and both will undergo a complete physical examination. Testing for human immunodeficiency virus (HIV) or other sexually transmitted diseases may be performed. The male partner will be asked to provide several specimens for a semen analysis and perhaps other tests, such as sperm antibody tests and sperm penetration assays.

The female examination includes a pelvic exam and tests to determine the time of ovulation An ovulation detection kit, basal body temperature (BBT) chart, and in some cases a cervical mucus examination may be needed to determine the time of ovulation The physician may also recommend a hysterosalpingogram, hysteroscopv or laparoscopv prior to insemination to check for obstruction of the fallopian tubes.

Women usually need one or more of these procedures if their medical history or physical exam suggests a possibility of having infections, tubal damage or endometriosis. Additionally, an endometrial biopsy may be recommended to determine whether or not the ovaries are producing adequate hormones.

How is SEMEN COLLECTED FOR HI?

The sperm needed for HI can be collected several ways. A man may masturbate into a sterile cup no more than two hours before a scheduled insemination appointment. This can be done in the privacy of home or at the doctor’s office. Semen can also be collected during intercourse in a special condom that the doctor can provide. If a man has a retrograde ejaculation, the sperm can be retrieved in the laboratory from urine he has collected.

THE INSEMINATION PROCEDURE

Inseminations are scheduled to occur around the time of ovulation. The time of ovulation is often estimated with the use of ovulation detection kits and/or BBT charts. Inseminations are usually performed once or twice each month depending on the regularity of the menstrual cycle. The insemination procedure is relatively simple and only takes a few minutes to perform. The woman lies on an examining table and the physician inserts a speculum into her vagina. The semen sample is injected into the cervical opening through a plastic syringe (figure 1). This procedure is known as intracervical insemination (ICI). A plastic-coated sponge or cap may be placed into the vagina before the speculum is removed to keep the sperm near the cervix and can be taken out four to six hours after the insemination.

Another method, intrauterine insemination (IUI), involves inserting specially prepared (“washed”) sperm directly into the uterine cavity. This method may be used for several reasons, including poor sperm/cervical mucus interaction or to increase pregnancy rates. IUI allows the sperm to bypass the cervix so that an increased number can reach the uterine cavity and subsequently the fallopian tubes,

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Figure 1 : Two types of insemination

where fertilization usually occurs. If the woman has irregular ovulation. The physician may prescribe drugs to induce ovulation. IUI may be performed in conjunction with these medications to increase the chances of successful fertilization. Recent data suggest that increasing the number of sperm reaching the fallopian tubes by intrauterine placement may also increase the pregnancy rate in couples with unexplained infertility, especially with the addition of ovulation drugs.

Sperm Washing

When intrauterine insemination is used, it is necessary to separate the sperm from the seminal plasma. This removes prostaglandins and other substances that could cause adverse reactions or severe uterine contractions. In order to separate the sperm a laboratory technician performs a sperm washing procedure. This involves diluting the semen with a sterile fluid and then separating the sperm from the liquid component. The sperm are then returned to a small amount of the sterile fluid which is used for the insemination procedure.

Sperm washing attempts to remove chemicals and bacteria that can cause infections or adverse reactions when placed directly into the uterus. Additionally, the sperm washing procedure may increase the sperm’s ability to fertilize the egg.

PSYCHOLOGICAL ISSUES

The inability to conceive a child is an emotionally difficult experience for many couples. When infertility is due to a cervical or male factor, several issues may occur, Men often feel guilty and can experience a loss in self-esteem and a decreased sense of masculinity because of being unable to impregnate their partner. At times, men may fear losing their partner because of infertility. They may also feel resentment toward their partner if a female factor is impeding their fertility. If there is a male factor impeding fertility, women may feel anger toward the man and. at the same time, guilty for feeling this way about something he has no control over. Furthermore, the inseminations may make both partners feel that someone has intruded into their sex life. which may affect the couple’s intimacy.

Couples may find it difficult to talk about these feelings because they seem so personal. However, it is important to find ways to communicate and work through the grief.

SUCCESS RATES

The success rate of HI depends upon several factors. First of all, the cause(s) of the fertility problem is important. Men who have good sperm counts and high motility, but are unable to have intercourse or cannot achieve a pregnancy due to a cervical factor in the female partner, have a much higher chance of success than patients who are undergoing HI because of sperm abnormalities. Female factors also play an important role. If the female partner is older than 35. the chances of a successful pregnancy are significantly decreased. The predictability of ovulation is also important. The more regular the menstrual cycle, the greater the chance of pregnancy. The presence of endometriosis or a history of pelvic infection or tubal disease decreases the success rate. Success is more likely if there has been a previous pregnancy. There is an approximate two to four percent chance of birth defects in all children born. including those resulting from HI. Sperm washing and the insemination procedure do not increase or decrease this risk. The success rate of insemination may be as high as 15 percent per cycle, which is comparable to the chance that fertile couples have of conceiving during any given month.

SUMMARY

Around 40 percent of infertility cases result from disorders in the male. These factors may be the sole cause of infertility, or there may be a combination of male and female abnormalities. Husband insemination is an important procedure in the treatment of male infertility and, in some cases, female infertility. With HI, many couples can experience pregnancy, childbirth, and the joy of raising children.