ARTIFICIAL INSEMINATION

BY
R. MOHANA KRISHNAN
Artificial insemination is the process of
introducing semen into the vagina, cervix or
uterus to produce pregnancy by means others
than sexual intercourse.
 Infertility - Statistics
Research by the World Health Organisation (WHO)
estimated that in 2010, 48.5 million couples
worldwide were unable to have a child.
They found that 1.9 percent of women aged 20-44
who wanted a child were unable to have their first
live birth and 10.5 percent of women who had
previously given birth were unable to have another
baby after five years of trying.
This represented a 0.1 percent and 0.4 percent
decrease from 1990, respectively.
 INDICATIONS - Male factors
• IMPOTENT
Fertile , • HYPOSPADIAS/ EPISPADIAS
• EJACULATORY FAILURE
but
• OLIGOZOOSPERMIA
Infertile • AZOOSPERMIA

, due to
 INDICATIONS – Female factors

• Fallopian tube damage/tubal factor/tubal

ligation
• Endometriosis
• Advanced maternal age
• Genetic abnormalities
• Recurrent pregnancy loss
Recent Discovery
 Development

Direct introduction of sperms

into vagina – IUI

IVF: mixing the sperm and ovum

in a petri dish and culture it .

I.C.S.I and P.I.C.S.I – Recent

advances
• The sperm used in conventional methods
were collected either from the husband or
donor , but pooled donor semen was
commonly used.
• With advances in medicine , even if the
husband has single mature sperm it can be
used.
• Donor semen/ovum is usually prefered when
the husband or the wife suffers from any
genetic anomalies.
Dr Gianpierro Palermo
 I.C.S.I –Intra Cytoplasmic Sperm
Injection
The sperm is collected by masturbation if not
possible the following methods are used:
1. PESA( Per Cutaneous Sperm Aspiration
2.TESA(Testicular Sperm Aspiration/Micro
TESA
1. PESA:
In this procedure a small needle is inserted
through the skin of the scrotum to collect
sperm from epididymis.
2. TESA:
In this procedure a small portion of the
testicular tissue is removed with the help of
local anaesthesia to extract the few viable
sperms . Useful in cases of azoospermia.
• The collected sperm is washed within 1 hour
of collection.
• The process of washing the sperms removes
the chemicals in the semen that causes
discomfort to women and increases the
success of fertilization
 Oocyte retrival
• Oocyte is retrieved by administring
gonadotropins (HCG , FSH (urofilotropin))
• But before that tests for ovarian reserve
should be done .
• This is done by use:
* 3 Day FSH
* AMH ( anti mullerian hormone ) Assay
* Antral follicle counts
• Higher the baseline FSH , lesser the chance of
success for I V F

• Higher the AMH levels , higher is the success

of I.V.F

• Higher the antral follicle count , higher is the

success for I.V.F.

• None of the methods is reliable by itself , so a

combination of these tests s usually used.
Transvaginal Ultrasonic guided
aspiration
• Ooocyte is generally retrieved by application
of general anaesthesia or conscious sedation
with paracervical block
 PICSI – Physiological Intra Cytoplasmic
Sperm Injection.
• PICSI is a additional sperm selection tool in ICSI.

• In this procedure microscopic droplets of hylauronan

are adsorbed on a culture plate and the sperms are
placed on in the plate.

• Hyaluronan is a chemical present in the cumulus

oophorus of the oocyte , and the hyaluronan binding
sperm are more mature in nature and are less
aneuploidic .
• PICSI is indicated when there is
1 . Failure of fertilisation with ICSI.

2 .History of miscarriage

3 .High sperm DNA fragmentation

This procedure is done under microscope using
multiple micro manipulating devices
The oocyte is stabilised with holding
pipette using gentle suction applied by
microinjector.
A single sperm is collected using a
micropipette. The oocyte is then punctured
through the oolemma and the sperm is now
directed towards the cytoplasm.
• The polar body inside the oocyte is positioned
in 12 o clock or 6 o clock position to avoid
damage by injection , the oocyte is put in cell
culture and checked for signs of fertilization.
• The egg is accepted only if it contains two
pronuclues and two polar bodies or is
discarded otherwise.
• The embryo is allowed to differentiate on its
own and it can be implanted on either day 3
or five after fertilization
• but sometimes after day 3 the embryo fails
to differentiate and therefore day 5 embryo is
usually prefered.
Day 3 embryo
DAY 5 BLASTOCYST
 Grading of embryos
• For this process , Gardner’s system of classification devised
by Dr . David Gardner in late 1990’s is used.

• The Gardner blastocyst grading system assigns 3 separate

quality scores to each blastocyst embryo:

• Blastocyst development stage - expansion and hatching

status

• Inner cell mass (ICM) score, or quality

• Trophectoderm (TE) score, or quality

Expansion
Blastocyst development and stage status
grade

Blastocoel cavity less than half the volume

1
of the embryo

Blastocoel cavity more than half the volume

2
of the embryo

Full blastocyst, cavity completely filling the

3
embryo

Expanded blastocyst, cavity larger than the

4
embryo, with thinning of the shell

5 Hatching out of the shell

6 Hatched out of the shell

ICM grade Inner cell mass quality

A Many cells, tightly packed

B Several cells, loosely grouped

C Very few cells

TE grade Trophectoderm quality

A Many cells, forming a cohesive layer

B Few cells, forming a loose epithelium

C Very few large cells

High Quality 4AA Blatocyst IVF Embryo
 PreImplantation Genetic
Diagnosis(PGD)
• It is a genetic profiling in which the embryos
formed by ICSI/PICSI are subjected to series
of tests to rule to any genetic defects in the
embryo.
• A biopsy of the embryo can be performed at
any stages of embryonal development , but
the usual methods are:
• Polar body biopsy
• Blastomere biopsy
• Blastocyst biopsy
• POLAR BODY BIOPSY usually is less
deleterious to embryo but can rule out only
diseases of maternal origin .
• BLASTOMERE BIOPSY better than PB but the
cells at this stage show Mosiacism and
therfore whether biopsy from 2 cells would
determine the quality of the embryo is
questionable .
• BLASTOCYST BIOPSY provide large amount of
starting material for diagnosis and chromosal
mosiacism is less at this stage.
• FISH and PCR are the two most commonly
employed techniques in PGD.

• There is a ethical aspect associated with this

this procedue Prenatal sex Diagnosis, but
instead of using it for family balancing it can
be used to determine diseases more prone to
a gender than the other.
 PRECAUTIONS
* Consent of the donor and his wife is
essential.

*The identity of the donor is kept confidential

and the donor should not know to whom his
semen is donated and the results of the
insemination
• The donor sample is screened thoroughly by
all available tests for any abnormalities.

• The donor should not be a relative of either

of the spouse and should have had a children
of his own.

• There should not be any Rh incompatiblity

between the donor and the recipient.
• Written consent from the women and his
husband to use an unknown donor is sought.

• Pooled semen should be used whenever

possible because there is technical possibility
that the husband may ,in fact be the father of
the child .

Single donor sperm is usually to fertilize only

about ten children.
 Legal Aspects
• The following are the legal aspects of A.I.D

1. Adultery:
A.I.D is not considered as adultery
in India ,as S497 I.P.C requires sexual
intercourse as a part of adultery
2. Legitimacy:
The husband is not the father of the child and
cannot inherit the property
3. Nullity of marriage and divorce :
If A.I is done due to the impotence of the
husband , it is a ground of claim for the wife.
The husband can claim nullity if A.I is done
without his consent.
4. Natural birth:
A child born out of A.I is illegitimate unless it is
adopted by the parents. If a child is born to the
same couple afterwards by coitus that child is
considered to be legitimate .

5. Unmarried or widow :
They can have a child from A.I but the child is
illegitimate .
• 4. Natural birth:
A child born out of A.I is
illegitimate unless it is adopted by the parents.
If a child is born to the same couple afterwards
by coitus that child is considered to be
legitimate .

5.Unmarried or widow :
They can have a child from A.I
but the child is illegitimate .
• 6: Incest :
• There is a chance of incest
between the child from A.I and the donors
child but it is not considered as an offence in
India
 Complications
• The husband may develop psychiatric
symptoms because of the presence of child of
someone else.

• If the child is mentally or physically retarded

the husband may develop bitter feelings as he
may be held responsible by others
• Similarly a neurosis may develop in the
mother because she will feel the child belongs
to her alone.
• She may be obsessed to know about the
donor and may want to have a second child
from the same donor.
• The child will suffer mentally if he knows his
past history
 POINTS OF INTEREST
• Denmark is the leading exporter of sperms in
the world because of the reportedly high
quality sperm from altruistic donors.
• Certain countries like UK and Sweden are in
shortage of sperm donors.
• Russia is a attractive spot for reproductive
tourists because of liberal legislation.
THANK YOU