Preliminary examinations
Administrative

The technique of artificial insemination involves the introduction of sperm - either from your partner or from a donor - directly into your uterus. AI(D)

• is a simple and painless intervention,
• takes place on an outpatient basis, and
• is practically the same for couples using their own sperm and couples using donor sperm.

Here is some more information:

• about possible stimulation options, under stimulation with IUI;
• about the treatment step by step, under procedure in detail.

If you want to know what your chances are - statistically - of getting pregnant, click Chance of success.
The CRG doctor will discuss your personal chances of success during the consultation and after the preliminary examinations.

Preliminary examinations     

Apart from the routine examinations which precede every type of fertility treatment, the Fallopian tubes of women over the age of 37 wishing to have AI(D) are closely examined.
This is done either by hysterosalpingography, HyFoSy or diagnostic laparoscopy.
Even if a woman is younger, but fails to conceive after six attempts of IUI, the above examination will be performed before further treatment is planned.

Administrative      

AI, like every form of ART treatment, comes with a number obligations. For the general administrative procedure at UZ Brussel, see practical information.
We will specify the following though

Ovarian stimulation for artificial insemination is the same as for timed intercourse:

Taking anti-oestrogens
Injections of gonadotrophins
Final hCG-injection - or not?

In recent years, the preferred approach is to bring insemination treatment in line with your natural cycle.
Your natural cycle's progress is therefore closely monitored:

• with blood analyses to determine hormonal values, and
• with ultrasound scan(s) to evaluate follicle development.

Sometimes light ovarian stimulation with hormones prior to artificial insemination is necessary.
This kills two birds with one stone:

• egg maturation is better,
• ovulation is more predictable.

 

Ovarian stimulation for artificial insemination is the same as for timed intercourse:

• either anti-oestrogen is taken in tablet form (clomiphene citrate),
• or gonadotrophins are administered in injection form.

Side effects are limited in both cases:

• anti-oestrogens can lead to a swollen abdomen, hot flushes and, exceptionally, flashing lights.
• hormonal injections may cause mild abdominal pain.

Taking anti-oestrogens       
By taking the anti-oestrogen clomiphene citrate (see How does this 'anti-hormone' work?) the brain is fooled into thinking there are insufficient levels of oestrogen present and more FSH is produced, thus stimulating the ovaries.
If clomiphene citrate is given at the start of the menstrual cycle, it will lead to the simultaneous development of several follicles.

Injections of gonadotrophins      
Another option is the direct injection of hormone preparations hMG, FSH or rec-FSH, to imitate the effect of the gonadotrophins FSH and LH.
This stimulates the ovaries to produce several eggs.
The dosages have to be precisely determined, because we don’t want to trigger a 'super ovulation' like in IVF.
The injections are given under the skin (subcutaneous).

Final hCG-injection or not     
Because both stimulation methods usually lead to a 'natural' LH peak and therefore a natural ovulation 36 to 42 hours later, the LH levels in the blood must be monitored regularly to determine when exactly ovulation will occur.
However, if there is no LH peak and the ultrasound shows one to maximum three follicles mature enough for fertilisation (bigger than 17mm), an injection of hCG will be administered to trigger ovulation.
This injection is also under the skin. You can do it yourself at home, but the DPM notifies you of the exact timing.
 

From day 3
In case of light ovarian stimulation
From day 11, 12
Insemination with sperm of your partner
Insemination with donor sperm
Support and follow-up of the result
Follow-up in case of pregnancy

Crucial for the success of the insemination is that egg and sperm find each other at the right time: both have a limited lifespan.
Therefore meticulously follow the instructions of the Daily Patient Monitoring department (DPM), the team that follows up your treatment and schedules blood tests and ultrasound scans.

The ART treatment starts on 3 of your cycle      

• On day 3 of your cycle you take a blood sample. Based on the hormonal values measured in this blood sample, you will receive the necessary instructions from the DPM department by phone.
• If your treatment requires light ovarian stimulation, you will be told during this phone call whether you can start this now or whether you should wait a while.
• If on day 3 you are told that you can proceed with your treatment or start stimulation, an ultrasound scan will be planned, usually around day 11 or 12 of your cycle.

  Practical

  Read more here about the where-when-and-how of the ultrasound.

 
In case of light ovarian stimulation       

• Stimulation with anti-oestrogens: you take the prescribed dose every day from day 3 up to and including day 7.
• Stimulation via injections with gonadotrophins hMG or rec-FSH: you follow your CRG doctors' instructions regarding which medicine and which dosages on which day to start the treatment and when to stop.
• On the day of the ultrasound (day 11 or 12 of your cycle) another blood test is taken. You don't need an appointment for this.
• You then have the ultrasound which you scheduled on day 3.
• Between 3 p.m. and 6 p.m., still the same day, when the results of the ultrasound and blood test are known, the DPM will contact you.

From day 11-12 there are different possibilities     

• Either your blood analysis shows an LH-peak.
  This means ovulation is imminent: ovulation will follow within 36 to 42 hours normally. If the peak has already passed at the moment of the blood test, ovulation will occur earlier. The DPM will immediately give you an appointment for insemination, usually within 24 hours.
• Or the blood analysis shows no LH-peak.
  In this case the result of the ultrasound determines what happens next:
  • if the follicle is still too small (diameter < 17 mm.) you must contact the DPM to schedule another ultrasound and (prior) blood test;
  • if the ultrasound shows at least one and a maximum of three ripe follicles, you will need to inject the specified hCG dose (or have someone inject it for you) at the indicated time. This substitution hormone triggers ovulation.

• Good hygiene

  The personnel treating you very much appreciate good hygiene.
  A shower or wash before your consultation and clean feet make it more pleasant for everyone around.

  Or the ultrasound shows more than three ripe follicles. In this case the risk of multiple pregnancy (with major risks for mother and babies) will be too great to allow the procedure to take place. Together we will decide what needs to be done:
  • a number of follicles can be punctured, leaving just one or two for insemination;
  • artificial insemination is replaced by IVF treatment:
    all ripe eggs are collected following egg retrieval and fertilised in the laboratory with the sperm of the partner or a donor;
  • artificial insemination is replaced by egg vitrification:
    all ripe eggs are collected following egg retrieval and frozen for later fertilisation;
  • (current) treatment is stopped. Ovarian stimulation is adjusted in later attempts.
• After completion of the AI treatment, a pregnancy test is performed between day 26 and 28.
  Levels of hCG (pregnancy hormone) in the blood will indicate whether the treatment was a success or not (see infra, follow-up of result).

Insemination with sperm of your partner (AI)     

A fresh sample is preferable for IUI using your partners' sperm. This maximises the chances of fertilisation.

• A couple of hours before insemination, your partner will be required to produce a sperm sample by masturbation.

• The sample goes to the lab, where the best sperm is selected.
  
  • Preparing the sperm takes about an hour and a half: insemination is therefore only possible about two hours after production of the sample.
• In the event of your partners' absence on the day of insemination, or if he fears that he will be unable to produce a sample at the crucial moment, he can have a sample frozen in advance. An appointment needs to be made with the Andrology lab for this.
  Insemination can be done with this sample if the quality is still good enough after thawing.
• Insemination is done in the consultation room and is usually carried out by a CRG counsellor. Your partner is allowed to be there with you:
  
  • you lie in a gynaecological chair ;
  • your vagina is dilated with a speculum, and
  • with a special catheter the sperm is inserted through your cervix into your uterus.
• You then have to lie down for ten minutes. This considerably increases the chances of success of insemination.

 

Insemination with donor sperm (AID)    

AID inseminates eggs with sperm of a carefully selected donor. For the selection criteria, see Donation, the main points.
In most cases the donor remains completely anonymous to the patient and her possible partner. The donor himself is also completely unaware of where his sperm is used.
Belgian law also allows the option of a known donor, who was found by the prospective parent(s) in question.
But even then frozen sperm is always used for AID, which is thawed shortly before insemination.
The reason for this is that the CRG wants to be absolutely certain that the sperm is healthy. In principle, it can take several months before an infection with jaundice (Hepatitis B, C) or HIV, which causes AIDS, comes to light. This is why the centre stores all donor sperm for at least six months before it is used. All potential donors are of course screened for all possible infections and diseases.
For more information click on sperm donation or surf to www.spermadonor.be if you would like to become a sperm donor yourself.

Blood test: pregnant?     

After completing the AI treatment, you will have a blood test on day 15 after the insemination to determine whether you are pregnant.
Just like you, we hope for a positive outcome.
But even if your period has started, the blood test is still recommended on day three of your period. From the blood we can determine whether a normal ovulation occurred and if the bleeding is indeed a period. This is important to know for future treatment.

Facilitating implantation with progesterone (if applicable)
Depending on the situation you may be required to insert progesterone pessaries deep into your vagina as of the day of insemination.
Progesterone assists in the development of the lining of the womb and facilitates the process of implantation of the embryo.

• The day itself you do this once in the evening: because you will have to wait until after the insemination before you start with the progesterone treatment.
• On the next day, you insert the pessaries three times a day at regular intervals and you continue doing this until the DPM tells you to stop.
• Please wash your hand before inserting the pessaries to minimise vaginal infections.
• Because there will inevitably be some vaginal discharge, sanitary towels are recommended.

 

Follow-up in case of pregnancy    

If you are pregnant, you will receive further guidance from your GP or gynaecologist who referred you to us.
However, UZ Brussel wants to know about the further progress of your pregnancy and will stay in contact even after birth. We will send you two questionnaires:

• the first at the end of the first term of your pregnancy,
• the second after the estimated delivery date.

Our questionnaires are, on the one hand, out of personal interest: we'd like to know whether the treatment was successful and whether you experienced any problems
On the other hand they are also part of a scientific study we conduct into pregnancies and children resulting from fertility treatment. The aim is to improve the quality of our treatments and to map the effects of certain changes (e.g. in stimulation medication).
We also have to meet legal obligations regarding the collection of statistical data on (the health of) our patients and their babies born from IVF/ICSI or AI(D).

We therefore insist that our patients complete and return the questionnaires. Not only does it help scientific research, it also helps many future patients. And one day you may be one again.
There is no need to worry about your privacy: all data is processed strictly anonymously. There is absolutely no chance that medical or other information you provide can be traced back to you personally.