The procedure in detail
It is crucial for the techniques' chances of success, that the sperm and the egg meet each other at just the right moment. Both have only a short time during which they are viable.
So follow the instructions of Daily Patient Monitoring (DM), the team that follows up and guides your treatment based on blood analyses and ultrasound scans.
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Download the instruction form insemination with clomifeen citrate |
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Download the instruction form insemination with gonadotrofines |
In case of light ovarian stimulation
AS OF THIS POINT THERE ARE TWO POSSIBILITIES:
- either your blood test will indicate that there is a peak of LH levels. Ovulation will follow within 36-42 hours. If the peak has already passed at the moment of the blood test, ovulation will occur earlier. You will then be given an appointment for insemination, within 24 hours.
- or the blood test does not indicate an LH peak. In this case, the results of the Ultrasound will determine what happens next:
- if the follicle is still too small (<17mm diameter) a new ultrasound scan will be planned, with a prior blood test;
- if the ultrasound reveals at least one and a maximum of three ripe follicles, you will be required to inject the hCG at the exact time determined by the DM. This will trigger ovulation 36-42 hours later. You will then be given an appointment for the insemination itself. See below for information regarding the provision of a sperm sample for insemination.
- should the ultrasound reveal a presence of more than three ripe follicles, the risk of multiple pregnancy will be too great to allow the procedure to take place. What must happen next will be discussed and decided with you:
- a number of follicles can be removed by puncturing them, leaving just one or two behind for insemination;
- insemination can be replaced by IVF treatment and all ripe egg cells will be collected and fertilized in the lab;
- the current treatment can be postponed and the stimulation adjusted in subsequent attempts.
- after completion of the artificial insemination, a pregnancy test is performed between day 26 and 28. Levels of hCG in the blood will indicate whether the treatment was a success or not.
Insemination with sperm from your partner |
The moment of insemination |
A fresh sample is preferable for insemination using your partners' sperm. This maximises the chance of fertilization. Shortly beforehand, your partner will be required to produce a
sperm sample by masturbation. The sample then goes to the lab, where the best sperm are selected for insemination. The selection process takes about 90 minutes, so the insemination itself will take place a couple of hours after the 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. The insemination can then make use of that sample, if its quality is still good enough after thawing.
Insemination using donor sperm
This process makes use of donor sperm instead of that from your partner. The carefully selected donor (see
donation the main points) remains strictly anonymous. The donor himself in also completely unaware of where his sperm is used.
Frozen material is always used when performing donor inseminations. The sperm is thawed and evaluated shortly before it is needed. The reason behind this is that the CRG wishes to be absolutely certain that the sperm is healthy and disease free. In principle, it can take several months before an infection with Hepatitis or HIV comes to light. Therefore the centre stores all donor sperm for at least six months before using it. All potential donors are of course screened for all possible infections and diseases.
Blood test: pregnant? You will have a blood test on day 15 after the insemination to determine whether you are pregnant. Just like you, we hope that the result is positive. But even if you have a period in the meantime, the blood test will still take place on day three of your menstruation. From the test 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 the implantation of the embryo with projesterone (if applicable)
Depending on the situation, you may be required to place progesterone pessaries in the vagina as of the day of intercourse. Progesterone assists in the development of the endometrium (the lining of the womb) and facilitates the process of implantation of the embryo. If you are prescribed progesterone therapy, you will start therapy on the day of the insemination in the evening (once). From the following day, pessaries must be inserted three times a day at regular intervals (8am, 4pm, 10pm) and you must continue until the DM tell you to stop.
To prevent infections this is best done with well washed hands. There will inevitably be some moderate discharge from the vagina as a result of the pessaries, the use of sanitary towels is recommended.
Follow-up studies from UZ Brussel
If you are found to be pregnant, you will receive further guidance from the family doctor or gynaecologist who referred you to us. However, we at UZ Brussel will still ask for information on the further progress of your pregnancy and will stay in contact even after the birth. We will send you two questionnaires in this respect. You will receive the first at the end of the first term of your pregnancy. The second is sent shortly after the estimated delivery date.
Our questions are of personal interest: we like to know whether the treatment was successful and whether you have experienced any problems. However, they are also part of the scientific investigation we are continuously performing with regard to pregnancies and children resulting from fertility treatment.
We do this to constantly improve the quality of our treatments and to document the effect 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 KI(D).
We therefore insist that our patients complete and return the questionnaires. This not only helps scientific research, it also helps many future patients, of which you may be one.
There is no need to worry about your privacy: all data is provided strictly anonymously. There is absolutely no chance that medical or other information you provide can be traced back to you personally.