Heterologous insemination (HI)

In general there are two different kinds of insemination:

  • homologous: the sperm of the male partner will be used
  • heterologous: a donor sperm will be used (eg. it the partner doesn’t produce sperm or for lesbian couples)

In order to conduct a heterologous insemination you will need a notary deed through which you consent to the use of donor sperm. Thereby both female partners will automatically be considered as rightful parents after the birth of the child.

The insemination process

  • Insemination during the natural cycle

It is not necessary to undergo hormonal stimulation prior to the insemination. You can determine the moment of ovulation at home with urine tests (= LH tests) or have your cycle monitored in ultrasound examinations. The spontaneous ovulation can then be predicted. If the couple wants to plan the ovulation for career or private reasons, it is possible to trigger it with an injection.

  • Insemination during a stimulated cycle

In some cases, a hormonal stimulation of the ovaries is required, because there is a hormonal disorder which prevents ovulation. A higher pregnancy rate can be obtained if more than one ovum is released in the ovulation. To do this, either pills (e.g. Clomiphen) or injections (e.g. Puregon, Gonal-F or Menopur resp. Merional) can be used. The injection medication for stimulating the ovaries is very expensive. Therefore, often an approval by your medical insurance is necessary. However, we cannot guarantee that the insurance will give their approval. However the procedures (ultrasounds, insemination itself) always have to be paid privately.

Determination of ovulation

Predicting the ovulation

The ovulation is determined via ultrasound or at home with an LH urine streak test (e.g. Conceive, ClearPlan etc.). We will let you know on which day of the cycle the tests should be started and whether an ultrasound check-up is necessary. If the patient cannot come for an ultrasound we will inform you via telephone when the LH urine streak test should be started.

The test should always be conducted with morning urine. As soon as the test is positive the insemination must follow.

 

Thawing and preparation of the donor sperm for the insemination

The donor sperm will be thawed in preparation for the heterologous insemination. The sample was already washed and prepared for quality improvement before the cryopreservation took place. After the ejaculate is obtained and liquefied it is centrifuged in different stages with a special medium. The non-motile and malformed sperm cells are separated from the healthy motile ones. Moreover, the preparation activates the sperm cap (acrosome) which is an important prerequisite for fertilization of the ovum. The resulting concentrate, around 0.5 ml, can be inserted into the uterine cavity via a sterile catheter.

The insemination (procedure)

In this procedure, purified semen is injected through a thin catheter directly into the uterine cavity at the time of ovulation. The insemination is conducted on the gynaecologist’s examination chair. It is not painful and is over in several minutes. You can return to work after an insemination and do not have to rest afterwards. The insemination is performed either just before the ovulation in a natural cycle or after a hormonal preparation.

Possible complications

Early ovulation (before the insemination)
The follicles which form either during a natural cycle or during stimulation can induce the pituitary gland to release the bodies signal for ovulation too early meaning the follicles can burst prematurely. The Institute is not liable for omission of ovulation even if this is only detected immediately before the insemination.

Too many or no follicles
In very rare cases, the hormone treatment can lead to the formation of ovarian cysts or excessive amounts of follicles. However, it is also possible that despite a high dosage of hormones no ovarian reaction is achieved. In such cases, it is necessary to end the treatment and to continue at a later time with another form of stimulation.
We would like to point out that the treatment will also be aborted if more than three follicles form as the risk for a multiple pregnancy is too high. In such cases, the patients should refrain from unsafe sex and the planned insemination will not be conducted. The risk of a multiple pregnancy exists even if only two or three follicles form, however, the chance lies by about 25% and in most cases such a situation leads to twins.

Infections
Even though the preparation serves to flush out possible bacteria the procedure can lead to an infection of the uterus which may spread to neighbouring organs.

Success rates

Succes rates

The chances of achieving pregnancy through insemination correspond to the age correlation levels of spontaneous pregnancies. As can be seen in the graph below, the rate increases with hormonal stimulation (CC or FSH) and, moreover, the rate rises cumulatively with the amount of attempts. However, we recommend discussing the further procedure after 3 to 5 unsuccessful attempts and to possibly consider IVF treatment.