An insemination is often performed in cases of male procreativity issues. If the sperm count and motility are reduced or if the amount of malformed sperms is high, insemination could bring the desired success. An insemination is also helpful when there are antibodies in the mucus of the uterine cervix. They prevent the sperm cells from making their way to the egg cell.

Ovulation is a prerequisite for obtaining pregnancy. To accomplish this, a follicle containing the ovum is formed in the first days of the monthly cycle. When this follicle reaches a size of 18 to 24 millimeters, a hormonal signal is sent out by the pituitary gland. This causes the follicle to burst and the contained fluid transports the egg cell directly into the tube. There, the ovum awaits fertilization by a sperm cell.

We distinguish between two kinds of inseminations:

  • Homologue: the sperm of your partner will be used
  • Heterologue: donated sperm will be used (e.g. when there is no sperm existent or for lesbian couples)

For the heterologous insemination we need a notarial deed in which you agree to the use of donated sperm. After the birth of your child both partners count as parents.

Procedure of the insemination

  • Insemination during the normal monthly 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 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 when more than one ovum is released in the ovulation.

To this end, either pills (e.g. Clomiphen) or injections (e.g. Puregon, Gonal-F or Menopur resp. Merional) can be used. The injected compounds are very expensive. Therefore, 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.

Obtaining sperm cells

On the day of the insemination we need the sperm cells from your partner. The partner can deliver the seminal sample directly at the Kinderwunschzentrum or at home, but only if he can arrive within one hour of the delivery and the sample is transported at body temperature. In the latter case we require a declaration that the sperm was delivered by the partner and he is aware that it will be used for the respective treatment.

There should be no ejaculation two to seven days prior to the sampling in order to produce an optimal sample. If you bring the sample from home please make sure the container is labeled with your name, date and the time of ejaculation. Please wash your hands with soap first and only then deliver the sperm sample through masturbation into a sterile container (you will receive a sterile container from us).

Important: Some men have erection problems or trouble providing a seminal sample through masturbation. Please inform us of such problems in due time. The possibility to freeze a sample from an earlier point in time exists, however this costs an additional 600 €. Furthermore, the sample quality may be decreased during the freezing or the thawing process which can reduce the chance of success.

Preparation of the sperm cells for insemination

Washing and preparing the sperm has a great impact on quality improvement. 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

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

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.

The conduction of an insemination is only sensible if enough sperm cells with forward progression are present in the sample after preparation. In case the sperm sample is not qualified for insemination we will advise against the conduction of the procedure as the success rate is decreased.

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

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.

Heterologous insemination (donor sperm)

Some men suffer from complete infertility – in such cases no sperm cells are produced in the testicles. Consequently, a pregnancy can only be achieved using donor sperm. Furthermore, a donor can be chosen if there is a risk of genetic diseases or a testicular biopsy (TESE) is refused. In February 2015, the Austrian reproductive law was amended and now offers the possibility for lesbian couples to make use of donor sperm for insemination or IVF. Heterosexual as well as lesbian couples need a notary deed for the treatments to register them as legitimate parents.