Artificial insemination, also called "intrauterine insemination," is used to treat a number of fertility issues, including low sperm count and poor cervical mucus. Insemination may also be used for sex selection after sperm is separated in the laboratory. Sperm are placed into the cervix or uterus after undergoing lab preparation to enhance fertilization. Alternatives to insemination can sometimes provide better results, but they also have drawbacks.
In Vitro Fertilization
The main alternative to insemination for fertility problems, such as abnormal sperm or female fertility issues, is in vitro fertilization. In vitro fertilization involves stimulating the ovaries to produce eggs, then removing the eggs from the ovaries using a long needle during an egg-retrieval procedure. Eggs are placed with sperm in the laboratory and examined for fertilization the next day. Embryos are placed back into the uterus several days after egg retrieval, a process called "embryo transfer."
ICSI and Sperm Aspiration
Injection of a single sperm directly into an egg, called "intracytoplasmic sperm injection," or ICSI, benefits some sperm defects. Removal of the sperm directly from the testes, called "sperm aspiration," helps men who have blockages in the reproductive system become fathers without having to use donor sperm for insemination.
Donor Embryos
Many fertility clinics maintain a list of embryos available for adoption. Embryos are thawed and implanted into the uterus during an embryo transfer. For couples that can't achieve pregnancy through insemination and who don't want to consider traditional adoption or in vitro fertilization, embryo adoption may provide a viable route to parenthood.
Sex Selection
Sperm separation by swim-up or gradient techniques for sex selection in insemination has a low success rate, with between 10 to 30 percent failure rate for having a child of the desired sex, the Human Fertilisation and Embryology Authority states. Sperm separated by Microsort, a more involved and expensive method, results in 90 percent success rates for females and around 85 percent for males, the Center for Human Reproduction says. Cells from embryos created during IVF can be removed and tested using special equipment that determines the sex of the embryo. This method, called Preimplantation Genetic Diagnosis, has a 100 percent success rate.
Benefits
In vitro fertilization can bypass some of the fertility issues treated by artificial insemination or donor insemination. Embryos are placed directly into the uterus, which ensures not only that embryos do exist but that they reach the right area for implantation. An IVF cycle may also provide enough embryos to use for several embryo transfers that can be done years apart. Using ICSI overcomes motility issues and poor sperm quality by allowing laboratory technicians to pick the best sperm from a sample. Perhaps most important, sperm aspiration directly from the testicles followed by ICSI allows couples who would otherwise need to use donor sperm from another man to become biological parents. Using donor embryos allows a couple to become parents without the risks and expense of traditional adoption and gives life to an embryo that might otherwise be discarded.
Risks
In vitro fertilization also has drawbacks over insemination, mostly cost-related. The cost is significantly higher, and, like insemination, there's no guarantee of success. Success rates in IVF vary tremendously, depending on the number of embryos implanted, the woman's age and the quality of the IVF lab, but generally range from between 30 to 35 percent of women under age 35, down to 6 to 10 percent for those over age 40, the American Pregnancy Association reports.
Considerations
Getting pregnant becomes a long and winding road for many infertile couples. While insemination techniques help many get pregnant, using IVF and related techniques helps many couples achieve a higher pregnancy rate, if they can afford IVF and have no ethical concerns over creating embryos in the lab or other invasive fertility techniques.
