Intrauterine insemination

　　Intrauterine insemination is a method of assisting pregnancy by injecting male semen into the female cervix or uterine cavity by artificial means. It is mainly used for male infertility. There are two types of artificial insemination: intra-spousal artificial insemination and extra-spousal artificial insemination. If the male has sexual organ abnormalities such as small penis, hypospadias, impotence, premature ejaculation, or if the female has cervical stenosis or unexplained infertility, intra-spousal artificial insemination can be used. If the male has a blocked vas deferens or azoospermia, extra-spousal artificial insemination can be adopted. If the male is over 50 years old, has abnormal seminal fluid, or has inflammation in the urinary system, or if the female has reproductive organ malformations or other systemic diseases, artificial insemination is not recommended. To avoid medical and ethical disputes, the doctor should explain the method, success rate, complications, and other ethical and social issues of artificial insemination to the subjects before the operation can proceed.

　　Intrauterine insemination, whether AID or AIH, although the operation is not complicated, is not absolutely safe and may cause various complications if not careful. Common complications include:

　　1. Infection

　　This is mainly related to the lack of aseptic concept of the operator and the inability to maintain absolute sterility in the semen. There have been reports of adnexitis and pelvic inflammatory disease caused by artificial insemination. The use of appropriate antibiotics after artificial insemination has a certain preventive effect.

　　2. Bleeding and injury

　　This is mainly related to improper operation methods, inappropriate instruments (too simple), and rough and unskilled operation.

　　3. Lower abdominal pain

　　This is often caused by too fast and too high sperm injection speed and pressure, leading to uterine spasmodic contraction and pain. If intrauterine insemination is performed and too much semen is injected, the semen can flow into the abdominal cavity through the fallopian tubes, causing刺激性下腹痛.

　　4. Inducing endometriosis

　　This is relatively rare and is often caused by too fast, too much, and too high pressure of sperm injection into the uterine cavity.

　　5. Potential medical and genetic ethical risks

　　In AID, when the semen of a sperm donor is inseminated into two or more women, the children born to these women are genetically related as half-siblings. Due to the confidentiality of AID, these half-siblings cannot and will not be able to recognize each other. If by chance they marry as adults, it will cause consanguineous marriage, which may cause hereditary harm to the next generation, although such coincidences are rare.

　　Indications for artificial insemination

　　(1) Azoospermia, severe oligospermia, asthenospermia, and teratospermia.

　　(2) Failure of vasectomy reversal in men who hope to have children and difficulties in ejaculation.

　　(3) Severe hereditary diseases that are unsuitable for childbearing in the male and/or family.

　　(4) Incompatibility of maternal and fetal blood types, which cannot lead to the survival of newborns.

　　(5) Unexplained infertility.

　　To avoid artificial insemination, both partners should take preventive measures against infertility in their daily lives:

　　1. Pre-marital examination.This is the first step to ensure fertility and the practice of eugenic breeding. If a pre-marital examination reveals congenital malformations, diseases, or endocrine disorders that affect fertility, or systemic diseases such as tuberculosis in one or both partners, they should be treated before marriage to avoid infertility after marriage.

　　2. Actively prevent and treat reproductive organ inflammation.Inflammation of the reproductive organs of both genders is a common cause of infertility. Whether it is daily health care, menstrual hygiene, marital intimacy, contraception, artificial abortion, or gynecological examination, one should prevent infections of the reproductive organs. Once an infection is detected, it should be treated early to avoid leaving sequelae of infertility.

　　3. Maintain a good mental state.Various adverse mental factors, such as long-term tension, depression, anxiety, irritability, and fear, can lead to dysfunction of male and female reproductive systems, and are prone to infertility. It is not uncommon for couples to quickly conceive after eliminating these adverse mental factors.

　　4. Eliminate adverse lifestyle factors.Smoking, excessive drinking, and haphazard use of medications (especially sedatives and sex hormones) can be one of the causes of infertility after marriage, fetal deformities, and spontaneous abortion. Both partners should quit smoking and reduce alcohol consumption, and avoid taking medicine randomly.

　　5. Master the timing of sexual intercourse for conception.Fertile women generally ovulate only once a month, and their survival time is only 2-3 days. Only by seizing this opportunity for sexual intercourse can it be easier to conceive. If both partners have normal reproductive function and the female's menstrual cycle is normal, sexual intercourse can be carried out every other day from the 11th to the 17th day of the menstrual cycle, that is, during the ovulation period, to increase the chance of sperm and egg meeting. After sexual intercourse, the female should also elevate her buttocks and continue to lie for more than 30 minutes to allow sperm sufficient time to enter the fallopian tubes. Moreover, the female should not urinate urgently after sexual intercourse to prevent seminal fluid from flowing out. Some couples are eager to have a child and have frequent sexual intercourse, thinking that this can increase the chance of conception. In fact, this not only harms health but also reduces sperm quality, which is not conducive to conception.

　　Before artificial insemination, both partners should undergo the following laboratory tests to confirm whether they are infertile or not.

　　Female:

　　1. Speculating on the presence of ovulation and predicting the ovulation period: by measuring the basal body temperature and checking cervical mucus or hormone levels to judge.

　　2. Endocrine function test: at different times of the menstrual cycle, the levels of serum estrogen and progesterone are measured to understand the ovarian function, such as polycystic ovary syndrome; the basal metabolic rate is measured to understand the thyroid function; adrenal function tests and serum prolactin measurements are conducted, etc.

　　3. Tubal patency examination: including hysterosalpingography, mainly to understand whether the fallopian tubes are patent, and whether the development of the uterus and fallopian tubes is normal, and whether there are malformations, etc. For those with subpatent fallopian tubes (such as mild adhesions), it also has a therapeutic effect.

　　4. Endometrial examination: through biopsy, the functional state of the endometrium can be understood, and at the same time, it can also exclude uterine cavity lesions such as tuberculosis and fibroids.

　　5. Immunological examination: to understand whether there are antibodies against sperm, antibodies against endometrium, and other factors present.

　　6. Examination of the internal and external reproductive systems: a preliminary understanding of the size and position of the uterus, whether it is normal, and whether there are masses, tenderness, inflammation, and other conditions in the uterus, fallopian tubes, and ovaries.

　　Male:

　　1. Vasography examination: this examination involves injecting contrast medium into the vas deferens through incision or percutaneous puncture, so that the vas deferens, seminal vesicle, and seminal duct can be displayed, to understand whether the vas deferens is patent, and whether there are pathological changes in the seminal vesicle, and to clarify the causes of male infertility.

　　2. Testicular biopsy: if the testicular biopsy is normal, obstructive azoospermia should be considered first. The pathological examination of the testicle can show varying degrees of spermatogenic dysfunction: such as hypofunctional spermatogenic function, characterized by the presence of spermatogenic cells at all stages in the seminiferous tubules; spermatogenic arrest, characterized by the presence of spermatogenic cells but a decrease in number, unable to develop into sperm; severe spermatogenic dysfunction, which may lead to hyaline degeneration of the seminiferous tubules, fibrosis of the membranes, and other irreversible changes.

　　3. Infrared thermal imaging: suitable for the diagnosis of male reproductive system tumors and male reproductive system inflammation. Radioisotope examination: can detect some hidden diseases, such as varicocele, testicular torsion, and testicular tumors.

　　4. Testicular ultrasound: It can detect gross changes in the testes, and testicular biopsy can provide more reliable diagnostic and treatment evidence. If obstructive azoospermia is suspected, sperm duct造影 should be performed to observe whether there is obstruction of the sperm duct and to clarify the site of obstruction.

　　5. Endocrine examination: Serum FSH (follicle-stimulating hormone), LH (luteinizing hormone), PRL (prolactin), T (testosterone), DHT (dihydrotestosterone) can help distinguish between primary testicular failure and secondary testicular failure.

　　6. Ultrasound examination: It is mainly used to understand conditions such as hydrocele, epididymal hematoma, varicocele, epididymal cyst, epididymitis, testicular tumor, and testicular torsion. Doppler ultrasound is helpful in diagnosing varicocele, and prostate diseases can also be examined by ultrasonic methods.

　　7. Fructose measurement: Fructose measurement can be used to distinguish whether there is poor development or absence of seminal vesicles, or obstruction of the seminal duct. However, the value of fructose measurement results is limited.

　　8. Chromosome karyotyping analysis: It is used to diagnose poor testicular development, congenital malformations of external genitalia, and unknown causes of azoospermia. It is of great value in the diagnosis of spermatogenic disorders, and the discovery of special translocations and deletions can help determine whether they are newly developed or inherited, providing important clues for doctors to understand the relationship between chromosomal abnormalities and spermatogenic disorders.

　　Although there are many factors that cause infertility and sterility, not all of them are related to diet and nutrition. For couples suffering from infertility and sterility, while adjusting with medication and improving lifestyle, slightly emphasizing changes in diet can also be a kind of auxiliary method.

　　1. Protein is a very important substance for reproductive function, endocrine, and hormones. After protein absorption, it will be transformed into amino acids. Among them, an amino acid called arginine is an important raw material for sperm production and can also enhance the activity of sperm, helping to maintain the normal function of the male reproductive system. Foods rich in protein and vitamins, such as lean meat, eggs, fresh vegetables, and fruits, and foods rich in arginine such as eels, sea cucumbers, cuttlefish, octopus, peanut kernels, walnuts, and more, are all beneficial for conception.

　　2. Zinc is an essential substance that testes know testosterone (androgen), and it is also closely related to sperm production and quality. Even during pregnancy, it is necessary to supplement zinc appropriately. Zinc is an important element for promoting fetal growth and development. If zinc is deficient in the early pregnancy, it can interfere with the development of the fetal central nervous system. If zinc is deficient in the late pregnancy, it can affect the development of the nervous system. Foods rich in zinc include beans, peanuts, millet, radishes, Chinese cabbage, oysters, beef, chicken liver, eggs, lamb chops, pork, and more.

　　3. Animal internal organs contain a lot of cholesterol, about 10% of which is adrenal cortex and sex hormones. Appropriately eating more animal internal organs can enhance sexual function.

　　4. Vitamin E, also known as tocopherol, indicates its relationship with fertility from its name. Deficiency of vitamin E can cause damage to the testes, thereby affecting fertility. Foods rich in vitamin E include germ, whole grains, beans, eggs, sweet potatoes, green leafy vegetables, and more.

　　The current methods of artificial insemination mainly include:

　　1. Intra-cervical and Intra-cervical Canal Insemination.The patient assumes a lithotomy position and carefully injects 0.2 to 0.5 milliliters of liquefied or processed semen into 1 centimeter from the cervical canal. Then, a blunt plastic plug is used to block the external orifice of the cervix, and the remaining semen is injected into the anterior fornix. After completing the operation, the patient lies on their back for 20 to 30 minutes.

　　2. Cervical Cap Insemination.Intra-vaginal or cervical canal artificial insemination may result in most of the semen溢出阴道外, and the small amount of semen that remains is also often destroyed by the acidic environment of the vagina, and the patient also needs to lie on their back for a period of time. The use of a cervical cap can overcome these shortcomings, but since the external diameter of the patient's cervix is different, it is difficult to select a cervical cap of appropriate size, and it is often prone to dislocation. Some people have tried using a vacuum negative pressure cervical cap that can fit closely with the cervix. The cervical cap is left in the vagina for 8 to 16 hours, and the patient removes it themselves at that time.

　　3. Intra-vaginal Insemination.Because this method does not require exposure of the cervical os, it is easier to control. The patient assumes a lithotomy position, with a pillow under the buttocks, and the collected semen is injected into the vagina after waiting for complete liquefaction and blocked with a plastic plug. The patient lies on their back for 20 to 30 minutes. This method can be performed by the couple themselves under the guidance of a doctor.

　　4. Intrauterine Insemination.Intrauterine Insemination is a non-physiological process. The sperm, along with the seminal plasma, is injected into the uterine cavity, which can cause a series of problems. Firstly, the sperm can quickly pass through the fallopian tube into the abdominal cavity, reducing the chance of meeting the egg; secondly, it may increase the risk of infection, therefore, it is advisable to rinse the vagina with Lactated Ringer's solution, use instruments should be strictly disinfected, and, antibiotics should be applied throughout the body during artificial insemination; further, due to the action of prostaglandins contained in the seminal plasma, it can cause uterine spasm and abdominal pain. Therefore, the semen must be processed, and the amount of semen injected should be limited to less than 0.3 milliliters. In addition, since the prostaglandins in the semen come from the seminal vesicle, some people advocate using the first ejaculate for intrauterine artificial insemination to reduce the occurrence of abdominal pain.