Before every treatment, the couple is informed about what will happen, the procedure, possible risks and legal consequences, and signs the relevant informed consent. Consent templates for all treatments have been elaborated by the Pan-Hellenic Association of Clinical Embryologists (PEKE).
Each written consent is issued in two copies, one to be given to the couple for their records and the other to be kept in the couple’s medical file, at the assisted reproduction clinic.
The signature of the consents is not a bureaucratic formality, but offers substantial protection to the couple as well as to the assisted reproduction clinic. The couple must read the document carefully before signing it, as well as clearly understand its full content. If there are any questions, they must be discussed with the doctor and his team, in order for unclear issues to be clarified.
When this technique is applied, sperm is injected in the patient’s uterus during a natural menstrual cycle or following ovarian stimulation and ovulation induction.
Initially, the sperm undergoes a special process (possible microbes and useless cells are eliminated and the sperm is activated in the laboratory). This procedure takes approximately 2 hours. Then, the activated sperm is introduced near the top of the internal uterine cavity with the use of a special, thin catheter. When the sperm is placed in that part of the uterus, a shorter distance remains to be covered, so that sperm reaches oocytes at ovulation.
The whole procedure is totally pain-free and feels like a Pap Test.
This technique is suitable for the following cases:
• Patients under 35 who experience a short period of infertility, when the sperm is of relatively good quality (good final result following activation) and both fallopian tubes are open and free of adhesions.
• Patients who do not ovulate and need medication for ovarian stimulation and ovulation induction.
• When there is cervical mucus deficiency, due to previous surgery (cervical mucus normally facilitates sperm). This is the only case where intrauterine insemination in a natural menstrual cycle – i.e. with no ovarian stimulation – is meaningful.
Cervical mucus deficiency is a rare cause of infertility and usually occurs after an extensive loop excision of the cervix (removal of abnormal cells due to human papilloma virus -HPV infection).
• IVF with sperm donor.
Although pregnancy achievement rates with the aid of intrauterine insemination are relatively low (10-15% per cycle), the technique in question has the advantage of being far less invasive than IVF (it is closer to natural conception) and therefore, less costly. However, there are some significant disadvantages:
• In case many oocytes are produced during ovarian stimulation, there is an increased possibility of multiple pregnancy, since in intrauterine insemination there is no way to control the number of fertilised oocytes.
• In older women with limited ovarian reserve, oocytes must be “saved”. In that case, IVF maximises the chances of achieving pregnancy, because this technique has increased success rates.
In general, the value of intrauterine insemination is relatively limited (the technique is mainly useful in “easy” infertility cases). Low cost (compared to IVF) offers no substantial advantage, because success rates are quite low, thus reversing financial benefit.
Moreover, besides being psychologically exhausting, multiple intrauterine insemination cycles may delay pregnancy achievement, which leads to precious time being wasted (especially for women over 35). For that reason, Mr. Evripidis Mantoudis believes that no more than 3-4 intrauterine insemination cycles must be followed, depending of course on the particularities of each couple (e.g woman’s age etc.)