History The first recorded case of artificial insemination was by
John Hunter in 1790, who helped impregnate a linen draper's wife. The first reported case of artificial insemination by donor occurred in 1884:
William H. Pancoast, a professor in Philadelphia, took sperm from his "best looking" student to inseminate an anesthetized woman without her knowledge. The case was reported 25 years later in a medical journal. The
sperm bank was developed in
Iowa starting in the 1950s in research conducted by University of Iowa medical school researchers
Jerome K. Sherman and Raymond Bunge. In 1916, Australian eugenicist
Marion Louisa Piddington published a pseudonymous tract titled
Via Nuova or Science & Maternity in which she called for a programme of mass artificial insemination for the sweethearts of soldiers who had been killed in World War I. She described this as a "conscription of the virgins" – comparable to the
conscription of men for military service – who would receive "artificial insemination from a eugenically-desirable donor". Piddington promoted her scheme for several years in Australia, Britain and the United States under the name of "scientific motherhood", but it was poorly received. In the United Kingdom, British obstetrician
Mary Barton founded one of the first
fertility clinics to offer
donor insemination in the 1930s, with her husband
Bertold Wiesner fathering hundreds of offspring. In the 1980s, direct intraperitoneal insemination (DIPI) was occasionally used, where doctors injected sperm into the lower abdomen through a surgical hole or incision, with the intention of letting them find the
oocyte at the
ovary or after entering the genital tract through the
ostium of the fallopian tube.
Patients and gamete donors Artificial insemination (AI) is a medical procedure in which sperm is introduced into a woman's reproductive system to achieve pregnancy without sexual intercourse. The sperm used may come from the recipient's partner or from a donor, whose identity may be known or anonymous. Various methods exist to obtain sperm for use in artificial insemination. Originally, artificial insemination was primarily employed to assist heterosexual couples experiencing fertility difficulties. However, advances in reproductive technologies, such as intracytoplasmic sperm injection (ICSI), have reduced the necessity of AI for many couples. Nevertheless, AI may still be recommended in specific cases. Prior to the procedure, both partners typically undergo medical evaluations to identify and address any physical or reproductive factors that could hinder natural conception. This may include assessing the male's sperm count, motility, and viability, as well as evaluating the female's ovulation and reproductive tract. Certain conditions, such as immune reactions against sperm or cervical issues like scarring, blockage, or thickened cervical mucus, may make artificial insemination a suitable option. In modern practice, artificial insemination is frequently used by women without a male partner—such as single women or women in same-sex relationships—using donor sperm to achieve pregnancy. In 2016, an article was published in Seventeen magazine that highlighted the story of Kacie Saxer-Taulbee, a teenager conceived from a sperm donor father. Using her donor's cryobank number in the
Donor Sibling Registry, she managed to find other siblings conceived from the same donor. They became known as the "5010ers" and formed a Facebook group to keep in touch.
Barriers for patients and donors Some countries have laws which restrict and regulate who can donate sperm and who is able to receive artificial insemination. Some women who live in a jurisdiction which does not permit artificial insemination in the circumstance in which she finds herself may
travel to another jurisdiction which permits it. Compared with
natural insemination, artificial insemination can be more expensive and more invasive, and may require professional assistance.
Preparations Timing is critical, as the window and opportunity for fertilization is little more than twelve hours from the release of the ovum. To increase the chance of success, the woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as
basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of her cervix. To improve the success rate of artificial insemination, drugs to create a
stimulated cycle may be used, but the use of such drugs also results in an increased chance of a multiple birth. Sperm can be provided fresh or
washed. Washed sperm is required in certain situations. Pre- and post-concentration of motile sperm is counted. Sperm from a sperm bank will be frozen and quarantined for a period, and the donor will be tested before and after production of the sample to ensure that he does not carry a transmissible disease. Sperm from a sperm bank will also be suspended in a
semen extender which assists with freezing, storing and shipping. If sperm is provided by a private donor, either directly or through a sperm agency, it is usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided in this way may be given directly to the recipient woman or her partner, or it may be transported in specially insulated containers. Some donors have their own freezing apparatus to freeze and store their sperm.
Techniques . The cervix is part of the
uterus. The
cervical canal connects the interiors of the uterus and
vagina. Semen used is either fresh, raw, or frozen. Where donor sperm is supplied by a sperm bank, it will always be quarantined and frozen, and will need to be thawed before use. The sperm is ideally donated after two or three days of abstinence, without lubrication as the lubricant can inhibit the sperm motility. It may also be performed privately by the woman, or, if she has a partner, in the presence of her partner, or by her partner. ICI was previously used in many fertility centers as a method of insemination, but its popularity in this context has waned as other, more reliable methods of insemination have become available. During ICI, air is expelled from a needleless syringe which is then filled with semen which has been allowed to liquify. A specially designed syringe, wider and with a more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The woman lies on her back and the syringe is inserted into the vagina. Care is optimal when inserting the syringe, so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose and a catheter may be attached to the tip of the syringe to ensure delivery of the semen as close to the entrance to the cervix as possible. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for safety and for the best results, bearing in mind that the purpose of the procedure is to replicate as closely as possible a natural deposit of the semen in the vagina. The syringe (and catheter if used) may be left in place for several minutes before removal. The woman can bring herself to orgasm so that the cervix 'dips down' into the pool of semen, again replicating closely vaginal intercourse, and this may improve the success rate. Following insemination, fertile sperm will swim through the cervix into the uterus and from there to the fallopian tubes in a natural way as if the sperm had been deposited in the vagina through intercourse. The woman is therefore advised to lie still for about half-an-hour to assist conception. One insemination during a cycle is usually sufficient. Additional inseminations during the same cycle may not improve the chances of a pregnancy. Ordinary sexual lubricants should not be used in the process, but special fertility or 'sperm-friendly' lubricants can be used for increased ease and comfort. When performed at home without the presence of a professional, aiming the sperm in the vagina at the neck of the cervix may be more difficult to achieve and the effect may be to 'flood' the vagina with semen, rather than to target it specifically at the entrance to the cervix. This procedure is sometimes referred to as '
intravaginal insemination' (IVI). Sperm supplied by a sperm bank will be frozen and must be allowed to thaw before insemination. The sealed end of the straw itself must be cut off and the open end of the straw is usually fixed straight on to the tip of the syringe, allowing the contents to be drawn into the syringe. Sperm from more than one straw can generally be used in the same syringe. Where fresh semen is used, this must be allowed to liquefy before inserting it into the syringe, or alternatively, the syringe may be back-loaded. A conception cap, which is a form of
conception device, may be inserted into the vagina following insemination and may be left in place for several hours. Using this method, a woman may go about her usual activities while the cervical cap holds the semen in the vagina close to the entrance to the cervix. Advocates of this method claim that it increases the chances of conception. One advantage with the conception device is that fresh, non-liquefied semen may be used. The man may ejaculate straight into the cap so that his fresh semen can be inserted immediately into the vagina without waiting for it to liquefy, although a collection cup may also be used. Other methods may be used to insert semen into the vagina notably involving different uses of a conception cap. These include a specially designed conception cap with a tube attached which may be inserted empty into the vagina after which liquefied semen is poured into the tube. These methods are designed to ensure that semen is inseminated as close as possible to the cervix and that it is kept in place there to increase the chances of conception.
Intrauterine Intrauterine insemination (IUI) involves injection of 'washed' sperm directly into the uterus with a
catheter. Washing involves the removal of chemicals other than sperm which are in the natural ejaculate. In forms of vaginal insemination, including artificial vaginal insemination and ICI, these chemicals will be filtered out by the vagina. Insemination in this way also means that the sperm do not have to swim through the cervix which is coated with a mucus layer. This layer of mucus can slow down the passage of sperm and can result in many sperm perishing before they can enter the uterus. Donor sperm is sometimes tested for mucus penetration if it is to be used for ICI inseminations but partner sperm may or may not be able to pass through the cervix. In these cases, the use of IUI can provide a more efficient delivery of the sperm. In general terms, IUI is usually regarded as more efficient than ICI or IVI. It is therefore the method of choice for single and lesbian women wishing to conceive using donor sperm since this group of recipients usually require artificial insemination because they do not have a male partner, not because they have medical problems. Owing to the high number of these recipients using donor sperm services, IUI is therefore the most popular method of insemination today at a fertility clinic. The term 'artificial insemination' has, in many cases, come to mean IUI insemination. It is important that washed sperm is used because unwashed sperm may elicit uterine cramping, expelling the semen and causing pain, due to content of
prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, during
menstruation.) Resting on the table for fifteen minutes after an IUI is optimal for the woman to increase the pregnancy rate. Using this technique, as with ICI, fertilization takes place naturally in the external part of the fallopian tubes in the same way that occurs following intercourse. For heterosexual couples, the indications to perform an intrauterine insemination are usually a moderate male factor, the incapability to ejaculate in vagina and an idiopathic infertility. A short period of ejaculatory abstinence before intrauterine insemination is associated with higher
pregnancy rates. For the man, a
TMS of more than 5 million per ml is optimal. In practice, donor sperm will satisfy these criteria and since IUI is a more efficient method of artificial insemination than ICI and, because of its generally higher success rate, IUI is usually the insemination procedure of choice for single women and lesbians using donor semen in a fertility centre. Lesbians and single women are less likely to have fertility issues of their own and enabling donor sperm to be inserted directly into the womb will often produce a better chance of conceiving. A 2019 showed that pregnancy rates were similar between lesbian women and heterosexual women undergoing IUI. However, it was found that there is a significantly higher multiple gestation rate among lesbian women undergoing ovulation induction (OI) when compared to lesbian women undergoing natural cycles. Unlike ICI, intrauterine insemination normally requires a medical practitioner to perform the procedure. One of the requirements is to have at least one permeable tube, proved by hysterosalpingography. The infertility duration is also important. A female under 30 years of age has optimal chances with IUI; A promising cycle is one that offers two
follicles measuring more than 16 mm, and
estrogen of more than 500 pg/mL on the day of
hCG administration. One of the prominent private clinic in Europe has published a data A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were associated with the live-birth rate The steps to follow in order to perform an intrauterine insemination are: • Mild controlled ovarian stimulation (COS): there is no control of how many oocytes are at the same time when stimulating ovulation. For that reason, it is necessary to check the amount being ovulated via ultrasound (checking the amount of follicles developing at the same time) and administering the desired amount of hormones. • Ovulation induction: using substances known as ovulation inductors. • Semen capacitation: wash and centrifugation, swim-up, or gradient. The insemination should not be performed later than an hour after capacitation. 'Washed sperm' may be purchased directly from a sperm bank if donor semen is used, or 'unwashed semen' may be thawed and capacitated before performing IUI insemination, provided that the capacitation leaves a minimum of, usually, five million motile sperm. • Luteal phase support: a lack of
progesterone in the endometrium could end a pregnancy. To avoid that 200 mg/day of micronized progesterone are administered via vagina. If there is pregnancy, this hormone is kept administering until the tenth week of pregnancy. The cost breakdown for Intrauterine Insemination (IUI) involves several components. The procedure itself typically ranges from $300 to $1,000 per cycle without insurance. The cost of the sperm may vary widely, with prices per vial ranging from $500 to $1,000 or more from a sperm bank. Additional expenses might include consultation fees, ovulation-inducing medication, ultrasounds, and blood tests. IUI can be used in conjunction with
controlled ovarian hyperstimulation (COH). Clomiphene Citrate is the first line, Letrozole is second line, in order to stimulate ovaries before moving on to IVF. Still,
advanced maternal age causes decreased success rates; women aged 38–39 years appear to have reasonable success during the first two cycles of ovarian hyperstimulation and IUI. However, for women aged over 40 years, there appears to be no benefit after a single cycle of COH/IUI. A double intrauterine insemination theoretically increases pregnancy rates by decreasing the risk of missing the
fertile window during ovulation. However, a
randomized trial of insemination after
ovarian hyperstimulation found no difference in live birth rate between single and double intrauterine insemination. A Cochrane found uncertain evidence about the effect of IUI compared with timed intercourse or expectant management on live birth rates but IUI with controlled ovarian hyperstimulation is probably better than expectant management. Due to the lack of reliable evidence from controlled clinical trials, it is not certain which semen preparation techniques are more effective (wash and centrifugation; swim-up; or gradient) in terms of pregnancy and live birth rates.
Intrauterine insemination success factors Intrauterine insemination (IUI) procedures have shown to be more successful and effective with certain factors taken into account. One major factor is the health of the sperm that is used. Sperm motility, which is improved by the sperm washing procedure, sperm density, and the sperm concentration index, all of which are found through washing and studying of the health of the specimen, are major indicators of a positive pregnancy test following IUI. In non-tubal sub fertility, fallopian tube sperm perfusion may be the preferred technique over intrauterine insemination.
Intratubal Intratubal insemination (ITI) involves injection of washed sperm into the
fallopian tube, although this procedure is no longer generally regarded as having any beneficial effect compared with IUI. ITI however, should not be confused with
gamete intrafallopian transfer, where both eggs and sperm are mixed outside the woman's body and then immediately inserted into the fallopian tube where fertilization takes place.
LGBTQ+ concerns Although many fertilization procedures, like IUI are typically carried out in a medical setting, society is increasingly recognizing the important role that this plays in the lives of individuals who might otherwise not conceive through heterosexual penetrative sexual intercourse. Artificial insemination using a sperm donor for LGBTQ+ individuals and couples is one of the more cost-effective avenues to parenting. While clinic based IUI may be open to many, it typically still includes hetero-reproductive narratives which dates from the early days of fertilization procedures when these were often exclusively for married couples and when there was a resistance in many societies to extend these services to the LGBTQ+ community. Indeed, in the early days, there were very few fertility clinics which would provide services to single women and lesbian couples. In the UK, notable pioneers in this respect were the
British Pregnancy Advisory Service (BPAS) and the Pregnancy Advisory Service (PAS), both of which operated before statutory control of fertility services in 1992, and the London Women's Clinic (LWC) which provided artificial insemination to single women and lesbians from 1998. Most donor insemination procedures undertaken in many countries today are for lesbian couples or single mainly lesbian women, yet much of their rhetoric and advertising is directed at heterosexual couples. Indeed, many
sperm banks seem reluctant to inform donors that most of their donations will be used for lesbians and single women. To improve the way society talks about and carries out donor insemination inclusive language may be used. One way to do this is to bring LGBTQ narratives into this process, with a particular emphasis on this being a family-centered process. Even in a medical setting, it is important to bring intimacy and family-centeredness into this process, as this promotes connectedness and inclusiveness in what can be seen as a hostile and discriminatory environment. After a sperm donor is selected, a couple can proceed with donor sperm IUI. IUI is an economic option for same-sex couples and can be done without the use of medication. According to a study from 2021, lesbian women undergoing IUI had an average clinical pregnancy rate of 13.2% per cycle and 42.2% success rate giving the average number of cycles at 3.6.
Pregnancy rate (may be twice as large as
total motile sperm count). Values are for intrauterine insemination. (Old data, rates are likely higher these days) The rates of successful pregnancy for artificial insemination are 10-15% per
menstrual cycle using ICI, and 15–20% per cycle for IUI. In IUI, about 60 to 70% have achieved pregnancy after 6 cycles. However, these pregnancy rates may be very misleading, since many factors have to be included to give a meaningful answer, e.g. definition of success and calculation of the total population. These rates can be influenced by age, overall reproductive health, and if the patient had an orgasm during the insemination. The literature is conflicting on immobilization after insemination has increasing the chances of pregnancy. Previous data suggests that it is statistically significant for the patient to remain immobile for 15 minutes after insemination, while another review article claims that it is not. A point of consideration, is that it does cost the patient or healthcare system to remain immobile for 15 minutes if it does increase the chances. For couples with
unexplained infertility, unstimulated IUI is no more effective than natural means of conception. The pregnancy rate also depends on the
total sperm count, or, more specifically, the
total motile sperm count (TMSC), used in a cycle. The success rate increases with increasing TMSC, but only up to a certain count, when other factors become limiting to success. The summed pregnancy rate of two cycles using a TMSC of 5 million (may be a TSC of ~10 million on graph) in each cycle is substantially higher than one single cycle using a TMSC of 10 million. However, although more cost-efficient, using a lower TMSC also increases the average time taken to achieve pregnancy. Women whose age is becoming a major
factor in fertility may not want to spend that extra time.
Samples per child The number of samples (ejaculates) required to give rise to a child varies substantially from person to person, as well as from clinic to clinic. However, the following equations generalize the main factors involved: For
intracervical insemination: :N = \frac{V_s \times c \times r_s}{n_r} •
N is how many children a single sample can give rise to. •
Vs is the volume of a sample (ejaculate), usually between 1.0
mL and 6.5 mL •
c is the concentration of motile sperm in a sample
after freezing and thawing, approximately 5–20 million per ml but varies substantially •
rs is the pregnancy rate per cycle, between 10% and 35% The
medicalization of infertility creates a framework in which individuals are encouraged to think of infertility quite negatively. In many cultures donor insemination is religiously and culturally prohibited, often meaning that less accessible "high tech" and expensive ARTs, like IVF, are the only solution. An over-reliance on reproductive technologies in dealing with infertility prevents many – especially, for example, in the "
infertility belt" of central and southern Africa – from dealing with many of the key causes of infertility treatable by artificial insemination techniques; namely preventable infections, dietary and lifestyle influences. Although these risk factors are minor and generally manageable, there is a significant knowledge gap between identity groups around risk factors for fertility treatments in general. For instance, it was found that LGBTQ+ individuals had "had significant knowledge gaps of risk factors associated with reproductive outcomes when compared to heterosexual female peers." Therefore, it is imperative that providers take extra care in educating their LGBTQ+ patients on potential risk factors of artificial insemination. The implications of this knowledge gap between LGTBQ+ individuals and their heterosexual counterparts are serious and worth noting. Lack of access to proper information and risk factors around procedures like these may dissuade someone from pursuing these procedures altogether. As a result, there will be less normalization of LGBTQ+ family making and reproduction, which only perpetuates this cycle of lack of information among LGBTQ+ folks.
Legal restrictions Some countries restrict artificial insemination in a variety of ways. For example, some countries do not permit AI for single women, and other countries do not permit the use of donor sperm.
Europe As of May 2013, the following European countries permit medically assisted AI for single women: •
Armenia •
Belarus Once the children began to be recognized as legitimate, legal questions around who the parents of the child are, how to handle surrogacy, paternity rights, and eventually artificial insemination and LGBT+ parents began to arise. Prior to the use of artificial insemination, the legal parents of a child were the two people who conceived the child or the person who birthed the child and their legal spouse, was revised to address non married couples and states that an unmarried couple has the same rights to the child that a married couple would. This bill includes expanding "father" to mean any person who would fill the role of a father, regardless of their gender and "mother" is expanded to anyone who gives birth to the child regardless of gender. In addition, this act would also change any language of "husband" or "wife" to "spouse." Under the 1973 UPA, married heterosexual couples making use of artificial insemination through a licensed physician could list the husband as the natural father of the child, rather than the sperm donor. Some religious groups, such as the Catholic Church, and individuals have also criticized artificial insemination because acquiring sperm for the procedure is seen as "a form of adultery promoting the vice of masturbation."
Other morality-based opposition There are critics of artificial insemination who voice concerns regarding the potential for AI to encourage
eugenicist practices through selection of particular traits. The line of reasoning follows the history of artificial insemination in breeding livestock and other domesticated animals wherein preferred traits are encouraged through human-controlled selection. ==Other animals==