The "miracle of childbirth" is preceded by a lot of other crucial miracles that enable this wondrous event to take place. Chief among these is conception. For women and their partners who have had little or no trouble conceiving, it may be hard to appreciate the frustration and heartbreak felt by couples who do have difficulty becoming pregnant.
Fortunately, for many of these people, there are several courses of treatment, including one long-standing option, artificial insemination. For the details on this technique, I consulted Dr. Anne Namnoum, director of assisted reproductive technology in the Division of Reproductive Endocrinology at Johns Hopkins School of Medicine.
Q: What is artificial insemination?
A: Artificial insemination is the assisted placement of sperm in a woman's reproductive tract, either in the vagina, cervix or uterus. Sperm can be contributed by the husband or by a donor. There are several different ways to perform the insemination, according to the site of sperm placement. It is interesting to note that the procedure is not new. One of the first well-documented attempts at artificial insemination occurred in the 1790s, with a normal pregnancy ensuing.
Q: What makes a couple candidates for the procedure?
A: Problems with either the male or female reproductive system, or both, can lead to a failure to conceive normally.
Problems for men that may be indications for artificial insemination include anatomic abnormalities of the penis; ejaculation disorders, including retrograde ejaculation, where semen winds up in the bladder; and problems such as impotence. A more common indication is a decrease in the sperm count and/or decreased sperm motility (movement).
Otherwise fertile women can suffer from cervical mucus abnormalities, which can prevent the penetration of sperm on its journey to the uterus.
A comparatively large number of couples experiencing problems fall into the unexplained infertility category, in which testing yields no clear answers. Artificial insemination may be part of a treatment plan for these people.
Q: What are some treatment methods?
A: The idea is to help the sperm to reach its destination -- the egg-bearing fallopian tubes of the woman. Catheters or other instruments can introduce the sperm directly into the vagina, cervix or uterus. In the case of male infertility, the most motile sperm can be placed, by means of a catheter, at the top of the uterus near the fallopian tubes. The same technique can be used to bypass the cervix, in cases where the cervix is causing infertility.
Sometimes these treatments are used in conjunction with fertility medications. The idea is to maximize the odds of conception: to increase the sperm density, then deliver it to the right place at the time of ovulation. If the woman has not had her period two weeks later, a pregnancy test is performed.
Q: How widespread a problem is infertility?
A: The numbers are significant. It is estimated that 10 percent to 15 percent of couples nationwide are infertile. Of these, 30 percent to 40 percent suffer from male infertility, and about 10 percent may have a cervical problem. Couples with unexplained fertility problems account for 10 percent to 15 percent of the total.
Q: How successful are these procedures?
A: Success rates for artificial insemination depend on a number of underlying factors. Fertility drugs have been shown to make a difference. Generally speaking, a 3 percent to 20 percent success rate per attempt has been demonstrated, but again, there is a wide variation.
Q: How safe is the procedure?
A: The procedure carries with it a small risk of infection, although this has been minimized as techniques have become more refined. Since the sperm used often is bypassing a woman's natural disease barriers, it is processed for removal of bacteria, white blood cells and other substances.
Q: Is artificial insemination usually covered by health insurance?
A: Coverage varies from company to company. Most insurance plans will not cover donor insemination. Some require documentation of a husband's sperm before covering the procedure. Increasingly, plans that cover artificial insemination are limiting the number of attempts for which they will pay. Couples considering the procedure should check with their insurance plans.
Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.