artificial insemination

Humans

History

The first recorded case of artificial insemination was by Lazzaro Spallanzani in 1784, who performed it on a dog. It was followed in 1790 by John Hunter, 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.

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.

Some countries have laws which restrict and regulate who can donate sperm and who is able to receive artificial insemination.

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.

Techniques

Semen used is either fresh, raw, or frozen.

Intracervical insemination (ICI) is the method of artificial insemination which most closely mimics the natural ejaculation of semen by the penis into the vagina during sexual intercourse. It is painless and is the simplest and most common method of artificial insemination involving the introduction of unwashed or raw semen into the vagina at the entrance to the cervix, usually by means of a needle-less syringe. The vagina acts as a filter to separate out the sperm from other chemicals in the ejaculate, as with intercourse, so that only sperm pass through the cervix on their way to the uterus.

Although ICI is the simplest method of artificial insemination, a meta-analysis has shown no difference in live birth rates compared with IUI.

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.

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).

Pregnancy rate

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

=

V

s

×

c

×

r

s

n

r

{\displaystyle 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%

nr is the total motile sperm count recommended for vaginal insemination (VI) or intra-cervical insemination (ICI), approximately 20 million pr. ml.

The pregnancy rate increases with increasing number of motile sperm used, but only up to a certain degree, when other factors become limiting instead.

Social implications

One of the key issues arising from the rise of dependency on assisted reproductive technology (ARTs) is the pressure placed on couples to conceive, "where children are highly desired, parenthood is culturally mandatory, and childlessness socially unacceptable".

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.

If good records are not kept, the offspring when grown up risk accidental incest.

Risk factors

The risk factors of artificial insemination are comparatively low to other forms of fertility treatment. The most prominent risk factor would be infection after the procedure, with other risk factors including a higher risk of having twins or triplets, and minor vaginal bleeding during the procedure.

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."

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.

As of May 2013, the following European countries permit medically assisted AI for single women:

Artificial insemination used to be seen as adultery and was illegal until the 1960s when states started recognizing the child born from artificial insemination as legitimate. 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, but artificial insemination complicates the legal process of becoming a parent as well as who is the parent of the child. Deciding who the parents of the child are is the largest legal predicament around artificial insemination. However, questions around surrogacy and donor's rights also appear as a side question to determining the parent(s). Some major cases that deal with artificial insemination and parental rights are, K.M v E.G, Johnson v Calvert, Matter of Baby M, and In Re K.M.H.

When children are conceived the traditional way, there is little discrepancy around who the legal parents of the child are. However, because children conceived using artificial insemination may not be genetically related to one or more of their parents, who the legal parents of the child are can come into question. Prior to the passage of the Uniform Parentage Act in 1973, children conceived via artificial insemination were deemed as "illegitimate" children. The Uniform Parentage Act then recognized the children born from artificial insemination as legal and laid precedent for how the legal parents of the child were decided. However, this act applied only to the children of those married couples. It established that the person who birthed the child was the mother and the father would be the husband of the woman. In 2002, the Uniform Parentage Act, which is adopted individually on a state by state basis, 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 extended who has the right to be a parent to a man who would supposedly fill in the social role as a "father." There were now numerous ways to establish parental rights for both the mother and the father depending on if the child was born using a sperm donor or a surrogate. Currently, a revised version of the Uniform Parentage Act is starting to be passed in a few states that expands how parental relations can be determined. 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."

Opposition and criticism

Some theologically buttressed arguments reject the moral validity of this practice, such as Pope John XXIII. However, according to a document of the USCCB, the intrauterine insemination (IUI) of "licitly obtained" (normal intercourse with a silastic sheath i.e. a perforated condom) but technologically prepared semen sample (washed, etc.) has been neither approved nor disapproved by Church authority and its moral validity remains under discussion. 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."

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

Artificial insemination is used for pets, livestock, endangered species, and animals in zoos or marine parks difficult to transport.

Reasons and techniques

It may be used for many reasons, including to allow a male to inseminate a much larger number of females, to allow the use of genetic material from males separated by distance or time, to overcome physical breeding difficulties, to control the paternity of offspring, to synchronize births, to avoid injury incurred during natural mating, and to avoid the need to keep a male at all (such as for small numbers of females or in species whose fertile males may be difficult to manage).

Artificial insemination is much more common than natural mating, as it allows several female animals to be impregnated from a single male. For instance, up to 30-40 female pigs can be impregnated from a single boar. Workers collect the semen by masturbating the boars, then insert it into the sows via a raised catheter known as a pork stork. Boars are still physically used to excite the females prior to insemination, but are prevented from actually mating.

Semen is collected, extended, then cooled or frozen. It can be used on-site or shipped to the female's location. If frozen, the small plastic tube holding the semen is referred to as a straw. To allow the sperm to remain viable during the time before and after it is frozen, the semen is mixed with a solution containing glycerol or other cryoprotectants. An extender is a solution that allows the semen from a donor to impregnate more females by making insemination possible with fewer sperm. Antibiotics, such as streptomycin, are sometimes added to the sperm to control some bacterial venereal diseases. Before the actual insemination, estrus may be induced through the use of progestogen and another hormone (usually PMSG or Prostaglandin F2α).

History

The first viviparous animal to be artificially fertilized was a dog. The experiment was conducted with success by the Italian Lazzaro Spallanzani in 1780. Another pioneer was the Russian Ilya Ivanov in 1899. In 1935, diluted semen from Suffolk sheep was flown from Cambridge in Britain to Kraków, Poland, as part of an international research project. The participants included Prawochenki (Poland), Milovanoff (USSR), Hammond and Walton (UK), and Thomasset (Uruguay).

Modern artificial insemination was pioneered by John O. Almquist of Pennsylvania State University. He improved breeding efficiency by the use of antibiotics (first proven with penicillin in 1946) to control bacterial growth, decreasing embryonic mortality, and increase fertility. This, and various new techniques for processing, freezing, and thawing of frozen semen significantly enhanced the practical utilization of artificial insemination in the livestock industry and earned him the 1981 Wolf Foundation Prize in Agriculture. Many techniques developed by him have since been applied to other species, including humans.

Species

Artificial insemination is used in many non-human animals, including sheep, horses, cattle, pigs, dogs, pedigree animals generally, zoo animals, turkeys and creatures as tiny as honeybees and as massive as orcas (killer whales).

Artificial insemination of farm animals is common in the developed world, especially for breeding dairy cattle (75% of all inseminations). Swine are also bred using this method (up to 85% of all inseminations).

Although common with cattle and swine, artificial insemination is not as widely practiced in the breeding of horses. A small number of equine associations in North America accept only horses that have been conceived by "natural cover" or "natural service" – the actual physical mating of a mare to a stallion – the Jockey Club being the most notable of these, as no artificial insemination is allowed in Thoroughbred breeding. Other registries such as the AQHA and warmblood registries allow registration of foals created through artificial insemination, and the process is widely used allowing the breeding of mares to stallions not resident at the same facility – or even in the same country – through the use of transported frozen or cooled semen.

In modern species conservation, semen collection and artificial insemination are used also in birds. In 2013 scientist of the Justus-Liebig-University of Giessen, Germany, from the working group of Michael Lierz, Clinic for birds, reptiles, amphibians, and fish, developed a novel technique for semen collection and artificial insemination in parrots producing the world's first macaw by assisted reproduction.

Scientists working with captive orcas were able to pioneer the technique in the early 2000s, resulting in "the first successful conceptions, resulting in live offspring, using artificial insemination in any cetacean species". John Hargrove, a SeaWorld trainer, describes Kasatka as being the first orca to receive artificial insemination.

Violation of rights

Artificial insemination on animals has been criticised as a violation of animal rights, with animal rights advocates equating it with rape and arguing it constitutes institutionalized bestiality. Artificial insemination of farm animals is condemned by animal rights campaigners such as People for the Ethical Treatment of Animals (PETA) and Joey Carbstrong, who identify the practice as a form of rape due to its sexual, involuntary and perceived painful nature. Animal rights organizations such as PETA and Mercy for Animals frequently write against the practice in their articles. Much of the meat production in the United States depends on artificial insemination, resulting in an explosive growth of the procedure over the past three decades.

Criteria for benefiting from artificial insemination according to the 2021 Bioethics Law

According to the 2021 Bioethics Law, the criteria that must be met to benefit from artificial insemination are as follows:

Artificial insemination can be performed using sperm from the husband or frozen sperm from an anonymous donor.

Both spouses or the unmarried woman must consent in advance to artificial insemination or embryo transfer.

The parenting project must be validated through a series of interviews with professionals (doctors, psychologists, etc.).

Individuals benefiting from artificial insemination must be of reproductive age.

The 2021 Bioethics Law has expanded the scope of Medically Assisted Procreation (MAP).