Artificial Insemination or Surrogacy: Which is Better?

With various advances in technology, it has become easier than ever before to have a baby. There are now multiple methods of assisted reproduction treatment (ART) that are viable options for people who want to start a family.1 Out of these various technologies, artificial insemination and surrogacy have emerged as two of the most popular choices for couples. Here’s a closer look at the two techniques to help you decide whether you want to opt for artificial insemination or surrogacy.

Artificial Insemination or Surrogacy: What Are These Techniques in Fertility Treatment?

Artificial Insemination: Artificial insemination is a type of fertility treatment that involves delivering the sperm directly into the uterus or cervix in hopes of getting pregnant. Sometimes, the sperm sample is washed or prepared accordingly to increase the chances of the woman to get pregnant.2

There are two major methods of performing artificial insemination. These are intrauterine insemination (IUI) and intracervical insemination (ICI).3,4 In some cases, women are recommended to take medications for stimulating ovarian follicle growth so that the chances of conception increases.

Surrogacy: Surrogacy is an umbrella term that is used to describe a couple of different scenarios of getting a baby. There are several reasons why couples or individuals choose surrogacy for having a child. Some of these reasons include:

  • Infertility problems that prevent couples from either carrying the baby to full term or getting pregnant in the first place.
  • Same-sex couples who want to have children.
  • Single people who want to have biological children.

The two methods of having a child through surrogacy are:

Gestational surrogacy in which a gestational carrier carries the pregnancy for a couple or an individual. The egg used does not belong to the carrier mother and may come from either a donor or the intended mother. The sperm also may either come from a donor or the intended father. In this case, pregnancy is achieved through the process of in vitro fertilization (IVF).5

A traditional surrogacy in which the carrier mother itself donates her egg and carries the pregnancy for a couple or individual. The pregnancy is achieved through the process of IUI with the sperm taken from the intended father. In some cases, donor sperm may also be used.6

It is estimated that surrogacy can help 12 to 15 percent of couples who are dealing with severe infertility issues, as well as others who want to have their own biological children.7

Artificial Insemination or Surrogacy: Understanding the Process Involved

Artificial Insemination

The standard process of conceiving requires a sperm to travel up the vaginal canal through the cervix to reach the uterus, and into a fallopian tube where the egg is then fertilized. However, sometimes it happens that a man’s sperm lacks the mobility to make this long trip. In other cases, a woman’s cervix is not favorable to allow the sperm to reach the uterus. In such cases, artificial insemination can help a couple conceive.

Your doctor is likely to recommend that you pursue artificial insemination in the following conditions:

  • If after six months or longer of having unprotected sex, no conception happens, and the woman’s age is above 35.8
  • If, after a year of having unprotected sex, there is no conception, and the woman’s age is less than 35.

Here are the two main procedures of artificial insemination.

  1. Artificial Insemination by ICI

    Artificial insemination done through ICI (intracervical insemination) involves the insertion of the sperm into the cervix, which is located just outside of the uterus. The procedure takes place either at home or in a doctor’s clinic. The steps for carrying out ICI (intracervical insemination) include:9

    • A woman will need to closely monitor her ovulation cycle. A doctor is also likely to prescribe follicle stimulating medications to induce ovulation and increase the chances of a woman releasing several eggs during one cycle. Clomid is one of the most commonly prescribed medicine for boosting the production of eggs in women.10
    • A sperm sample can be taken from a donor, or the woman’s partner can provide the sperm.
    • The doctor will insert the sperm into the vagina with a special syringe, or the sperm can be placed inside a cervical cap that is then inserted into the cervix. This stays inside for a predetermined amount of time.
    • The woman will then be instructed to lie down for 20 to 30 minutes, allowing the sperm to move up the cervix and into the uterus.
    • A woman can then return back to her daily activities, and in around two weeks or 15 days, a pregnancy test will be taken to determine if the ICI process was successful.
  2. Artificial Insemination by IUI

    The process of IUI (intrauterine insemination) involves putting the sperm past the cervix and straightaway into the uterus to boost the chances of fertilization. The steps for IUI are also more or less the same as that of ICI, except that IUI is usually performed at a doctor’s clinic as it involves the use of specially prepared sperm.11 Some of the additional steps used in IUI (intrauterine insemination) include:

    The semen sample is washed or prepared for removing any potential proteins that could hamper the process of fertilization. This will make the sperm more concentrated, thus increasing the chances of conception.12

    The doctor will make use of a unique instrument known as a speculum to make it easier to reach the uterus. A special, thin device is inserted through the vaginal passage to place the sperm directly into the uterus.

Surrogacy

The most important part of starting the surrogacy process is to find a surrogate mother. Achieving a pregnancy through surrogacy depends on what type of surrogate you have selected.13

When you are using gestational carriers, the process involves:

  • Finalize a surrogate, most often done through an agency.
  • Come up with a legal contract and review it properly.
  • Egg retrieval is done if you plan to use the intended mother’s eggs, or donor eggs will be obtained.
  • Embryos will be created using either donor sperm or the intended father’s sperm.

The embryos are transferred to the surrogate or gestational carrier. If the embryos implant successfully, then pregnancy will follow. If the implantation fails, then the surrogate and intended parents may opt for trying one more cycle of IVF.

Once the child is born, the intended parents will be getting full and total legal custody as laid out in the legal contract signed beforehand.14

On the other hand, traditional surrogacy involves the donation of eggs, which is why IVF is usually not a part of the process. Here’s how a conventional surrogacy process looks like:

  • After choosing a surrogate, make a legal contract and review it thoroughly.
  • Go through the process of IUI with the use of donor sperm or the intended father’s sperm.
  • If the pregnancy takes place, then the surrogate mother will carry the baby to term. However, if the first cycle is not successful, then you can try again.
  • Once the child is born, the surrogate will legally terminate parental rights to the child. The intended parents may have to complete an adoption for step-parent form along with any other legal contracts that are required in your place of residence.15

Artificial Insemination or Surrogacy: Issues or Side Effects

Side Effects of Artificial Insemination

Following the procedure of artificial insemination, some women tend to experience some light bleeding or cramping. Others do not experience any side effects after the procedure.

Another essential side effect of artificial insemination that you must keep in mind before deciding if you want to go ahead with the procedure. Taking fertility medications to boost the chances of pregnancy greatly increases the likelihood of having multiple children, such as triplets or twins.

A common myth associated with artificial insemination and taking fertility medications is that they lead to a greater risk of having a child with congenital disabilities. However, the American Society for Reproductive Medicine has stated that this is simply a misconception and there is no truth in this belief.16

Side Effects of Surrogacy

The biggest risk surrounding surrogacy is that most countries do not have any laws governing the procedure of surrogacy. Often legal issues tend to arise when one of the parents is biologically related to the child, and the other parent is not.

Especially complicated is the process of traditional surrogacy, where the surrogate is the actual biological mother as well. In such cases, you will need to put in place a pre-birth order to be listed as the parent on the birth certificate after the baby is born. Not all countries or states allow this, meaning that the non-biological parents might have to resort to adoption proceedings to get custody of their child.

Artificial Insemination or Surrogacy: Success Rates

Success Rate of Artificial Insemination

The success rate of artificial insemination depends on factors such as the underlying fertility issue, the use of fertility medications, and a woman’s age. According to a study, the pregnancy success rate for artificial insemination through ICI is 37.9 percent after six cycles, and a 40.5 percent success rate for IUI after six cycles.17

Success Rate of Surrogacy

The success rate of surrogacy is also promising, with a reported rate of up to 60 percent of live births. This is because most surrogate women are usually fertile and young.18

So, which one to choose: Artificial Insemination or Surrogacy?

Surrogacy is not a straightforward process to have children, but many people choose this option these days. Artificial insemination is also widespread today, and many couples are successfully conceiving through this procedure.

However, it is essential to know that surrogacy is a more costly process than artificial insemination. Depending on the laws of your country or state, you may face several legal issues in getting your own child back after birth happens.

References:

  1. Inhorn, M.C. and Birenbaum-Carmeli, D., 2008. Assisted reproductive technologies and culture change. Annual Review of Anthropology, 37, pp.177-196.
  2. Corea, G., 1986. The mother machine: Reproductive technologies from artificial insemination to artificial wombs. MCN: The American Journal of Maternal/Child Nursing, 11(5), pp.357-363.
  3. ESHRE Capri Workshop Group, 2009. Intrauterine insemination. Human Reproduction Update, 15(3), pp.265-277.
  4. Patton, P.E., Burry, K.A., Thurmond, A., Novy, M.J. and Wolf, D.P., 1992. Intrauterine insemination outperforms intracervical insemination in a randomized, controlled study with frozen, donor semen. Fertility and Sterility, 57(3), pp.559-564.
  5. Brinsden, P.R., 2003. Gestational surrogacy. Human Reproduction Update, 9(5), pp.483-491.
  6. Ladomato, D., 2012. Protecting Traditional Surrogacy Contracting Through Fee Payment Regulation. Hastings Women’s LJ, 23, p.245. https://www.nichd.nih.gov/. 2020. How Common Is Infertility?. [online] Available at: <https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common> [Accessed 4 August 2020].
  7. Leridon, H., 2004. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Human reproduction, 19(7), pp.1548-1553.
  8. Byrd, W., Bradshaw, K., Carr, B., Edman, C., Odom, J. and Ackerman, G., 1990. A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm. Fertility and Sterility, 53(3), pp.521-527.
  9. Kase, N., Mroueh, A. and Olson, L.E., 1967. Clomid therapy for anovulatory infertility. American Journal of Obstetrics and Gynecology, 98(8), pp.1037-1042.
  10. Marcus, S.F. and Brinsden, P.R., 1999. Intrauterine insemination. A textbook of in vitro fertilization and assisted reproduction. 2nd ed. New York: Parthenon, pp.257-65.
  11. Christensen, G.L., 2010. Sperm preparation for artificial insemination. In Reproductive Endocrinology and Infertility (pp. 497-507). Springer, New York, NY.
  12. Havins, W.E. and Dalessio, J.J., 1999. Reproductive surrogacy at the millennium: Proposed model legislation regulating non-traditional gestational surrogacy contracts. McGeorge L. Rev., 31, p.673.
  13. Hisano, E.Y., 2011. Gestational surrogacy maternity disputes: refocusing on the child. Lewis & Clark L. Rev., 15, p.517.
  14. McEwen, A.G., 1999. So You’re Having Another Women’s Baby: Economics and Exploitation in Gestational Surrogacy. Vand. J. Transnat’l L., 32, p.271.
  15. Reproductivefacts.org. 2020. [online] Available at: <http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/fact-sheets-and-info-booklets/intrauterine-insemination-iui/> [Accessed 4 August 2020].
  16. Kop, P.A.L., Van Wely, M., Mol, B.W., De Melker, A.A., Janssens, P.M.W., Arends, B., Curfs, M.H.J.M., Kortman, M., Nap, A., Rijnders, E. and Roovers, J.P.W.R., 2015. Intrauterine insemination or intracervical insemination with cryopreserved donor sperm in the natural cycle: a cohort study. Human Reproduction, 30(3), pp.603-607.
  17. Simopoulou, M., Sfakianoudis, K., Tsioulou, P., Rapani, A., Anifandis, G., Pantou, A., Bolaris, S., Bakas, P., Deligeoroglou, E., Pantos, K. and Koutsilieris, M., 2018. Risks in surrogacy considering the embryo: from the preimplantation to the gestational and neonatal period. BioMed Research International, 2018.

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