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Before a woman undergoes artificial insemination, the cause of the infertility must be determined. In addition, the male partner’s sperm must be analyzed to determine if it is suitable for insemination. The woman must also have the regularity of her ovulation tested.

For couples, the process begins with a physician’s visit. The physician will take a medical history from both partners, and both will undergo a physical examination. Testing for human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) may also be performed.

The woman’s evaluation will include a pelvic exam. For women whose medical history or physical exam suggests a possibility of infection, tubal damage or endometriosis, a hysterosalpingogram, hysteroscopy or laparoscopy may be recommended. These tests allow the physician to check for obstruction in the fallopian tubes. In addition, an endometrial biopsy may be performed to determine if the ovaries are producing enough hormones. In addition, several blood tests may be required as part of the general infertility evaluation.

During the male partner’s examination, he will be asked to provide several semen samples for analysis. Sperm analysis examines sperm count, whether the sperm are formed normally and able to move freely, and sperm survival over a period of time. Testing may also include sperm antibody tests and sperm penetration assays (tests used to determine if a man’s sperm can travel through cervical mucus and penetrate an egg).

The results of these tests will be used to pinpoint the fertility problem. When the male partner’s sperm is normal, the woman may be monitored with blood tests and ultrasounds to determine if she is producing and releasing a mature egg every month. Blood tests allow the physician to measure levels of the hormone LH (luteinizing hormone) and, at times, estradiol levels. These levels can help determine if the woman is producing a mature egg. Ultrasounds enable the physician to monitor the growth of ovarian follicles and to verify that the egg is released from the follicle. 

For women with irregular ovulation, the physician may prescribe drugs to induce ovulation. These medications increase as well as coordinate egg production. They are usually given in pill form or may be given as an injection to trigger the release of the mature follicle or egg. For women who are getting their menstrual period less than two weeks after ovulation, physicians may also recommend the hormone progesterone.

Once a woman is determined to be a suitable candidate for artificial insemination, the next step is pinpointing the time of ovulation. Artificial insemination cannot be successful unless it is performed when the woman has a mature egg. To determine the time of ovulation, an ovulation test, basal body temperature chart and a cervical mucus examination may be used. Blood tests and ultrasounds may also be used.  When the woman is ovulating, her partner will be asked to produce a sample of semen for the insemination procedure. Men may be advised to abstain from sexual intercourse during the three days before the sample is taken. This ensures a good-quality sample. If there is no partner providing the sperm, the woman will obtain the sperm from another source, such as a sperm bank.

The required sperm can be collected in a number of ways, including:

• Cup collection. This method requires a man to masturbate and ejaculate into a sterile cup. It can be done in the home or at the physician’s office. The sample must be collected no more than two hours before the scheduled insemination appointment.
  
  
• Condom collection. During this process, semen is collected during intercourse using a special condom provided by a physician. 
  
  
• Split ejaculate. This method uses a two-part container to collect sperm. The initial spurt should be collected in one part of the container, and the rest is collected in the second part.
  
  
• Urine collection. During this process, semen is collected from urine in a laboratory. This is an option for men who have retrograde ejaculation, a condition that causes semen to be released backward into the bladder at male climax.

In some cases, men having treatments that cause or may cause sterility, including vasectomy, testicular surgery, prostate surgery, radiation and/or chemotherapy for cancer treatment, may choose to store their sperm for future use in an artificial insemination.

Women using donated sperm should have the sample on hand. Sperm banks can either ship the sperm to the woman’s home or to her physician’s office. Donated sperm is available from sperm banks around the country. Anonymous donors are screened for infectious diseases, as well as certain genetic diseases, depending on their genetic background. Because of the high risk of disease transmission during artificial insemination, sperm banks no longer use fresh sperm. Instead, the sperm is frozen and quarantined for a minimum of 180 days. The donor is then retested for infectious disease. If the donor tests negative again, the sperm is approved for use. The donated sperm, which can be frozen indefinitely, is stored in containers of liquid nitrogen until it is shipped upon request.

When the sperm being used is from a donor the woman or couple knows, fresh sperm can be used. However, physicians often insist that the donor have all testing for infectious diseases up to date.

Sperm being used for an intrauterine insemination (IUI) must be specially prepared before the procedure. Semen is composed of sperm and plasma (substances that nourish the sperm, not to be confused with blood plasma). In a process known as “washing”, the sperm is separated from the plasma. During the procedure, the semen is diluted with a sterile fluid. The sperm is then separated from the liquid component (plasma). Separating these two components removes substances that may cause complications.

Semen contains proteins, prostaglandins and bacteria. The introduction of these substances into the uterus could result in severe uterine pain, cramps, fainting or a life-threatening reaction. The process also concentrates the semen into a small sample of the most active sperm, thus increasing the chance of fertilization. A woman using donated sperm, can request sperm that is ready for intracervical insemination or sperm that is “washed” and ready for IUI.