A forensic medicine approach to artificial insemination in Nepal

1. ARTIFICIAL
INSEMINATION
- B I N E E L A
B H AT TA R A I
M B B S 3 R D Y E A R

3. ARTIFICIAL INSEMINATION
The artificial introduction of semen into the
vagina, cervix or uterus to produce
pregnancy is called artificial insemination.

6. ARTIFICIAL INSEMINATION IN VITRO FERTILIZATION
1.
This technique introduces previously selected semen into the
woman’s uterus that has been prepared by stimulating
ovulation.
This technique consists of retrieving a woman’s eggs to be
fertilised in the laboratory and later introducing the obtained
embryos inside the uterus.
2.
The fertilisation (uniting of the egg and sperm) happens “live”
inside the woman, specifically in the fallopian tube.
The fertilisation happens “live” outside the woman, in the
laboratory.
3.
It is a simpler technique since it does not require retrieving
eggs.
It is a more complex technique since it requires a surgical
procedure to obtain the eggs and be fertilised in the
laboratory.
4.
The ovarian stimulation should be minimal to avoid the risk of
multiple pregnancies. The growth of more than 2 or 3 follicles
should make us consider cancelling treatment.
The ovarian stimulation aims to obtain an adequate number
of eggs, which ranges between 6 and 15.
5.
It is more affordable if you consider the cost per treatment. The financial burden is higher, although it is more affordable
if you consider the cost per live birth.
6.
The chances of success are lower: about 15% per attempt,
considering couples with a good prognosis.
It is the treatment with the highest success rates per attempt.
In certain cases, the chances of achieving pregnancy are up
to 60%.
7.
Provides no real chance of success in cases of fallopian tube
blockage or severe male factor.
The possibilities of success, except in extreme cases, are
not necessarily affected by fallopian tube blockage or severe
male factor.
8.
It offers very poor results when the sterility time is over 3
years, it is due to a moderate male factor or the woman has
endometriosis.
This could be the first option for couples with a prolonged
sterility time, moderate male factors or women with
endometriosis.

7. TYPES:
1. Artificial insemination homologous or
Artificial insemination husband (A.I.H)
2. Artificial insemination Donor (A.I.D)
3. Artificial insemination donor and husband (A.I.H.D)

8. HISTORY
The first reported case of artificial insemination by donor
occurred in 1884: Dr. William H. Pancoast, a professor
in Philadelphia, took sperm from his "best looking"
student to inseminate an anesthetized woman. The
woman was not informed about the procedure, unlike
her infertile husband. The case was reported 25 years
later in a medical journal.[2] The sperm bank was
developed in Iowa starting in the 1920s in research
conducted by University of Iowa medical school
researchers Jerome Sherman and Raymond Bunge.
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.

9. BIOLOGICAL ASPECTS
Time duration of ovum survival
• 8 to12 hours after leaving the ovary
• 24 hours in a fertilized form
Viable time for asperm: 48 hours
• Sperm takes about 8 to 24 hours totravel from vagina to tubes
• Thus multiple insemination will benecessary.

11. INDICATIONS:
• When the husband is impotent
• When the husband is unable to deposit
semen in vagina due to hypospadiasis,
epispadiasis etc
• When the husband is sterile
• When there is Rh incompatibility
between husband and wife
• When the husband is suffering from
heriditary disease

13. PRECAUTIONS AND PROCEDURE
SEMEN COLLECTION:

14. WHEN A DONOR IS USED:
Consent of husband and wife
Donor’s identity should remain secret
Donor should be unknown to who his sperm has been donated to
Sperm collection from donor

15. DONOR SHOULD BE
• Mentally and physically healthy
• No familial or hereditary diseases
• Screened with all possible avilable tests
• Shouldn’t be a relative of either spouse
• Have children of his own
• Same blood group as that of husband

16. *A witness should be present at the time of insemination
*Physician who has given AI better avoid delivery of the child
*usually wise to do AI from a pooled semen

17. LEGAL ASPECT
NO STATUTORY LAW IN NEPAL

18. LEGAL PROBLEMS:
1. Adultery:
Not counted as adultery
2. Legitimacy:
#If not certified as AI, considered a natural child
#parents are biological ones
# cannort inherit property
3.Nullity of marriage and divorce
#if husband doesn’t know, can Divorce wife
#AI is not a basis of nullity of marriage except in impotency
4.Natural birth
#AI must be declared in certificate
5.Unmarried woman or widow
Child via AI born to unmarried women or widow will be
illigitimate
6.Incest
Incest betweeen naturally born child and child via AI is not
considered a crime.