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An artificial insemination with donor program was used in 92 couples. Twelve patients abandoned treatment. Seventy nine couples concluded, at least one year treatment. Pregnancy rate was 68% (62 pregnancies). Ten patients had previously been pregnant with the same method.
From late 1970 through December 1987, 580 women began 733 treatment programs (a total of 3405 insemination cycles) with fresh semen for artificial insemination by donor. The unadjusted pregnancy rate was 48.5% and the cumulative pregnancy rate after seven cycles by life-table analysis was 59.6% with a monthly fecundability of 11.9%. From 1988 to the present, 113 women have begun 115 treatment programs (a total of 371 insemination cycles) with cryopreserved semen for artificial insemination by donor. The unadjusted pregnancy rate to date is 18.3% and the cumulative pregnancy rate after seven cycles by life-table analysis is 48.6% with a monthly fecundability of 5.9%. This report shows that using cryopreserved semen for artificial insemination by donor will take somewhat longer to produce a pregnancy but the ultimate pregnancy rate will be similar to that with fresh semen for artificial insemination by donor.
PURPOSE: Our purpose was to investigate the role of the insemination technique used in an artificial insemination program with donor sperm (AID) in multiple pregnancy rates. METHODS: We carried out a retrospective nonrandom analysis of 300 pregnancies corresponding to 300 cycles in women from our Artificial Insemination Donor Sperm Program. All cycles were stimulated with gonadotropins. Single and multiple pregnancy cycles and intracervical and intrauterine pregnant cycles were compared. RESULTS: Intracervical insemination was performed in 173 cycles (58%), and intrauterine insemination in 127 (42%). Two hundred twenty-three pregnancies were single (74%), and 77 multiple (26%). In multiple pregnancy cycles, initial dose and mean total daily dose of gonadotropins, plasma estradiol levels, and number of follicles > or = 14 mm were significantly higher compared to those in single pregnancy cycles. Multiple pregnancy rte was significantly higher among pregnancies after intrauterine insemination (32%) than after intracervical insemination (21%). CONCLUSIONS: The intrauterine technique of insemination in AID-stimulated cycles with gonadotropins is related to multiple pregnancy risk.
It is of clinical importance to determine the factors which influence the outcome of insemination with frozen human semen. The number of inseminations per cycle and the season of the year had significant effects on the outcome of the insemination in all the recipients in the AID programme and in those who became pregnant within six cycles of treatment. The chance of pregnancy was greater with increasing number of inseminations per cycle. During winter the proportion of insemination cycles resulting in pregnancy was lower than in the other three seasons. The proportion of insemination cycles resulting in pregnancy was higher when the maximum cervical scores of the cycle were high (greater than 10 in a scale of 12) when compared with lower scores in all the recipients but not in those who became pregnant within six cycles. Duration of infertility and previous fertility of the recipients had a significant effect on the outcome of insemination in all the recipients but not in those who became pregnant within six cycles. Age of the recipient had a positive effect on the abortion rate.
Artificial insemination using husband's semen (A.I.H.) was carried out in 74 couples in most of whom the men had low sperm densities and/or a reduced sperm motility. There were 19 pregnancies (24%). The problems encountered and the reasons for failure are discussed.
The cervical cap was used in artificial insemination (husband) in the home by 63 couples. An overall pregnancy rate of 19% occurred regardless of the duration of use, and a rate of 44% was associated with use for at least six months or until pregnancy occurred. Comparison of pregnancy rates between those in the program and those who dropped out and conceived without therapy revealed no statistical difference.
Studies of artificial insemination of cranes and cryoconservation of their semen have been carried out in the nursery of rare species at the Oka Biosphere Reserve for many years. The criterion of successful cryoconservation of the semen is the obtaining of fertilized eggs after artificial insemination by the thawed semen. An experiment is described on artificial insemination of females of the white-naped crane Grus vipio by the frozen-thawed semen of the Siberian white crane G. leucogeranus after one-year storage of semen in liquid nitrogen. As a result, an interspecific hybrid of cranes was obtained, which confirmed the possibility of producing a bank of cryoconserved crane semen. The use of the white-naped crane females was due to the absence of conspecific males and unavailability of Siberian white crane females. Problems of artificial insemination and cryoconservation of semen of rare crane species are discussed.
Patients contemplating conception by artificial insemination can be assured that their pregnancy will be as normal as that following natural insemination. In particular, there is no evidence of increased rate of abortion or fetal abnormality. In general, the results of AIH are disappointing and patients should be made aware of this before such treatment is advised or undertaken. The indications must be well defined and a realistic prognosis given. Pregnancy rates with AID are good using either fresh or frozen semen. It is the moral and legal implications of this procedure which raise the problems. Therefore it is vital that a couple be allowed to consider these problems fully before proceeding and it is the responsibility of their medical practitioner to ensure that they have the facility to do this.
A case is reported of a woman who was exposed to human immunodeficiency virus through self-insemination. She was artificially inseminated with fresh semen obtained from a gay man in whom HIV seroconversion was taking place. Postexposure prophylaxis with antiretrovirals was initiated 10 days later, and despite successful conception, HIV infection was not established. A healthy male infant was subsequently delivered with no obvious toxicity related to medication.
In a retrospective study, from 1994 to 1998, of inseminations with frozen semen in dogs, a total of 312 bitches of 70 different breeds were inseminated with imported (n = 183) or domestic (n = 129) semen. The overall whelping rate was 70% and mean (+/- SEM) litter size was 5.3 +/- 0.2 pups. The whelping rate was higher after intrauterine insemination (71%; n = 305) than after intravaginal insemination (29%; n = 7; P < 0.05). Timing of insemination was crucial; timing classified as optimal resulted in a higher whelping rate and larger litter size (P < 0.05) than did timing classified as early, late or too late. In the too late category, none of the bitches (n = 5) whelped. For optimal timing, whelping rate and mean (+/- SEM) litter size were 76% (n = 252) and 5.6 +/- 0.2, for early 33% (n = 6) and 1.5 +/- 0.5, and for late 47% (n = 19) and 2.8 +/- 0.7. Two inseminations yielded a higher whelping rate (P < 0.05) and greater mean litter size (P < 0.05) than that of one insemination, 77% and 5.6 +/- 0.3, and 60% and 4.6 +/- 0.3, respectively. However, the results obtained after one insemination were poorer partly because of an over-representation of late insemination in this group. Semen classified as of poor quality (progressive motility < 50% or percentage of abnormal spermatozoa > 20%) gave a lower whelping rate (53%) than did semen of medium (progressive motility = 50%) or good quality (progressive motility > 50% and percentage of abnormal spermatozoa < 20%), which gave whelping rates of 76 and 74%, respectively (P < 0.05). The mean litter sizes were not significantly different. Eighty-two per cent of bitches (120 of 147) inseminated twice into the uterus at a time classified as optimal with frozen semen of good or medium quality whelped. The mean (+/- SEM) litter size was 5.6 +/- 0.3 pups in this group. These results show the potential of transcervical intrauterine insemination for routine artificial insemination in dogs.
Four large bovine artificial insemination centers implemented a program of surveillance of resident and newly acquired bulls for persistent bovine viral diarrhea virus infection. Infection was identified in 12 of 1,538 bulls. Several clinical abnormalities, including acute and chronic mucosal disease, were evident among the persistently infected bulls. Semen produced by such bulls consistently contained bovine viral diarrhea virus, and such contamination was not always accompanied by diminished seminal quality. Infected bulls were detected by means of virus isolation tests performed on blood specimens, but not by use of serologic testing. Ten of the 12 persistently infected bulls were results of embryo transfer. Virologic surveillance of breeding herds, artificial insemination and embryo transfer centers, and the cattle trade is necessary to prevent spread of this virus by modern cattle breeding practices. Attention is also necessary to prevent contamination by this virus of the fluids used for recovery, in vitro manipulation, and transfer of bovine embryos.
A longitudinal analysis of artificial insemination with donor semen (AID) in 114 consecutive couples revealed a 37% over-all pregnancy rate. The 45 pregnancies occurred in 39 patients, and approximately 90% of these pregnancies occurred within six cycles of AID. Pregnancy rates were higher in the age group 25 to 30, in those who received only fresh semen, and in those with a history of a previous pregnancy. Lower pregnancy rates were observed in patients age 31 or older, in those with pelvic disease, and in those randomly receiving freshly thawed semen or fresh semen. The use of a vaginal device for retaining semen, the use of patient positioning, or the duration of infertility did not appear to affect the success rate. When surgically correctable pelvic disease was treated, a pregnancy rate of 22% was obtained.
Factors influencing the probability of conception following artificial insemination with donor semen (AID) have been investigated in a series of 124 married females. Overall, 79 conceptions were achieved, for a cumulative rate of conception of 85.1% at the end of 1 year and an average fecundability of 15%, using life-table analysis. Women aged 30 or over or those with evidence of tubal or ovulatory problems had decreased probability of conception, although not to a significant extent. Women whose husbands were azoospermic had 20% fecundability in response to AID, significantly better than the 10% fecundability after AID observed in the women whose mates were oligospermic. Cycles during which AID was successful were significantly more likely to have had a positive postcoital test observed, compared with unsuccessful AID cycles.
Four of eight recipients of artificial insemination (AI) with cryopreserved semen from a symptomless carrier of human T-cell lymphotropic virus type III (HTLV-III) were found to have antibody to the virus. One has generalised, persistent lymphadenopathy while the other three remain symptom free 3 years after insemination. Three subsequently became pregnant more than a year after contact with the infected semen; the children, who are now over 1 year of age, are in good health and do not have HTLV-III antibodies. These observations emphasise the need for a rigorous screening programme for potential AI donors; they also suggest that fresh semen should not be used in AI. The findings confirm the role of semen in heterosexual transmission of the virus and suggest that in women with HTLV-III antibodies pregnancy and subsequent breast-feeding does not necessarily lead to infection of the infant.
This retrospective study compares results of artificial insemination by donor (AID) and in-vitro fertilization (IVF) trials, and especially of IVF treatment with fresh donor spermatozoa in patients who were unsuccessfully treated on 18 occasions by AID using frozen semen. AID gives cumulative pregnancy rate of 54.6% after six trials. But after 18 trials, 22.4% of the patients were still not pregnant. Treating them with IVF gave a probability of pregnancy as good as in the other IVF patients, 53.9% after six trials. However, pregnancy loss rates differed resulting in cumulative normal pregnancy rates of 16.2% in AID cycles ranking from 19 to 24 compared with 41.8% when going to IVF. In 'ex-AID' women, significantly more follicles were punctured, but the number of oocytes obtained and fertilized, embryos replaced, and the incidence of pregnancy did not differ from the other patients. Considering separately the various infertility factors encountered in the patients, the pregnancy rates still did not differ between ex-AID women and the others. Changing from long-term failed AID to IVF is certainly acceptable and even more so with the newly introduced technique of trans-vaginal puncture. The female infertility factors involved in AID failure are corrected in IVF.
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