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PubMed1989

Intrauterine insemination of washed husband's spermatozoa: a controlled study.

We performed intrauterine insemination with washed husband's spermatozoa in 27 couples with clear evidence of impaired sperm mucus interaction due to cervical hostility or immunologic male subfertility and in 30 couples with subnormal semen, but optimal cervical mucus qualities. In each couple insemination cycles were alternated with cycles during which normal intercourse took place. Both types of cycles were monitored for LH. When a clear rise of LH levels could be detected, either IUI was scheduled or intercourse advised for the following day. In the male subfertility group no difference between the pregnancy rates of insemination and intercourse cycles was present. In the group with impairment of sperm-mucus interaction, the pregnancy rate of the insemination cycles was 16%, whereas no pregnancies occurred during intercourse cycles.

Cervix Mucus↗
PubMed1989

Intrauterine insemination is not useful in oligoasthenospermia.

A prospective randomized study was conducted in 47 couples with infertility due to subnormal semen to compare luteinizing hormone (LH)-timed intrauterine insemination with LH-timed natural intercourse. No pregnancy occurred in 114 cycles of intrauterine insemination with washed sperm. Only one patient conceived during 1 of the 124 natural intercourse cycles. The only complication that occurred after intrauterine insemination was mild abdominal cramp in 3 cycles. The authors conclude that intrauterine insemination is not useful in the management of subfertility due to oligoasthenospermia.

Adult↗
PubMed1989

Current management of a donor insemination program.

Substantial evidence now exists to show that considerable maternal-fetal morbidity may result from microbiologic transmitted diseases that can be transmitted through artificial insemination by donor. In the present decade it has become increasingly clear that the use of fresh semen is potentially hazardous and its use has been discouraged by both the CDC and AFS. To minimize this risk, donor insemination programs should establish their own guidelines to thoroughly evaluate potential semen donors via history, physical examination, and laboratory evaluation before the use of donor semen after cryopreservation and quarantine. The management of a donor insemination program in the future requires uniform procedures for rigorous genetic and microbiologic screening before the selection and use of semen donors for artificial insemination.

Female↗
PubMed1989

A prospective randomized controlled trial comparing urinary luteinizing hormone dipsticks and basal body temperature charts with time donor insemination.

Especially now with the almost exclusive use of frozen semen, accurate timing of donor inseminations is an important point to address if a successful donor insemination program is to be established. To examine whether the timing of donor inseminations using urinary luteinizing hormone (LH) dipsticks (group 2) was significantly better than using basal body temperature (BBT) charts (group 1) we performed a prospective randomized controlled trial. There was no significant difference between the cumulative pregnancy rates at 6 months (0.23 versus 0.31 for groups 1 and 2, respectively) or the monthly fecundability (0.04 versus 0.07 for groups 1 and 2, respectively). Using these monthly fecundabilities we have calculated that approximately 378 patients in each arm of the trial would be needed to demonstrate a significant difference between the two groups. We therefore conclude that timing donor inseminations using urinary LH dipsticks does not significantly improve the conception rates.

Body Temperature↗
PubMed1990

Artificial insemination with donor semen: the necessity of frequent donor screening.

Artificial insemination with donor semen has become a well established alternative for couples with untreatable male factor infertility. Because of the widespread use of donor insemination, and the increasing awareness and prevalence of sexually transmitted diseases, the American Fertility Society recently redrafted procedural guidelines for the use of donor screening for insemination. Our series of donor screenings is reported to emphasize the necessity of donor evaluations at frequent intervals. From June 1986 through August 1987, 48 healthy male volunteers presented as potential semen donors for our donor program. Each was evaluated with a careful medical history, physical examination and 2 semen analyses for evidence of sexually transmitted disease. On initial evaluation, no donor presented with a positive human immunodeficiency virus antibody, abnormal karyotype, elevated serum glutamic oxaloacetic transaminase, rapid plasma reagent, or positive cultures for Chlamydia or Mycoplasma. One potential donor was excluded because of a positive hepatitis B-core antibody and 1 because of a positive IgM test for cytomegalovirus. At initial examination 3 potential donors had a positive culture for Ureaplasma; all 3 were treated with 3 weeks of tetracycline, and repeat cultures were all negative. Routine followup screening was performed on all donors at 3-month intervals for all sexually transmitted diseases. During this 14-month period cultures converted to positive for Ureaplasma in 4 donors. Furthermore, 1 donor at 6 months contracted gonorrhea. He was treated but no longer used as a donor. Since initiation of the outlined protocol more than 800 inseminations have been performed using fresh semen with no case of sexually transmitted diseases reported from our recipients. We conclude that careful sexual history, and frequent donor and semen evaluation are necessary for prevention of diseases that might be transmitted sexually. If these precautions are strictly observed use of donor semen is safe and effective.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Impact of three-dimensionally measured endometrial volume on the pregnancy rate after intrauterine insemination.

OBJECTIVE: The success of artificial reproductive techniques not only depends on the quality of oocytes and spermatozoa but also on the receptivity of the endometrium. The aim of this study was to assess the role of endometrial volume measurement by three-dimensional ultrasound in predicting the pregnancy rate (PR) in women receiving controlled ovarian hyperstimulation followed by intrauterine insemination. MATERIAL AND METHODS: 104 patients having intrauterine insemination (IUI) were included in this prospective trial. Ovarian hyperstimulation was performed with gonadotropins in 73 % of patients and with clomiphene citrate (CC) in 27 % of patients. Endometrial thickness, pattern and three-dimensional volume were measured immediately before insemination. RESULTS: In 104 IUI cycles a total of 14 clinical pregnancies were recorded (PR=13.5 %). The endometrial volume was 3.5 ml and was not significantly different in pregnant (4.0 +/- 1.5 ml) from non-pregnant women (3.4 +/- 1.9 ml). In the subgroup of women with an endometrial volume > or = 2 ml and trilaminar endometrium the pregnancy rate was 22 %, significantly higher than that in women without these two criteria (PR 6 %, p < 0.05). The negative predictive value of an endometrial volume < 2 ml for a clinical pregnancy after IUI was 96 %. Endometrial volume and thickness were significantly higher after ovarian hyperstimulation with gonadotropins (3.7 ml and 11.0 mm) than with CC (2.8 ml and 9.5 mm; p < 0.05). CONCLUSIONS: An endometrial volume < 2 ml at the day of insemination is associated with a poor likelihood of pregnancy. Endometrial volume measured by 3D ultrasound is a new objective parameter to predict endometrial receptivity.

Adult↗
PubMed1975

Artificial insemination with fresh donor semen.

A total of 141 patients received donor insemination during a 21/2-year period. Pregnancy was achieved by 57 per cent of these patients. When patients who were inseminated for less than three cycles are excluded, the pregnancy rate is 77 per cent. The mean conception time was three treatment cycles. In 69 pregnancies, the occurrence of abortion was that of the general population, and an increased male-to-female ratio was observed in the 36 live-born infants. Questionnaires sent to all couples and returned by 81 per cent indicated that donor insemination was not emotionally harmful to their marriage. Heterologous insemination is a safe, effective therapeutic alternative to adoption for selected couples.

Abortion, Spontaneous↗
PubMed1988

Intrauterine insemination.

Fifty-six couples with infertility due either to subnormal sperm (n = 40), hostile cervical mucus (n = 5) or idiopathic infertility (n = 11), were treated with intrauterine insemination of washed sperm. A total of 78 treatment cycles were completed. Nine pregnancies resulted from these insemination cycles, giving an overall pregnancy rate of 8.3% per treatment cycle. Eight pregnancies occurred in the andrologic group after 56 treatment cycles. One pregnancy was established in the patient group with idiopathic infertility after 15 treatment cycles, while no pregnancy occurred in the patient group with infertility due to cervical mucus hostility. The mean number of years of infertility in the couples conceiving following treatment was 7 years (range 3-11). The spontaneous pregnancy rate in this patient group is low. The data obtained in this study suggest that in selected patients intrauterine insemination will result in an acceptable pregnancy rate. There is a need for a randomized prospective study designed to compare the efficacy of intrauterine insemination with that of alternative treatment modalities.

Cervix Mucus↗
PubMed1984

Artificial donor insemination: analysis of 149 cases at North Carolina Memorial Hospital.

We analyzed 149 cases of artificial insemination with donor semen at North Carolina Memorial Hospital, Chapel Hill, to study its effectiveness. An overall pregnancy rate of 62.1% was achieved. Based on the mean monthly fecundity rate, the average monthly pregnancy rate was 16.5%, and the cumulative pregnancy rate after three, six, and ten cycles was, respectively, 40.3%, 68.5%, and 95.5%. A uniform evaluation of the women and correction of any treatable female factors before insemination contributed to a high success rate. Diagnostic laparoscopy after three to four failed insemination cycles yielded a high percentage of abnormal findings. These data suggest that almost all properly screened patients will conceive if allowed to undergo a sufficient number of inseminated cycles and that this procedure is a highly effective alternative means of circumventing male infertility.

Actuarial Analysis↗
PubMed1982

Effect of delayed insemination on in-vitro fertilization, culture and transfer of human embryos.

Oocytes were obtained from patients with tubal infertility at fixed times after the onset of the endogenous LH rise or hCG injection, and were inseminated immediately after recovery or after periods of 4-4 1/2, 5-5 1/2 and 6-6 1/2 h in culture in vitro. Delayed insemination resulted in a marked increase in the proportion of oocytes that were fertilized and developed to normal embryos and maximum rates occurred after 5-5 1/2 h in culture (0-1/2 h, 26%; 4-4 1/2 h, 50%; 5-5 1/2 h, 89%; 6-6 1/2 h, 69%). The range and mean (+/- s.d.) intervals from insemination for the pronuclear and early cleavage stages were 27-43 (35.6 +/- 4.4) h for 2-cell stages, 36-65 (45.7 +/- 8.3) h for 4-cell stages, 45-73 (54.3 +/- 12.6) h for 8-cell stages and 68-85 h for the 16-cell stage. In 7/50 patients receiving 1 or 2 embryos at the 2-, 4- and 8-cell stages, fetal development was normal and 2 women had twin pregnancies (36% success compared with 8% for single embryos). All pregnancies were from the groups in which insemination was delayed for 5-6 1/2 h. It is concluded that a short period of culture in vitro may allow the completion of oocyte maturation, and improve the results of in-vitro fertilization.

Cells, Cultured↗
PubMed1990

Improved semen qualities after continuous-step density gradient centrifugation: application to artificial insemination and pregnancy outcome.

For increasing sperm fertilizability in artificial insemination, it is effective to concentrate progressively motile sperm from whole ejaculate. We developed the continuous-step density gradient for the selective concentration of progressively motile sperm. The present procedure was applied to intrauterine artificial insemination. Infertile couples (n = 152) whose diagnoses involved oligoasthenospermia, cervical factor, and unexplained infertility were selected for artificial insemination with washed and concentrated sperm. Successful pregnancies (47) were obtained, with an overall pregnancy rate of 31% in the program. Sperm processing by this procedure improved pregnancy rates in couples with the sole diagnosis of oligoasthenospermia or cervical factor. In the patients in whom other fertility problems coexisted, however, it was essential to treat female fertility problems. Continuous-step density gradient centrifugation is effective in increasing the pregnancy rate in artificial insemination.

Centrifugation, Density Gradient↗
PubMed1975

Type and time of insemination within the menstrual cycle and the human sex ratio at birth.

Data that strongly suggest that the timing of insemination affects the human sex ratio at birth are presented. Two studies conducted by the author, including a total of 1,318 pregnancies, in which timing of insemination was related to the shift in basal body temperature are discussed, and previous literature is reviewed. The differential effect of type of insemination-natural versus artificial-is noted. The further question why timing and type of insemination affects the human sex ratio is also explored.

Animals↗
PubMed1976

Clomiphene-regulated ovulation for donor artificial insemination.

Seventeen couples with male-caused infertility requested donor artificial insemination between January 1, 1973, and December 31, 1974. All of the women were evaluated prior to the inseminations and were found to be ovulatory. They were treated with clomiphene, citrate 50 mg/day for 5 days beginning on day 4,5, or 6 of a menstrual cycle, and scheduled for two inseminations on the 5th and 7th days after completion of the clomiphene regimen. Fresh semen placed in cervical cups was used for the inseminations. The procedure was repeated in the following months until conception occurred.

Clomiphene↗
PubMed1959

Therapeutic donor insemination; a review of 440 cases.

Of 399 patients inseminated therapeutically with the semen of a donor, 303 became pregnant, the great majority of them within six months of the time inseminations were begun. The average number of inseminations was 6.2 and the average number of menstrual cycles over which they were carried out was 3.55. The greatest number of pregnancies occurred between the twelfth and the fifteenth day of the menstrual cycle. Seven patients had four pregnancies by this method, 17 had three and 59 had two. Emotional problems related to children of artificial insemination were far fewer than those associated with adoption.

Female↗
PubMed1990

Human immunodeficiency virus transmission through artificial insemination.

Six human immunodeficiency virus type 1 (HIV-1) seropositive semen donors were identified during an antibody screening program initiated at an artificial insemination clinic in New York City in 1985. A total of 176 women underwent artificial insemination with fresh semen from these six donors between 1978 and mid-1985. Of these 176 women, 134 women were HIV-1 antibody tested and 1 was found to be seropositive; she denied all other AIDS-associated risk behavior and her husband was seronegative. The results of this investigation provide additional evidence that HIV-1 transmission can occur through artificial insemination with semen from an infected donor although the risk of HIV-1 transmission appears to be lower than that reported by other investigators. It is clear that HIV-1 screening of all potential semen donors should be routine practice whenever artificial insemination is performed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Artificial insemination with donor cryopreserved semen: importance of the volume of semen and influence of ovulatory dysfunctions.

The study deals with a program for artificial insemination by means of cryopreserved donor sperm, conducted at AIED (Italian Association for Demographic Education) in Rome from 1983 to 1986. Two groups of women, both having an average age of 30, and with an equal proportion of women with factors of reduced fertility, were inseminated with a different volume of cryopreserved sperm: a) 100 women were inseminated with an average number of 6.3 straws per cycle (total number of cycles 297) and 55 pregnancies were obtained (pregnancy rate = 0.185 per cycle); b) 100 women were inseminated with a lower average number of straws; 4.1 per cycle (total number of cycles 297); in this group 23 pregnancies were obtained (pregnancy rate = 0.077 per cycle). The quality of the semen, the methods for pinpointing ovulation and for depositing seminal liquid in the female genital tract were the same for the two groups. The difference between the pregnancy rate of the two groups was statistically significant (p less than 0.0001). Altogether, 50 women with ovulatory dysfunctions underwent ovulation stimulation and among these 20 conceptions were recorded. These conceptions were obtained with 47 cycles of application (average number of cycles preceding conception cycle 1.35). This value proved to be higher than that for women not undergoing stimulation (1.10). Nevertheless, the difference was not found to be statistically significant even if considered separately for the two groups treated with different volumes of semen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Failure of hysteroscopic insemination of the fallopian tube in synchronized cycles.

The study consisted of a randomized, controlled trial of synchronized hysteroscopic insemination of the fallopian tube (SHIFT), in which selected infertile couples underwent hormonal delay of menstruation, ovulation induction, and insemination of a selected motile sperm population into the tubal isthmus above the utero-tubal junction. Of 40 couples recruited, only 2 became pregnant, both during a nonsynchronized control cycle. No conceptions were reported in either the 72 SHIFT or 73 non-SHIFT synchronized cycles. Hysteroscopic insemination was found to be a relatively easy procedure with a low rate of technical failure. There was low morbidity with no major clinical complications. However, 57% of tracked synchronized cycles showed a failed response to the follicular stimulation protocol; and 91% showed failure of follicular rupture greater than or equal to 52 hours after hCG induction. These failures of the ovulation synchronization/induction regimen were probably due to the use of medroxyprogesterone acetate for cycle synchronization, and should not preclude further evaluation of the technique of hysteroscopic insemination.

Clinical Trials as Topic↗
PubMed1979

A new technique for intrauterine insemination.

The 5-cm long endpiece of a soft Nelaton's catheter, ch 6-8, splinted with a rigid polyethylene cannula, proved to be a suitable instrument for intrauterine homologous inseminations. Sixty couples were treated; indications for intrauterine insemination were subfertile semen, poor postcoital test, antisperm antibodies in male or female, and unexplained infertility of more than 5 years. Seventeen pregnancies occurred, that is 28%. The best results were obtained in the group with unexplained infertility and in the group with poor postcoital tests, combined with a good result of the in vitro sperm penetration tests. Complications of the inseminations were rare. The method did not elicit sperm agglutinins in the female; however, if sperm agglutinins were already present in the female, the titre level increased after the intrauterine inseminations.

Catheterization↗