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A central semen bank in Denmark supplied deep-frozen semen. Selection of donors, freezing technique, and practical details about transport of specimens are described. In one of the gynaecological departments supplied with frozen semen, 22 out of 30 patients who had artificial insemination became pregnant. The advantages and disadvantages of using frozen semen are discussed.
Of approximately 339 patients evaluated at a private infertility service over a 5-year period, 24 couples underwent homologous artificial insemination (AIH). Nineteen of these were performed to circumvent the problem of oligospermia, and only one pregancy was achieved in this group; conceivably this pregnancy could have occurred by chance. The difficulty in controlling the numerous variables in a clinical fertility study and the limitations of the present methodology are also discussed. It would appear that the use of AIH to circumvent oligospermia has not been successful. However, the present series is rather small. AIH should continue to be offered to couples who have a well-defined indication such as impotence, premature ejaculation, or any anatomical defect which prevents successful intromission. The use of AIH for patients with mild oligospermia but excellent sperm motility probably deserves a limited trial, since it is less expensive and may offer some chance for success.
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.
Several studies on artificial insemination by donor (AID) semen have suggested that the gender of infants can be influenced by treatment of the women with clomiphene citrate (CC) and by the type of semen used (fresh versus cryopreserved). We conducted a 3-year prospective clinical trial to test these hypotheses. Two groups of pregnant women were evaluated. Group I (n = 130) comprised women whose ovulation was induced by CC; group II (n = 190) comprised those who conceived during spontaneous ovulatory cycles. In a total of 320 pregnancies, 55 spontaneous abortions occurred, 23.1% in group I and 13.2% in group II (P less than or equal to 0.05). Two tubal ectopic pregnancies occurred in group I. Of the 100 and 165 pregnancies carried to term in the treated and control groups, respectively, 11% and 1.8% involved twins (P less than or equal to 0.005). When only single births were considered, group I had 46.1% males in 89 term pregnancies, and group II had 60.5% males in 162 term pregnancies. Significantly more female offspring occurred in the group treated with CC (P less than or equal to 0.05). Because it is possible that a portion of the effects observed in this study were a function of cryopreservation of the AID semen, we compared data on frozen sperm with data on fresh sperm in terms of abortion, gender, and incidence of multiple births; there were no significant differences. Fertil Steril 40:481, 1983.
Although reproductive medicine is rapidly advancing within society, few studies have been conducted in this area on the opinions and attitudes of people in the community. A survey of the attitudes of 104 Geelong residents, selected by a random sampling technique, was conducted, in order to assess community attitudes to adoption, artificial insemination using husband and donor sperm, and in vitro fertilization. The results indicate that attitudes in general are positive, supporting the pro-natalist bias of society. AID was seen as the most problematic technique used, and was given less support in general than the other techniques. A surprising number of respondents felt that single and homosexual groups should have access to these techniques. Further results are discussed, including those bearing on the possibility of establishing a National Register for AID donor-offspring information.
Artificial insemination techniques form an important part of the spectrum of modern infertility treatment, and together account for nearly half (43.8 per cent) of the treatment-related pregnancies in our comprehensive infertility clinic. Disorders of sperm-mucus invasion and survival are not uncommon but have been very frequently overlooked in the past. Assessment by post-coital tests with a minimum six hour post-coital delay and mucus penetration tests for those with negative post-coital tests should be part of every clinic routine. We believe that these tests pick up a range of problems, the most important of which is antisperm immunological infertility, which can be treated with a fair degree of success by intrauterine AIH. The demand for AID has increased appreciably on a world-wide scale and provision of AID facilities in this and other countries is inadequate. An AID service should ideally be part of every organized infertility service. The future of AID probably lies with frozen semen banks serving satellite clinics within their area.
A routine has been established for genetic screening of donors in an artificial insemination and frozen sperm bank program. This report is a summary and analysis of the information obtained on the first 168 donor applicants and 89 recipients who were genetically screened. The specific forms for screening, family information obtained, characteristics of the donor and recipient groups, and guidelines for acceptance or rejection of donors are discussed. The donor and recipient often failed to perceive that the disorders in the family were genetic. The simple question of whether or not there were genetic or hereditary problems in the family was ineffective, even when the donor or recipient had formal medical training.
Artificial insemination with homologous (AIH) and heterologous (AID) samples is discussed. Specific emphasis is placed on the indications and timing of the procedure, the type of specimens available, the technique and the expected results. The legal and emotional ramifications of AID are discussed.
We report on a study of attitudes toward artificial insemination by donor (AID) of persons at risk for Huntington disease (HD). The subjects of the study were 91 at risk persons and 68 matched controls. Both groups were divided by sex and age (45 yr less than or equal to vs greater than or equal to 46 yr). Demographic data included age, occupation, marital status, religion, education, ethnic background, and family size. We recorded 1) attitudes toward reproduction, 2) nature of contact with affected family member(s), 3) effects of HD on family planning, 4) attitudes toward AID, and 5) concern about donor selection criteria. Results suggest that 1) men and women differ in several ways with regard to their views about AID, and 2) that more vigorous educational programs might increase utilization of AID for the prevention of not only HD, but other human genetic diseases as well.
Using an indirect lymphokine-assay, the leucocyte-migration-inhibition-test (LMI-test), the cellular sensitization of fertile and infertile patients before and after homologous and heterologous intrauterine insemination (IUI) was investigated. In this assay several preparations of spermatozoa ("washed"-, "swim-up"- and "pellet"-spermatozoa) in different concentrations (1, 5 and 10 x 10(6) sperms/ml culture medium) and seminal plasma were tested as antigen. In all investigated groups a cellular immune response against spermatic antigen was demonstrable and seemed to be dose dependent. In contrast to fertile women who reacted with an enhancement of the macrophage migration for low concentrations the same concentration of antigen induced an inhibition of macrophage migration in fertile patients. For high concentrations of spermatic antigens there was a difference in the intensity of cell-mediated immune response between fertile and infertile women. Since infertile patients demonstrated an increased level of cell-mediated immune response it is possible that infertility may be caused by this altered immunological reaction. This response changes after multiple IUI-treatment and that change might be caused by the high concentration of spermatic antigens as there was a difference in the intensity of cell-mediated immune response between fertile and infertile women. Since infertile patients demonstrated an increased level of cell-mediated immune response it is possible that infertility may be caused by this altered immunological reaction. This response changes after multiple IUI-treatment and that change might be caused by the high concentration of spermatozoa. The immunological response of infertile patients seems to be similar in those receiving husband and donor IUI.
A case of successful gonadotropins ovulation induction and donor artificial insemination (AID) followed by a complication of hydatidiform mole is presented. A review of the published papers related to this topic are commented. The organization of a world registry of AID depending on the World Health Organization is encouraged.
Artificial insemination with donor sperm (AID) has been a major form of treatment among infertile couples with defects in sperm production. In this report, we review our experience from 1980-1985. A total of 108 patients underwent AID, with 75 resultant pregnancies. Of patients achieving pregnancy, 47% became pregnant after the third cycle and 92% by the twelfth cycle. A higher success rate and/or smaller number of AID cycles were positively associated with patient age of 35 or less and negatively associated with endometriosis. This information is useful in counseling couples interested in pursuing AID.
A case is described of retrograde ejaculation due to bladder neck resection followed by ileal conduit with a non-functioning bladder, where, after unsuccessful attempts at artificial insemination with spermatozoa retrieved from the bladder, ejaculate was obtained at defecation followed by artificial autoinsemination by the male, leading to two consecutive pregnancies.
The role of artificial insemination with husband semen (AIH) in solving fertility problems has been studied by many investigators. Different conclusions have been made due to the variety of indications for AIH. This communication attempts to evaluate the use of the best split ejaculate fraction for AIH in 55 couples in which the only pathological condition was oligozoospermia or oligoasthenozoospermia. Couples in which the women had a known history of anatomical abnormalities were excluded. Although the seminal parameters of spermatozoal density and/or motility in the best split fractions were frequently found to be in the fertile range, the pregnancy rate achieved was only 18% (n = 10). This was comparable to the results obtained by others using whole ejaculates for AIH. The spontaneous pregnancy rate in the present study after termination of treatment was 13% (n = 6). The observations suggest that men with a long-standing history of seminal deficiency produce spermatozoa with a pathology that cannot be microscopically recognized.
The issue of secrecy and artificial insemination using donor semen has psychosocial, moral and legal implications. These implications are explored within the context of New Zealand AID practice, and particularly, recent legislation aimed at clarifying the status of the child. The results of two studies, one covering 37 donors involved in six AID programmes and the other covering 55 couples who had been accepted into one of the same six programmes, insomuch as they relate to issues of secrecy, are reported. Recipient couples and donors, while thinking that secrecy is important, have told other people-a not dissimilar situation to what occurred in the adoption field 25 years ago. Forty-one per cent of recipient couples and donors do not believe children should be told of their origins. A high 46% of couples had not yet decided if they would tell their child. Donors are almost equally divided over the child's right to non-identifying information about them. Donors are more likely than recipient couples to believe that the child who knows s/he has been conceived via AID will want information about them. Only 11% of donors and 5% of couples believe a child would want to know the identity of the donor, although for three quarters of both groups the issue is far from clear. Donors were not as opposed to the possibility of tracing occurring as some doctors suggest. Response to questions concerning the legal position suggests there is considerable confusion amongst both groups. The overwhelming majority of couples were intending to place the husband's name on the birth certificate, regarding him as the father.(ABSTRACT TRUNCATED AT 250 WORDS)
Infertility affects about 14% of the population in Cameroon. The majority of those affected are between 26-30 years old. Between 40-50% of all cases of infertility are associated with male failure, and azoospermia is implicated in 14.4% of the cases. There is thus an indication for assisted reproduction among this category of infertile couples particularly artificial insemination by donor (A.I.D.). A comparative study on fertile and infertile couples' perception of A.I.D. revealed that knowledge of A.I.D. is low, 35.30% of infertile respondents were aware of the procedure via à vis 30.6% of their fertile counterparts. Nonetheless 49% of infertile respondents accepted A.I.D. in principle compared to 37.75% of their fertile counterparts. Despite the high value respondents placed on having children and the strong desire by infertile couples to have their reproductive potentials fulfilled, only 19.6% of infertile respondents and 42.87% of their fertile counterparts respectively, would actually practice A.I.D. if the need arose. There are indications that respondents did not perceive A.I.D. as an acceptable solution to infertility. Evidently, the possible influence of socio-cultural barriers to A.I.D. as well as perceived socio-cultural alternatives which may be more acceptable to infertile couples than a technically assisted form of reproduction, have been overlooked.
OBJECTIVE: To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed. DESIGN: Fifteen-year prospective observational study. SETTING: Private infertility clinic. PATIENT(S): Three thousand, three hundred eighty-one cycles of husband or donor IUI. INTERVENTION(S): Ovulation induction with CC and IUI. MAIN OUTCOME MEASURE(S): Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR). RESULT(S): Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses. CONCLUSION(S): Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.
Synthetic LH-RH was administered by various routes to 19 patients during 37 treatment cycles in an attempt to trigger ovulation in association with insemination therapy. Thirty-five cycles were ovulatory; four pregnancies occurred, but two of them ended in spontaneous abortion. In 20 cycles, the hyperthermia response occurred one to three days after LH-RH administration, suggesting that ovulation occurred as a direct consequence of administered LH-RH. Low levels and delayed peak secretion of progesterone were found in two patients who had serial progesterone determinations during the luteal phase after LH-RH administration. Ovulation timing with LH-RH appears feasible, but efforts to ensure the availability of a mature follicle are required.