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PubMed1976

Artificial insemination donor: clinical and psychologic aspects.

Forty-four sterile sterile couples in whom the main cause of infertility was the male factor were investigated. Artificial insemination donor (AID) was performed, timed according to the basal body temperature chart. It was found that it is important to match not only the physical appearance of the couple to that of the donor but also the blood group of at least one of the future parents. Patients were interviewed by a psychologist in order to define their marital relationship, their attitude toward the infertility, their feelings about AID in comparison to adoption, their attitude toward the donor and pregnancy, and their attitude toward their physician. The role of the psycholgist in AID treatment was found to be important for careful selection of cases. He can also guide and prepare these couples to face family life in the future.

Adult↗
PubMed1978

Conception following insemination with a freeze-preserved retrograde ejaculate.

Retrograde ejaculation, an infrequent cause of male infertility, may be the sequela of prostate or bladder neck surgery or the result of interruption in the sympathetic innervation to the bladder neck. The diagnosis is established by history and examination of the urine. In infertile couples artificial insemination homologous (AIH) using retrograde ejaculate recovered from the bladder has been successfully accomplished, but conception has occurred only in isolated cases. A literature review of the subject is presented. The technique of semen recovery from the bladder is time-consuming and uncomfortable to the patient, while the quality of the semen recovered is variable and the risk of iatrogenic urinary tract infection is increased. To avoid the above problems, and to have sperm available for AIH at the time of induced ovulation in an anovulatory wife, we were able to freeze-preserve ejaculate recovered from the bladder for future use. A case of conception following AIH with freeze-preserved retrograde ejaculate is presented.

Adult↗
PubMed1978

The use of a one-day luteinizing hormone assay for timing of artificial insemination in infertility patients.

A 1-day rapid assay for luteinizing hormone (RLH) was developed by combined alteration of incubation temperatures and immune-complex precipitation of a commercially available LH kit. The RLH assay, compared with the standard 3-day assay, had the following characteristics: standard curve slope values of --2.47 and --2.314; assay sensitivity of 5.5 and 3.8 mIU/ml of serum; average coefficients of variation for the standard curves of 13.6% and 14.1% and for serum controls of 10.6% and 13.1%, respectively. Two consecutive RLH assays of split samples were highly correlated (r = 0.9908; P less than 0.001), as were split aliquots measured by RLH or the 3-day assay (r = 0.993; P less than 0.001). When 52 samples from portions of 5 normal menstrual cycles were assayed in both systems, agreement was again high (r = 0.9871; P less than 0.001). Representative curves of both RLH and standard LH assays, together with other data, are presented to show the feasibility of applying this method for timing of artificial insemination.

Adult↗
PubMed1979

Artificial insemination homologous with oligospermic semen separated on albumin columns.

Semen samples obtained from 27 infertile men were separated on human serum albumin (HSA) columns prior to artificial homologous insemination (AIH). The columns contained either a single 7.5% HSA layer or two 17.5% and 7.5% HSA layers. Separated specimens were free of seminal debris, had significantly improved motility and progressive drive, and had a decreased percentage of abnormal forms. The total sperm count was also significantly decreased after separation, especially with the two-layer technique. No conceptions occurred in 21 couples when two-layer separation was used, but four pregnancies in 12 couples resulted from AIH with semen separated on the single-layer column. The mean total count of motile sperm obtained for AIH was 5 million with the two-layer and 31 million with the one-layer technique.

Adult↗
PubMed1979

Better postcoital test for oligospermic patients using split ejaculate artificial insemination.

In 25 oligospermic patients who had negative postcoital tests, artificial inseminations were performed with the whole semen and split ejaculates. After 30 minutes, a sample of cervical mucus was obtained and examined microscopically for the presence of motile spermatozoa. There was a significant improvement of 64% using the split ejaculate, as compared with 44% using whole semen. We found a significantly higher sperm count and progressive motility in the split ejaculate (18 patients, 72%).

Cell Count↗
PubMed1982

Real time pelvic ultrasonography during the periovulatory period of patients attending an artificial insemination clinic.

Real time ultrasonography was used to examine the ovaries of 50 patients at the calculated time for artificial insemination with donor semen (AID). Forty-two (84%) had one or more follicles greater than 13 mm in diameter. Both ovaries were monitored daily until the main follicle had ruptured (mean number of examinations, 2.4 per patient; range, 1 to 5). Seven women became pregnant (mean follicular diameter, 21.6 mm; range, 18 to 25 mm). The fecundability rate was 12%, compared with 6% for a corresponding group of 50 patients who were not examined with ultrasound. Seven patients experienced mittelschmerz, and in 39 the leading follicle had ruptured before the rise in basal body temperature (BBT). Ultrasonography may be used to confirm the presence or absence of preovulatory follicle prior to treatment.

Body Temperature↗
PubMed1983

Screening of karyotype and semen quality in an artificial insemination program: acceptance and rejection criteria.

Semen quality and karyotype were screened in all men offering to be donors for an artificial insemination (AID) program. The criteria for accepting or rejecting semen have now been set with respect to this sample of the population. There was no evidence of differences between the pregnancy rates of the accepted donors. One of 172 potential donors with a clear medical history had a chromosomal abnormality, 4 had pericentric inversions of chromosome 9, and 14 had other heterochromatic variants. Of the recipients of AID, 5 of 196 women had chromosomal abnormalities, and 12 had heterochromatic variants.

Adult↗
PubMed1984

Artificial donor insemination: fresh versus frozen semen; the patient as her own control.

The efficacies of fresh versus cryopreserved semen in the treatment of male factor infertility by artificial insemination by donor (AID) semen were directly compared by using the patient as her own control. In any one cycle, either fresh or frozen semen was used. The type of semen preparation was randomly assigned for the first cycle and varied thereafter according to donor availability. The same donor was used for a given patient in six consecutive cycles. We treated 381 patients in this way. In 676 cycles fresh semen was used and 128 pregnancies were achieved. Fecundability, the chance of getting pregnant per cycle of exposure, was 18.9% with fresh semen. In 1200 cycles cryopreserved semen was used and 60 pregnancies occurred, for a fecundability of 5.0%. Therefore, in our clinic, fresh semen is more than three times as likely to induce pregnancy as frozen semen. The design that has been used in this therapeutic protocol provides a technique for internal quality control of the cryopreservation process and for the investigation of other variables potentially affecting the success rates with AID.

Female↗
PubMed1985

Timing and frequency of artificial insemination in women under menotropin therapy.

The timing and frequency of AID were reviewed in 36 women who received menotropin therapy. One hundred thirteen treatment cycles were reviewed with AID done once per cycle in 39, twice per cycle in 63, and three times per cycle in 11 cases. The pregnancy rate was 19.5% per treatment cycle, with 21 of the 36 patients (58%) conceiving. No difference in pregnancy rate was found with single or multiple inseminations when AID application included the day of hCG administration. Evidence is presented that suggests that frequently the fertilizing sperm may have resided in the woman for over 30 hours before fertilization occurred.

Chorionic Gonadotropin↗
PubMed1985

Treatment of idiopathic infertility, cervical mucus hostility, and male infertility: artificial insemination with husband's semen or in vitro fertilization?

Couples with male infertility (n = 86), idiopathic infertility (n = 68), and cervical mucus hostility (n = 48) of a long duration were treated either by in vitro fertilization (IVF) or artificial insemination with husband's semen (AIH). The incidence of pregnancy per cycle in couples in whom the male partner was infertile was significantly (P less than 0.01) higher after IVF, compared with AIH (21% versus 5%, respectively). The differences were most apparent in couples with asthenospermia (47% versus 0%, respectively); no significant difference was found when the infertility was caused by oligospermia only (11% versus 9%, respectively). More patients with idiopathic infertility became pregnant after one cycle with IVF, compared with AIH (20% versus 8%, respectively); but, because of intragroup disparity in size, this difference was not significant. A highly significant difference (P less than 0.01) was found after one attempt with IVF, compared with AIH, in patients with cervical mucus hostility (38% versus 3%, respectively).

Cervix Mucus↗
PubMed1990

Factors in the infertile couple influencing the success of artificial insemination with donor semen.

Factors influencing the success of artificial insemination with donor semen (AID) were investigated in a series of 928 infertile couples. A simple approach with one insemination/cycle, timed only by cycle length and basal body temperature, was used. The overall life-table cumulative conception rate was 82% and the average fecundability was 10%. The following factors were associated with a higher success rate: women less than 36 years, azoospermic compared with oligozoospermic husband and women with no history of abdominal surgery. The success rate decreased with increasing duration of infertility and in women with an abnormal hysterosalpingography or laparoscopy, and was unrelated to menarcheal age, the distance between the couples place of residence and the clinic, or if the woman had been pregnant before starting AID treatment.

Female↗
PubMed1987

Pharmacologic induction of multiple follicular development improves the success rate of artificial insemination with husband's semen in couples with male-related or unexplained infertility.

The use of artificial insemination with husband's semen (AIH) as treatment for couples with male-related or unexplained infertility is often disappointing. The aim of the present study was to evaluate whether the induction of multiple ovulation can increase the pregnancy rates in couples treated with AIH. Multiple follicular development was induced by means of clomiphene citrate (CC) plus purified follicle-stimulating hormone (FSH) in 17 couples undergoing AIH for male-related or unexplained infertility. In spite of the long duration of infertility (greater than 6 years), 10 couples (58.8%) achieved pregnancy within 6 months of treatment. This figure was significantly higher than that obtained in 120 couples who underwent AIH either during spontaneous cycles or after induction of follicular development with CC alone. These results suggest that the availability of multiple mature oocytes increases the conception rate during each cycle, as reported for in vitro fertilization (IVF) programs. It is therefore suggested that a trial of induction of multiple follicular development be performed in couples with male-related or unexplained infertility before their inclusion in protocols for invasive procedures, such as IVF or gamete intrafallopian transfer.

Clomiphene↗
PubMed1987

Superovulation with intrauterine insemination in the treatment of infertility: a possible alternative to gamete intrafallopian transfer and in vitro fertilization.

In vitro fertilization and embryo transfer (IVF-ET) and gamete intrafallopian transfer (GIFT) are used to treat intractable infertility in women with no distortion of the pelvic viscera, despite the lack of controlled trials demonstrating efficacy. The mechanism of any purportedly enhanced cycle fecundity in ovulatory women without significant distortion of the pelvic viscera is unclear, but both GIFT and IVF-ET increase the number of male and female gametes at the site of fertilization. Intrauterine insemination (IUI) during human menopausal gonadotropin (hMG)-stimulated superovulatory cycles has similar potential but does not require oocyte retrieval. To evaluate the possibility that simply increasing the number of gametes at the site of fertilization might account for pregnancies attributed to IVF-ET and GIFT, the authors retrospectively analyzed the outcome of couples undergoing IUI during hMG cycles between 1983 and 1986 in women with normal pelvic anatomy. IUI during hMG-stimulated cycles yielded a cycle fecundity (f) of 0.17 for endometriosis, 0.29 for cervical factor, and 0.19 for idiopathic infertility, which approaches the fecundity of normal women and equals or exceeds that reported for IVF-ET and GIFT. The authors conclude that treatment with IUI in hMG cycles, alleviating the need for invasive oocyte retrieval, should be considered for inclusion in a randomized, controlled trial in comparison with IVF-ET and GIFT.

Cervix Mucus↗
PubMed1988

Successful gamete intrafallopian transfer following failed artificial insemination by donor: evidence for a defect in gamete transport?

Gamete intrafallopian transfer (GIFT) was offered as an alternative treatment to 48 women who failed to conceive after artificial insemination with donor semen (AID) in numerous attempts (9 to 24 cycles). The evaluation of these women showed no major cause of infertility as evidenced by normal endocrine, cervical, uterine, and tubal factor studies. Their partners were either azoospermic or severely oligoasthenospermic. During the GIFT cycle, follicular development was induced with (1) clomiphene citrate (days 3 to 7) plus human menopausal gonadotropins (hMG) from day 6 on or (2) human follicle-stimulating hormone (days 3 to 4) plus hMG (day 5 on), until ultrasound revealed 2 follicles 16 mm and serum estradiol (E2) was greater than 700 pg/ml. Human chorionic gonadotropin (hCG) 10,000 IU was administered, and 36 hours later follicular aspiration was performed. One to three oocytes and 100,000 motile sperm were transferred to each fallopian tube through the fimbria via laparoscopy or minilaparotomy. Twenty-seven clinical pregnancies were achieved (56%) per GIFT cycle. Eight miscarriages occurred during the first trimester (29% of all pregnancies), whereas no ectopic pregnancies were observed. These data conclusively show the value of the GIFT procedure in the treatment of cases with failed AID.

Adult↗
PubMed1988

Intrauterine insemination as treatment for antisperm antibodies in the female.

Ninety-one women with long-standing infertility in the presence of humoral antisperm antibodies (ASA) underwent 473 cycles of intrauterine insemination of washed sperm (IUI), resulting in 26 pregnancies. Nine pregnancies were achieved in 67 women who underwent 285 IUI during unstimulated cycles (13% pregnancy rate; 3% pregnancy/cycles of treatment). Twenty women underwent 86 IUI after clomiphene citrate (CC) stimulation, resulting in 6 pregnancies (30%; 7% per cycle), while 28 underwent 102 cycles of IUI after human menopausal gonadotropins (hMG) stimulation, resulting in 11 pregnancies (39%; 11% per cycle). Twenty-one of the 26 pregnancies (81%) were achieved in the first 2 IUI cycles. During unstimulated and CC IUI cycles, all pregnancies occurred in the first two cycles of treatment, while with hMG stimulation pregnancies also occurred in the third, fourth, and fifth IUI cycles. Nine of these 91 women subsequently conceived spontaneously, and three others conceived through in vitro fertilization. Only 6 of the 38 pregnancies resulted in spontaneous abortion (16%). Thus, pregnancies achieved in women with ASA have no increased risk of abortion.

Adult↗
PubMed1989

Marital break-up among couples raising families by artificial insemination by donor.

The separation rate for Norwegian women who had given birth to children after artificial insemination by donor (AID, n = 227) was compared with the separation rate among all Norwegian women that met certain demographic criteria for equality (controls, n = 6,689). The criteria included identical year of maternal birth, similar age at marriage, and equally long period between marriage and birth of the first child. Mean duration of marriage at first delivery was 7.4 years, and mean age of the first child was 3.6 years at registration of the data. The incidence of marital break-up in the AID group was 1.8%, as compared with 3.0% to 3.7% in the control group. The difference is not significant (P approximately 0.15). The authors conclude that the separation rate in AID families does not differ significantly from the observed separation rate in a demographically matched population. The study highlights the importance of selecting a proper control group before statements of the magnitude of separations in AID families are made.

Adult↗
PubMed1989

Relationship of within-patient semen variability to outcome of intrauterine insemination.

To define the subpopulation of infertility patients who would benefit from intrauterine insemination (IUI) with swim-up homologous sperm, the relationship of within-patient semen variability to outcome of IUI was studied. The 61 women in the study had negative workups. Men had at least one semen sample with greater than or equal to 20 x 10(6) sperm/ml. The 6-month cumulative pregnancy rate for all patients was 31.8%. Patients with original sperm motilities consistently greater than or equal to 30% had a higher cumulative pregnancy rate (62.9%) than patients with one or more motility less than 30% (22.0%, P = 0.0015, log-rank test). Patients with post-swim-up motilities consistently greater than or equal to 70% had a cumulative pregnancy rate (51.2%) significantly greater than patients inconsistent for this parameter (15.6%, P = 0.0116). Consistency of sperm motility is a useful parameter for defining the subpopulation of patients who would benefit from IUI.

Female↗
PubMed1983

Semen abnormalities in artificial insemination donor candidates.

We screened 43 healthy adult male medical students as potential anonymous donors for the artificial insemination program at our university. Of the candidates 10 had varicoceles (5 bilaterally). Over-all, 34 men (79 per cent) had inadequate semen analyses by 1 or more criteria. Of the men with varicoceles 80 per cent also had abnormal findings. Three abnormalities were discovered most frequently in the semen of men with a normal physical examination and 5 deficiencies were found in those with a varicocele. Problems with semen quality were more common than those of sperm numbers.

Adult↗