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Artificial insemination by donor (AID) has been complicated by the transmission of several genital infections. We describe the case of a man with Reiter's syndrome whose illness followed AID treatment of his wife.
BACKGROUND: Infertility treatment can be psychologically burdensome. Evidence on music listening during artificial insemination by husband (AIH) remains limited. We evaluated whether a standardized periprocedural music intervention reduced psychological distress and explored its association with clinical pregnancy. METHODS: In this single-center, open-label randomized trial, 254 women undergoing AIH were allocated 1:1 to routine care or routine care plus two 30-minute music-listening sessions, immediately before and after AIH. The prespecified primary outcome was the continuous 21-item Depression Anxiety Stress Scales (DASS-21) score at follow-up; clinical pregnancy was secondary. DASS-21 was completed at baseline and at day 35 after AIH. Clinical pregnancy was assessed by ultrasonography at days 30 to 35. RESULTS: Continuous DASS-21 anxiety, depression, and stress scores did not differ between groups after adjustment for baseline scores (all P ≥ .868). Absolute postintervention differences were 0.01 point or less for anxiety and depression and 0.08 point for stress, indicating neither statistical nor clinically meaningful improvement. Clinical pregnancy occurred in 34/127 participants (26.77%) in the intervention group and 14/127 (11.02%) in the control group (exploratory secondary outcome; P = .001). CONCLUSION: The intervention did not improve the primary psychological outcome. The higher clinical pregnancy rate is hypothesis-generating because the trial was not powered for pregnancy, the proposed psychological mechanism was not demonstrated, and nonspecific attention and other unmeasured factors cannot be excluded. Replication using an attention-matched control, immediate state-anxiety and physiological measures, participant-preference assessment, and live-birth follow-up is required.
The cumulative probability of conception within 12 cycles of insemination with frozen-thawed donor semen increased from 59 to 70% by selecting the semen on the basis of its concentration of adenosine triphosphate (ATP) rather than on the basis of its motile sperm count. The success rate further improved to 83% by performing induction of ovulation in all recipients who did not achieve pregnancy within the initial 6 cycles.
Only 47 of 61 (77%) medical students were selected as sperm donors for artificial insemination. Fourteen were excluded because of family history 1, eye disorders 7, oligospermia 5, permanent structural chromosome aberration 1.
One hundred and fourteen couples with long standing infertility due to male factor, cervical factor and unexplained infertility were admitted for therapeutic trials with intrauterine insemination of washed, capacitated husband's sperm cells between May 1986 to October 1987 at The Egyptian IVF-ET Center, Cairo, Egypt. Three hundred and sixty-four trials were done (an average of 3.19 trial per patient). Fifty-eight patients got pregnant (16% pregnancy rate per trial). This simple and noninvasive procedure can be considered as an alternative treatment for infertility due to male factor, cervical factor, and unexplained infertility.
Eighty-one clinical pregnancies occurred from 508 cycles of intrauterine insemination (IUI) in 242 patients. Following 20 miscarriages 30 pregnancies have been delivered, and 31 remain ongoing at 16 weeks and beyond. This represents a 12% delivered/ongoing pregnancy outcome per cycle of IUI, in women of average age 30.9 years who with their partners had suffered on average 3.65 years of infertility. All forms of non-tubal infertility were treated with pregnancies occurring in all primary categories. No pregnancies occurred in 5 women who underwent IUI in 18 natural cycles. All pregnancies arose in the 237 women who received clomiphene citrate, human menopausal gonadotropin, or a combination of both with ovulation triggered by human chorionic gonadotropin. Dependent upon patient age and duration of infertility, we implement IUI as a frontline treatment for all cases of non-tubal infertility prior to subjecting patients to the more costly and invasive tubal transfer techniques.
Between 1977 and 1987, 14 couples in whom the male partner had retrograde ejaculation were treated with artificial insemination using the husband's sperm (AIH). There were 6 pregnancies in 4 couples, giving a cumulative probability of pregnancy at 12 months of 72%. The success rate depended on a number of factors, including semen quality, methods of sperm extraction from the urine, timing of ovulation and other complicating fertility factors.
The results of artificial insemination with donor semen (AID) are reported. The semen samples were stored in liquid nitrogen until needed. Eighty-two pregnancies occurred in 214 patients treated for 1610 cycles. Life table conception rates were 24.3 +/- 2.9 after six months and 32.7 +/- 3.3 after 12 months of treatment. Thirty of the 82 patients conceived within three treatment cycles and 53 by the sixth treatment cycle. Of the 82 pregnancies, there were 12 miscarriages, no stillbirths or neonatal deaths and one baby was born with a congenital abnormality.
The value of investigating tubal patency by hysterosalpingography, before artificial insemination with donor semen (AID), was studied retrospectively in 167 patients. The results suggest that unless there is a history of pelvic inflammatory disease preliminary hysterosalpinography is unnecessary. Conception rates were similar in women who had a normal hysterosalpingogram (44%), in those who had an abnormal hysterosalpingogram (46%), and in those who had no preliminary tubal investigation (39%) before AID. Life table analysis of expectancy of conception suggests that tubal patency testing should be delayed until after AID has been unsuccessful for four cycles. Laparoscopy is then the most worthwhile investigation.
The pregnancy rates after artificial insemination by donor semen (AID) have been compared with pregnancy rates in normal fertile women to assess the efficiency of AID. To do this, the curve y = a(1-(1-b)x) was fitted to life-tabled cumulative pregnancy rates. The equation describes a model in which the parameter a is the proportion of women who are potentially fertile under the conditions of treatment, and in which the parameter b is the pregnancy rate per cycle (or fecundity) of these fertile women. For 259 AID patients with no previous pregnancy a was 65% while for 57 AID patients with a previous pregnancy after AID 'a' was 99.9%. The values of b were similar for the two groups of patients, being 20% and 22% respectively. Women without fertility problems who had become pregnant after discontinuing oral contraception provided the reference group. Since only pregnant women were selected, a was 100% by definition. The values of b for the reference group were 22% for 100 primigravid women and 20% for 100 multigravid women. Only 65% of the AID patients were potentially fertile with AID, but those that were fertile became pregnant at the same rate as normal women who discontinued oral contraception.
Apparently normal but infertile women were treated by artificial insemination using fresh donor semen. In 228 couples in which the male partner was azoospermic the average monthly conception rate was 13.3% and the 12-month cumulative rate was 82.2% (SE 2.7%). In 116 couples in which the partner was oligospermic the monthly rate was 8.7% and the 12-month rate 66.6% (SE 5.0%, P less than 0.01). Previous smaller studies have given rise to conflicting or inconclusive results, but the reduced conception rates in the partners of oligospermic men in this large study suggests that unexplained female factors, discussed in the paper, contribute to their infertility in up to a third of patients.
Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density less than 1 x 10(6)/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4.7 (SE 3.8)% and without treatment was 6.6 (SE 3.9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.
A survey conducted amongst the 40 donor insemination centres in the UK registered by the Royal College of Obstetricians and Gynaecologists (RCOG) showed that most of the clinics had no structured policy for control of common (non-HIV) sexually transmitted diseases within their programmes.
It has been argued that artificial insemination with donor semen (AID) can be detrimental to the psyche of the sterile husband. This issue has been scrutinized on a larger scale empirical basis using four groups of husbands whose wives were either pregnant due to AID or were under AID without being pregnant yet or were pregnant without AID or were assumedly fertile without being pregnant. Psychometric data was obtained of the corresponding husbands. The results indicate that AID is no threat to the husbands of all groups. Infertile men do not seem to be a psychological risk group. Fertile men tend to reject AID.
Results of intrauterine insemination (IUI) in 39 couples are presented. Indications were male subfertility, cervical factor, unexplained infertility and immunological factor. The patients received a total of 119 treatment cycles. Nine pregnancies were achieved (23.1%) during IUI treatment. The monthly fecundity rate (MFR) during treatment was 7.6%. After stopping IUI, within a follow-up of 1 year 13 pregnancies occurred. Seven pregnancies occurred spontaneously without invasive treatment methods. The MFR was calculated to be 4.8% for this group. We conclude that couples with IUI treatment do achieve pregnancies more quickly, but IUI does not influence a patient's eventual chance to become pregnant.
The psychological and psychodynamic determinants and end-products of A.I.D., both of a positive and negative nature, are reviewed. Studies do not support the contention that a decision to participate in artificial insemination, in itself, is indicative of an emotional disturbance. There is no justification for the automatic requirement of psychological or psychiatric examinations of couples requesting this procedure. Some legal issues are reviewed.
The conception rate of 32 infertile women undergoing tubal microsurgery and subsequent artificial insemination by donor (AID) was compared with that of 71 women undergoing tubal microsurgery alone. The follow-up period ranged from 1 to 6 1/2 years. Nine (28%) of the patients in the AID group conceived, resulting in 8 (89%) live births and 1 (11%) spontaneous abortion. In the normal semen group 42 (59%) of the patients conceived, resulting in 31 (74%) live births, 6 (14%) tubal pregnancies and 5 (12%) spontaneous abortions. In the AID group the following term pregnancy rates were achieved: 40% after bilateral lysis of periadnexal adhesions, 25% after fimbriolysis and 14% after salpingostomy. The corresponding figures in the group with normal semen analysis was 67%, 64% and 29%, respectively. It is concluded that patients who in addition to tubal microsurgery have been treated with AID for 9-12 menstrual cycles seem to have about a 50% poorer chance of achieving a term pregnancy compared with patients whose husbands have normal semen quality.
A retrospective analysis was undertaken to determine whether there was any difference in conception and abortion rate in an artificial insemination by donor program between couples whose husbands were azoospermic (group A) and couples whose husbands were severely subfertile (group O). The pregnancy rate was significantly higher in group A (64%) than in group O (47%) (p less than 0.05). The abortion rate was significantly lower in group A (10%) than in group O (23%) (p less than 0.05). This study confirms the opinion of other authors [4, 9] that pregnancy may occur despite severely abnormal semen. In fact, the difference in pregnancy and abortion rate between the two groups could be explained by assuming that the average fertility of the women in group O is lower than that in group A.