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In cases of artificial insemination for genetic indication, it may be useful to determine that in fact the foetus is the result of AID. Chromosome markers may or may not provide an answer, when HLA typing of amniotic fluid cells can.
Today families are being created by such procedures as test tube fertilization, artificial insemination and surrogate parenting. In addition to traditional couples, moreover, single persons, gay couples and others are seeking to form family units. In the eagerness to produce an offspring there is often little thought given to the needs or the feelings of the child so produced. There is a need for sociomedical data as well as a more open approach in these situations.
The Ericsson albumin filtration technique was used to collect a fraction rich in Y sperm for selective insemination in couples desiring a male infant. Of 35 conceptions in which sex was known at delivery or spontaneous abortion, there were 28 males (80%). Twelve pregnancies were achieved after separation of sperm in a Sephadex gel filtration system designed to allow for collection of a fraction enriched in X sperm. Seven pregnancies have resulted in females, two in males, and one in twins of each sex. One patient aborted, and one is still pregnant. While selection for either sex can be done electively, on the basis of sociologic preference, female selection has, as an additional indication, avoidance of male offspring to carriers of sex-linked diseases.
A preliminary survey to assess and quantify attitudes to Artificial Insemination by Donor (AID) has been conducted with the aid of an article in a national magazine. The consensus of 375 individuals (mostly with a vested interest in infertility) concerning their attitudes to semen donation, hypothetical receipt of donor semen, legal aspects and the keeping of donor records, etc., have been analysed and their answers correlated to their age, sex, ethnic grouping, educational level, religion, and marital and fertility status as well as their place of residence. Within the limitations of this study, three major conclusions can be drawn. Firstly there are probably many potential semen donors in the general community and recruitment techniques need to be improved to capitalize on this source. Secondly, a centralized non-identifying National Register of donor information may be tolerated, and finally, the couples questioned felt an AID child should not be likened to one received through adoption. These and other findings would suggest that attitudes towards AID are changing and consequently some of the practices within AID programmes may need to be altered. Further statistically conducted surveys are warranted to determine these current attitudes.
One hundred and seventy-seven semen donors were used in an artificial insemination service using frozen semen over a 4 year period. Although the donors were selected for good semen quality, pregnancy rates varied markedly from less than five to greater than 20 pregnancies per 100 treatment cycles. When the characteristics of the 25 most fertile and 25 least fertile donors were compared, only sperm morphology was significantly different. Sperm concentration and motility before and after thawing of semen were similar in the two groups as were the proportions of adverse prognostic factors in the recipients. It is concluded that using more stringent criteria for selection of donors on the basis of sperm morphology and discarding donors who do not produce pregnancies within 12 cycles should improve overall pregnancy rates.
Requests by single women for artificial insemination by donor (AID) raise important ethical issues concerning the obligations of physicians and the well-being of the children who would be conceived. Specific objections to AID for single women can be raised, including that the absence of a father may adversely affect the child or that a lesbian mother may influence the child to become homosexual. A review of the relevant social science research indicates, however, that these and other objections are not supported by the available data. In support of AID for single women it can be argued that the life of the child who would be produced could be expected to have value, considered in itself. Consideration of the various aspects of the issue suggests that AID for single women is permissible in selected cases and that the physician has a right to refuse to carry out such requests.
In cases of artificial insemination for genetic indication, it may be useful to determine that in fact the foetus is the result of AID. Chromosome markers may or may not provide an answer, when HLA typing of amniotic fluid cells can.
--128 women underwent artificial insemination with husband's semen (A I H) after an over 3 years period of sterility. --The most frequently recorded indication was low sperm density and/or reduced sperm motility. To increase sperm concentration and motility split ejaculates were most often utilised but also different other methods. --The pregnancy rate was 31 p. 100 and the success rate per cycle was 5 p. 100.
Donors are crucial to any artificial insemination by donor (AID) programme but information about them is limited. This paper discusses the sources, characteristics and processing of semen donors.
This survey of the psychological literature on Artificial Insemination by Donor (AID) pays particular attention to the secrecy. Studies of couples beforehand do not arrive at criteria for choosing psychologically suitable couples. Follow-up questionnaires are superficial and cannot inform us which couples and what percentage of couples encounter psychological difficulties. Case reports of couples who encountered difficulties are too few to permit generalization and cannot specify AID's role in generating symptoms. A second look at the data suggests that, although overlooked, the secrecy surrounding AID may create psychological difficulties, a view supported by the findings at our clinic. A plea is made with specific recommendations to create an ambience in which openness is possible, and which will allow in-depth research of the psychological aspects of AID.
An improved method of semen preparation for artificial insemination, which involves filtration on an albumin column followed by resuspension in fasting blood serum, is described. The proportion of motile sperms, the quality of motility, motility index, and life span of the sperms in vitro are improved. Six pregnancies have resulted from the use of this method.
Two hundred twenty-six patients received artificial insemination with fresh donor semen (AID) using the cervical cap technique; 52 patients underwent the procedure for 2 conceptions. Using life-table analysis to adjust for uneven patient follow-up, the cumulative pregnancy rate was 62.5% after 6 months of AID, and 82.4% after 10 months. Moreover, using a mathematical model of cumulative pregnancy following AID, the estimated cure rate was not significantly different from 100%, and the estimated monthly probability of pregnancy among those cured was 15.5%. Age was found to be inversely related to pregnancy success, while parity had no effect. For those who continued to undergo AID beyond 6 months, the monthly probability of pregnancy did not decline. Patients can be advised that their chance of conception with AID should approach that of normal fertile couples.
One thousand, three hundred and fifty-seven women were treated by artificial donor insemination (AID) using frozen semen at seven Australian centres. Eight hundred and forty-three of the husbands were azoospermic and five hundred and fifteen had pathological semen. The wives of azoospermic men had a significantly higher rate of success when the two groups were compared by life table analysis. It appears likely that the wives of oligospermic men who require AID are less fertile, and may be a contributory factor in the couple's subfertility.
Forty-three couples who first conceived by artificial insemination by donor (AID) between 1975-1977 jointly completed an anonymous questionnaire about their attitudes to the AID programme. There were 80 children, and 30 couples had 2 or more children by AID. All children developed normally. The attendance rate of husbands at the births was 94%. All but one couple reported stable marriages and the majority thought that the AID pregnancies had improved their marital relationship, and none thought it had deteriorated. Selection for treatment relied upon the traditional medical interview only and no structured psychosocial interviews were used. The majority of the couples (84%) did not plan to tell their children of their AID origins.
The effect of prostaglandin F2-alpha on sperm motility in vitro was studied on 26 pathologic sperm samples. A highly significant increase of sperm motility was observed after addition of a physiologic concentration i.e. 2500 ng/ml to the sperm samples. Sperm motility was improved quantitatively as well as qualitatively. The percentage of motile sperms in the sperm samples which responded to prostaglandin F2-alpha was X = 32.8% and in the controls X = 15.6%. Highly concentrated prostaglandin F2-alpha did not affect sperm motility. The mechanism of action and therapeutic implications of prostaglandin F2-alpha in vitro are discussed in the view of activation of sperm motility in native and kryopreserved ejaculates prior to homologous insemination.
The authors have reviewed 140 cases of AID using frozen sperm in fine straws. With a follow-up of one year from the date the last couple was brought into the survey, the crude percentage for conception is 65 and can reach up to 73.3% with a mean rate of conception per cycle of 10% in couples who carry on for a minimum of six cycles. The ability of the sperm to fertilise seems comparable whether they come from one or other of two centres for the study and storage of human sperm. The level for conception is less affected by features such as whether the sperm is fresh or frozen, or the number of spermatozoa that have been inseminated, than by the patient's age and also her fertility, in which also psycho-emotional factors have to be taken into account, but these are difficult to qualify. When the causes of lowered female fertility are able to be pinpointed and are curable, the hope for a successful pregnancy from AID should approach that found in so-called normal patients.
After examination of ovarian and tubal function 246 women underwent 1238 AIH in 847 menstrual cycles. During the treatment period 74 patients became pregnant once or several times; altogether 99 pregnancies were observed. Whereas only 22 pregnancies occurred in cycles with AIH, the other 77 occurred in cycles without AIH. The ratio of pregnancies after AIH and those occurring without insemination decreases in relation to the degree of deterioration of the semen quality. With normal semen the ratio of pregnancies with AIH and those without AIH was 1:2.5. With semen of grade I this ratio became 1:4 and with grade II 1:10. On the basis of these results the following conclusions can be drawn: (1) with more or less normal semen quality and disturbance of the cervical mucus penetration AIH appeared to be reasonable; (2) with severe or even moderate subfertile semen findings AIH is not indicated; (3) an indication for AIH is the impossibility of cohabitation or ejaculation.
The total three year experience with frozen sperm used with artificial insemination by donor (AID) at Prince Henry's Hospital. Melbourne is presented. During this period, 252 women have had one or more cycles of treatment, with life table pregnancy rates of 47.6 +/- 3.55 after six cycles and 62.8 +/- 4.00 after 12 cycles. There was no difference in outcome between patients with azoospermic or oligospermic husbands, but patients requiring ovulatory stimulants or who have tubal abnormalities have a much lower success rate.