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At least 1,711 records · Page 95Linked to original sources
PubMed1995

Subzonal insemination, partial zona dissection or intracytoplasmic sperm injection? An easy decision?

This review aims to analyse and compare the results to date of subzonal insemination (SUZI), partial zona dissection (PZD) and intracytoplasmic sperm injection (ICSI) to evaluate critically whether it is now possible to replace SUZI and PZD by ICSI. It appears that ICSI is a much more efficient assisted reproduction technique than SUZI and PZD for resolving cases of severe male infertility and/or repeated failure of conventional in-vitro fertilization (IVF). For ICSI compared with SUZI and PZD, fertilization (49.4, 17.7 and 16.8% respectively), percentage of patients reaching embryo transfer (91.0, 55.1 and 23.3% respectively), percentage of transfers performed with two or three embryos (83.3% ICSI and 39.3% SUZI), pregnancy rate per embryo replacement (28.2, 18.7 and 16.5% respectively) and pregnancy rate per oocyte retrieval (24.8, 10.3 and 3.8% respectively) are all improved. In addition, cases of severely impaired semen characteristics, which were condemned to infertility for life with conventional IVF, SUZI or PZD, can now be treated and resolved efficiently with ICSI.

Cytoplasm↗
PubMed1995

Intrafollicular insemination for the treatment of infertility.

The effectiveness of intrafollicular insemination (IFI) for the treatment of non-tubal infertility was investigated in a pilot study. A total of 50 infertility patients with normal tubal function verified by laparoscopy or hysterosalpingography were stimulated with clomiphene citrate/human menopausal gonadotrophin. Washed spermatozoa were injected into one to three pre-ovulatory follicles via vaginal puncture 12 or 30 h after human chorionic gonadotrophin administration. Natural progesterone was given for luteal support. The IFI procedure was technically very simple and convenient for the patient and no complications were recorded. One normal intra-uterine pregnancy resulted. The results indicate that by comparsion with other assisted reproductive technologies IFI is very inefficacious for treating non-tubal infertility. Our data suggest that the intrafollicular environment in the preovulatory period is not favourable for fertilization.

Adult↗
PubMed1995

Computer image sperm selection as a novel approach to subzonal insemination in the human.

Utilizing real-time computer image analysis, individual spermatozoa were selected using microaspiration. Selection criteria were based on potential hyperactivation motility characteristics; the amplitude of lateral head displacement > 7.5 microns, curvilinear velocity > 70 microns/s and linearity of < 30%. For this pilot study, 16 patients (eight in each group) were recruited. Using subzonal insemination (SUZI), up to five (mean = 4.4 +/- 0.3) spermatozoa selected using computer-image sperm selection (CISS) were micro-injected, or up to 15 (mean = 12.8 +/- 1.3 SD) unselected spermatozoa. In the group which utilized CISS, 28 out of 49 (57%) oocytes were fertilized compared with 13 out of 52 (25%) utilizing conventional SUZI (P < 0.04); polyspermy was 20% (n = 10) and 2% (n = 1) respectively. CISS with SUZI showed increased efficiency in achieving fertilization and is a novel approach to studying individual sperm function in a sperm egg bioassay where gamete ratios are close to unity.

Adult↗
PubMed1995

Artificial insemination by donor: an alternative for single women.

Artificial insemination using donor spermatozoa (AID) has been known as a treatment for heterosexual couples where the husband has been found to be infertile. The first woman without a male partner wanting a child by AID was admitted to the fertility centre in 1981. In the literature, two categories of alternative requests, i.e. those from lesbian couples and those from single women, are treated as equivalent family structures since both lack a father figure. However, single women shoulder the responsibility for the child's upbringing alone, whereas in lesbian couples partners share this responsibility. Some of the objections raised to alternative types of parenthood therefore refer more to women not having a partner at all. Since 1981, 94 single women have asked the Fertility Centre of the Free University of Brussels to be considered for AID treatment. Data from this group of alternative requests have been collected. The aim is to draw up a profile of the single women who request AID, and to make a distinction between applicants who were accepted and those who were refused.

Adult↗
PubMed1995

Intrauterine insemination: a first-step procedure in the algorithm of male subfertility treatment.

Despite the widespread clinical use of intrauterine insemination (IUI) in the treatment of male subfertility, its therapeutic value remains unclear. The objective of this review was to determine why its efficacy has not been consistently documented in the literature and to give strong evidence supporting the therapeutic merit of ovarian stimulation/IUI in male subfertility treatment. Because (i) this technique is much easier to perform and less expensive than assisted reproduction methods, and seems to be reasonably effective in controlled studies of a male subfertility treatment, and (ii) we may expect that financial resources available for the health care of infertility patients will be limited in the future, we believe that ovarian stimulation/IUI must become the first-line treatment in most cases of male factor subfertility, provided that the multiple gestation incidence can be reduced to an acceptable level.

Algorithms↗
PubMed1996

Analysis of the attitudes and emotional processes in couples undergoing artificial insemination by donor.

Osgood's Semantic Differential Questionnaire was used to study 40 couples undergoing an artificial insemination by donor (AID) programme. The following reference concepts were used: Father, Mother, Work, Marriage, Myself, Children, Pregnancy, Guilt, Sex and Family. The results show that women consider ¿being a Mother' as something emotionally ¿warm', take a positive position, feel ¿nervous' and wish the event happened quickly; this is significantly different to men, who give less importance to this fact. Men are more concerned about the pregnancy and consider it a ¿hard', ¿strong' and ¿heavy' experience. The score in the concept Guilt significantly stands out from the rest of the concepts in both men and women; it is also striking how AID women relate the concept Mother with the concept Father, whereas men establish the association between Mother and Work.

Adult↗
PubMed1996

Simplified ultralong protocol of gonadotrophin-releasing hormone agonist for ovulation induction with intrauterine insemination in patients with endometriosis.

The present study was designed to assess the usefulness of the simplified ultralong protocol of gonadotrophin-releasing hormone agonist (GnRHa) for ovulation induction with intrauterine insemination (IUI) in patients with various stages of endometriosis. A prospective randomized trial was set up to compare the simplified ultralong protocol (ULP) and the long protocol (LP) of GnRHa for ovulation induction with IUI in patients with endometriosis. There was no evidence of other factors in infertility in any patient. In the ULP group (39 patients), 4 weeks after a single injection of 3.75 mg Decapeptyl had been given, daily s.c. administration of 0.1 mg Decapeptyl was initiated and continued for at least 2 weeks prior to ovarian stimulation. In the LP group (41 patients), daily s.c. administration of 0.1 mg Decapeptyl was initiated from the mid-luteal phase of the cycle preceding the stimulation cycle. After 14 days of administration, ovarian stimulation was started if pituitary desensitization had been achieved. The amount of gonadotrophins required, number of days of gonadotrophin administration, serum oestradiol response, and the number of mature follicles were comparable in both groups. The clinical pregnancy rate per cycle was significantly higher in the ULP group at 48.7% (19/39) compared with 26.8% (11/41) in the LP group. The miscarriage rates were 21.1% (4/19) in the ULP group and 18.2% (2/11) in the LP group. In patients with stage I or II endometriosis, there was no significant difference between the two groups with respect to clinical pregnancy rate per cycle (47.4 versus 35.0%). In patients with stage III or IV endometriosis, the clinical pregnancy rate per cycle was significantly higher in the ULP group at 50.0% (10/20) compared with 19.0% (4/21) in the LP group. This study suggests that a simplified ULP of GnRHa could give better chances of achieving pregnancy in endometriosis patients undergoing assisted reproductive technologies and that this protocol may be more useful in patients with an advanced stage of endometriosis.

Adult↗
PubMed1997

Treatment of the male with follicle-stimulating hormone in intrauterine insemination with husband's spermatozoa: a randomized study.

We have examined the potential of follicle-stimulating hormone (FSH) therapy for the male to improve pregnancy rates in intrauterine insemination (IUI) with husband's spermatozoa. A prospective randomized trial was performed in 148 couples undergoing IUI because of male subfertility. In the treatment group, 150 IU FSH were administered to the husbands, either i.m. or s.c., three times a week, starting 3 months before the beginning of IUI cycles and maintained until the fifth IUI cycle. In the control group no treatment was given. FSH therapy did not change semen parameters. The pregnancy rate per cycle was 13.47% in the FSH group versus 10.07% in the non-FSH group; the pregnancy rate per woman was 44.38% in the FSH group versus 37.18% in the non-FSH group. Although the pregnancy rate increase was > 30% per cycle and > 20% per woman, statistical significance was not achieved. The cumulative pregnancy rate was 59.20% in the FSH group versus 42.91% in the non-FSH group. The pregnancy rate outside the IUI cycle was 14.70% (10/68) in the FSH group versus 2.5% (2/80) in the non-FSH group, the difference being statistically significant. In conclusion, a non-significant trend towards higher pregnancy rates in IUI was observed in the FSH group.

Female↗
PubMed1997

Female and male partner age and menotrophin requirements influence pregnancy rates with human menopausal gonadotrophin therapy in combination with intrauterine insemination.

This study analyses the influence of female and male patient age and human menopausal gonadotrophin (HMG) requirements on clinical pregnancy rates and live birth rates with ovulation stimulation using HMG in combination with intrauterine insemination (IUI). In this study, 363 consecutive HMG/IUI treatment cycles in 184 patients carried out at a university fertility centre were analysed in a retrospective fashion. The main outcomes measured were clinical pregnancy rates and live birth rates. Increased female partner age (> or = 35) and male partner age (> or = 40) were found to negatively influence pregnancy rates with HMG/ IUI therapy. In addition, this study demonstrated a critical threshold of HMG requirements beyond which pregnancy did not occur. No pregnancies occurred in treatment cycles requiring > 25 ampoules (1875 IU) of menotrophins to achieve follicular maturity, irrespective of patient age. In conclusion, female partner age, male partner age, and HMG requirements all significantly influence pregnancy rates with HMG/IUI therapy.

Adult↗
PubMed1997

Discontinuous Percoll gradient preparation for donor insemination: determinants for success.

The use of cryopreserved donor spermatozoa for insemination has become necessary to decrease the risk from sexually transmitted infectious diseases. Lower fecundity rates have been reported with this practice. Efforts have been applied to increase success, including identification of those sperm characteristics which correlate with increased fecundity. Data from in-vitro fertilization have revealed sperm morphology, motility and zona pellucida binding as important sperm parameters. Discontinuous Percoll gradient preparation yields a high concentration of motile spermatozoa. Using this preparation for thawed donor spermatozoa, we have identified post-preparation motility and progression as factors associated with increased fecundity. Consideration should be given to screening sperm donors with a freeze-thaw Percoll gradient preparation prior to acceptance into a donor bank.

Adult↗
PubMed1997

Artificial insemination and in-vitro fertilization using donor spermatozoa: a report on 15 years of experience.

Donor insemination (DI) using cryopreserved semen commenced at The Royal Women's Hospital in 1976. Over the next 15 years we performed 5953 treatment cycles to achieve 816 pregnancies (13.7% per cycle) and 706 live births. In-vitro fertilization (IVF) using donor spermatozoa commenced in 1986. Over the next 5 years we performed 303 treatment cycles for 185 couples. Including subsequent transfer of cryopreserved embryos, a total of 33% of couples achieved a successful pregnancy by IVF. Statistical analysis indicated that, for DI pregnancies, the most important semen variable was the percentage post-thaw motility, whilst for normal fertilization in IVF it was the pre-freeze motility. These results may be explained by the compensatory effects of post-thaw processing of spermatozoa for IVF, but not for DI in our clinic.

Adolescent↗
PubMed1997

Donor insemination: child development and family functioning in lesbian mother families.

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.

Adult↗
PubMed1997

Donor insemination: Dutch parents' opinions about confidentiality and donor anonymity and the emotional adjustment of their children.

Results from a comparative study investigating 38 donor insemination (DI) Dutch families with 4-8 year old children are presented. The aims of this study were to investigate parents' opinions on the issues of confidentiality and donor anonymity, to assess the emotional development of the children, and to examine in DI families the association between secrecy with regard to the use of a donor and the emotional adjustment of the children. The DI families were compared to families with a child conceived by in-vitro fertilization (IVF) and to families with a naturally conceived child. Secrecy appeared to be associated with DI and not with IVF: 74% of the DI parents intended not to inform the child about the way in which she/he was conceived, whereas none of the IVF parents intended to keep the secret. Only one set of DI parents and two sets of IVF parents had actually told the child. As to donor anonymity, a spread of opinions appeared among DI parents; 57% preferred an anonymous donor, 31% would have liked non-identifying information about the donor, 9% preferred the donor's identity to be registered and 3% remained unsure. Parents' major concern was to know more about the medical/genetic background of the donor. Mothers and fathers in the DI families differed in their opinions concerning the issues of confidentiality and donor anonymity: fathers, more often than mothers, were secretive with regard to the use of a donor and husbands, more often than their wives, were in favour of donor anonymity. With regard to the emotional development of the children, more emotional/behavioural problems were revealed among DI children than among children who were naturally conceived. No association was found between secrecy and the emotional/behavioural adjustment of the children.

Affective Symptoms↗
PubMed1997

Cytomegalovirus detection in cryopreserved semen samples collected for therapeutic donor insemination.

The presence of cytomegalovirus (CMV) in semen was retrospectively evaluated in 178 cryopreserved semen samples obtained from 97 donors recruited by two sperm banks. Thirty-three (34.0%) donors were CMV-seronegative, 51 (52.6%) were CMV-seropositive and 13 (13.4%) had an unknown serological status. CMV was detected in sperm specimens by cell culture and polymerase chain reaction (PCR). CMV was detected in five (2.8%) samples from two (2.0%) donors by cell culture and in 10 samples (5.6%) from five donors (5.1%) by PCR; all the samples which were positive by cell culture were also positive by PCR. Our data indicate that cryopreserved semen specimens obtained from healthy volunteer donors represent a potential source of CMV infection through therapeutic donor insemination. PCR, which is more sensitive than cell culture, should be used for direct and rapid identification of CMV in semen samples collected from volunteer donors. CMV detection in semen by PCR could be advantageously compared to CMV-antibody tests in serum which are only indicative of a former CMV infection.

Adult↗
PubMed1997

The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis.

A systematic review was conducted to evaluate the effectiveness of intrauterine insemination (IUI) with or without ovarian stimulation using gonadotrophin in the treatment of persistent infertility. Relevant randomized controlled trials were identified by a diverse strategy including a hand search of 43 core journals from 1966 to the present. Two approaches to meta-analysis were used to summarize data. First, using a standard Mantel-Haenszel approach, eight trials comparing FSH/IUI with FSH/timed intercourse for unexplained infertility were combined. The common odds ratio for pregnancy was 2.37 [95% confidence interval (CI), 1.43, 3.90], suggesting a significant improvement with IUI following ovulation induction in this patient group. Although the data were statistically homogeneous, clinically important heterogeneity was present. Second, across all diagnostic groups, the independent effects of treatment with follicle stimulating hormone (FSH), clomiphene citrate, IUI, as well as the diagnoses of male factor and endometriosis were assessed using stepwise logistic regression. Based on 5214 cycles reported in 22 trials, the odds ratio for pregnancy associated with FSH use was 2.35 (95% CI, 1.87, 2.94) for IUI, 2.82 (95% CI, 2.18, 3.66) for male factor, 0.48 (95% CI, 0.37, 0.61), and for endometriosis 0.45 (95% CI, 0.27, 0.76). This summary of the best available evidence may prove useful in counselling couples who are considering FSH and/or IUI therapy.

Clomiphene↗
PubMed1998

Semen preparation by standard swim-up versus swim-up with test yolk buffer incubation in intrauterine insemination: a randomized study.

In order to compare the standard swim-up semen preparation with and without test yolk buffer (TYB) incubation in intrauterine insemination (IUI), we conducted a prospective multicentre randomized trial. A total of 121 infertile couples with male factor (n = 52) or unexplained infertility (n = 69) was randomly assigned to two groups following ovulation induction. Semen was prepared by standard swim-up in group A (n = 64) and by swim-up followed by TYB incubation in group B (n = 57). A maximum of two IUI cycles was performed. A total of 104 cycles was performed in the swim-up group and 90 in the TYB group. Overall, 15 pregnancies were achieved in group A and 23 in group B, with an overall pregnancy rate of 24.8 and 50.0% per patient respectively (chi2(1), P < 0.05). In the male factor group, pregnancy was achieved in six out of 24 couples (25%) following standard swim-up and in six out of 28 (21.4%) following swim-up and TYB incubation (chi2(1), not significant). In the unexplained infertility group, pregnancy was recorded in nine out of 40 couples (22.5%) following standard swim-up and in 17 out of 29 couples (58.6%) following swim-up and TYB incubation (chi2(1), P < 0.05).

Female↗
PubMed1998

Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: the effect of patient age on clinical outcome.

The purpose of this investigation was to examine the influence of female and male patient age on pregnancy rates with sequential clomiphene citrate (CC) and human menopausal gonadotrophin (HMG) ovulation induction with intrauterine insemination (IUI) therapy after previous CC and IUI treatment failure. A total of 208 patients previously unable to conceive with CC/IUI therapy underwent 416 treatment cycles of sequential CC/HMG with IUI at a university fertility centre between May, 1991 and August, 1995. Clinical pregnancy rates, live birth rates, and the effect of female and male partner chronological age were retrospectively examined. Treatment with sequential CC/HMG with IUI resulted in clinical pregnancy rates ranging from 5.9 to 23.1% despite previous CC/IUI treatment failure. Clinical pregnancy rates, live birth rates, and cumulative pregnancy rates declined significantly in female patients > or = 35 years of age compared to those < 35 years of age. A statistically significant decline in clinical pregnancy rates could not be demonstrated as a function of increasing male partner age. Pregnancy rates in patients undergoing ovulation induction with sequential CC/HMG with IUI decline significantly with increasing female partner age.

Adult↗
PubMed1998

Births of normal daughters after MicroSort sperm separation and intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection.

The world's first deliveries of normal babies after use of flow cytometric separated human sperm cells (MicroSort) for preconception gender selection are reported. Offspring were of the desired female gender in 92.9% of the pregnancies. Most of these pregnancies and births were achieved after simple intrauterine insemination.

Cell Separation↗