Psychological reactions of couples to artificial insemination with donor sperm.

The case histories of 62 couples successfully treated by AID were established through nondirective interviews, and were surprisingly similar in all cases. Several distinct stages were regularly observed: the awareness of wanting a child while the woman cannot become pregnant; the investigation of the couple's sterility with as a result, the announcement that the husband is sterile; a period in which the couple adapt to this situation; the disappearance of the feeling of guilt both of the husband, wounded in his "virility," and of the wife, ashamed of her desire for a child; acceptance of the idea of AID; request for AID; conflict with the medical profession; the disturbing seances of AID, usually in the presence of the husband; uneasiness at the beginning of pregnancy; euphoric continuation of pregnancy; uncomplicated delivery of a child whose father is very involved in its upbringing, and then request for a second child by AID.     

Results of donor insemination related to specific male infertility and unsuspected female infertility

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.     

Results of donor insemination related to specific male infertility and unsuspected female infertility

Summary. 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 <0·0l). 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.     

Psychological aspects of donor insemination: evaluation and follow-up of recipient couples.

OBJECTIVE: To evaluate the utility of psychological screening for couples entering a donor insemination program. DESIGN: Each spouse completed questionnaires. A psychologist reviewed them and rated the psychological fitness of the couple for participation in the program. Follow-up questionnaires were sent to each couple at a mean of 11 months after entry into the program. SETTING: Applicants for donor insemination were studied in an infertility program in a large, tertiary referral center. PATIENTS, PARTICIPANTS: Consecutive applicants to enter the donor insemination program were required to participate in the initial evaluation. INTERVENTIONS: Couples judged by the psychologist to be at risk for a poor psychological outcome had an assessment and counseling interview with the psychologist before proceeding with insemination. MAIN OUTCOME MEASURES: Initially, the Stress and Infertility Questionnaire measured specific anxieties related to donor insemination, marital and sexual impact, and attitudes about confidentiality; the Brief Symptom Inventory measured psychological distress; and the Dyadic Adjustment Inventory assessed marital satisfaction. At follow-up, 48% of couples returned a modified version of the Stress and Infertility Questionnaire and the other two questionnaires. RESULTS: The psychologist's rating was predictive of pregnancy rates (59% for excellent candidates, 41% for acceptable couples, and 14% for couples psychologically at risk). At-risk couples were more likely to drop out of the program (50% versus only 20% of other couples). Sexual problems were reported by 59% of women and 53% of men. Couples believed that a child should not be told of the donor insemination (74% of wives and 80% of husbands). Initially, 64% of wives and 70% of husbands chose total secrecy with families or friends, and these attitudes shifted little over time. CONCLUSION: This screening procedure is cost-effective and suggests that psychological intervention should be attempted with at-risk couples.     

Sperm-freezing and donor insemination.

A comparison between freezing of human sperm using glycerol or glycerol egg-yolk citrate is presented. Freezing was performed with a gradual lowering of the temperature using alchol-liquid nitrogen or by immersion into liquid nitrogen. Great variations were observed within the same donor sperm sample when the sperm was frozen according to different techniques and marked post-thaw, motility variations were also found between spermatozoa from different donors. No statistically significant differences were found in the number of pregnancies obtained following inseminations with sperm frozen according to the two methods.     

影响人工授精妊娠率的多因素分析

目的:探讨影响夫精人工授精妊娠率的相关因素。方法:选取2013年3月至2014年9月在南通大学附属医院生殖医学中心行宫腔内人工授精(IUI)治疗的夫妇146对,共277个周期。分析女性年龄、不孕年限、IUI治疗周期数、促排卵方案,扳机方法及扳机日相关指标等与临床妊娠率的关系。结果:年龄25岁组的妊娠率明显高于年龄30岁组(25.8%vs 11.2%,P0.05);妊娠组的扳机日促黄体生成素(LH)水平高于非孕组[(29.7±8.44)vs(16.6±1.52),P0.05]。子宫内膜分型为A型者的妊娠率显著高于非A型者(P0.05)。GnRH-a扳机后排卵率优于HCG(P0.05);4个治疗周期内随着周期数的增加累计妊娠率上升,卵泡期为10~16天妊娠率最高。结论:夫精人工授精治疗中,患者年龄、HCG日LH值、子宫内膜分型与妊娠率相关,GnRH-a扳机后排卵率优于HCG。     

Artificial insemination with donor frozen sperm

The cryopreservation of human sperm decreases its fecondity, by reduction in the number of motile sperm. However the fertilizing ability of the spermatozoa is not faded. The use of frozen sperm requires an optimization of the methods of artificial insemination to hope to approach the results obtained with fresh sperm. Intrauterine insemination with sperm selection meets this aim.     

Intrauterine insemination of cryopreserved donor semen

The use of cryopreserved specimens is becoming the standard of care for donor insemination. Commercial specimens often have low numbers of actively motile sperm. Intrauterine insemination may be of value in the wives of men with oligoasthenospermia. Accordingly, an intrauterine insemination protocol using one or two vials of commercial semen with a minimum of 24 million motile sperm per vial was used to determine if acceptable monthly conception rates could be obtained. During the study period, there were 82 insemination cycles, resulting in 20 pregnancies in 35 women. The monthly conception rate was 24% and monthly ongoing pregnancy rate was 18%. If confirmed by other investigators, intrauterine insemination may be a way to improve the pregnancy rate with cryopreserved semen.     

Artificial insemination with fresh donor semen

One hundred and thirty-four patients received artificial insemination with fresh donor semen (AID). Using the life-table method of analysis, 72 pregnancies occurred, yielding a crude conception rate of 53.7%. The 134 women received an average of three inseminations per cycle for a total of 1,282 inseminations near the day of ovulation. The majority of pregnancies occurred by the seventh cycle. Forty-two pregnancies were achieved using a single donor; 30 pregnancies required changing the donor once, twice, or more. Among 42 patients who subsequently were treated with clomiphene citrate, 16 conceived. Two of these patients became pregnant after receiving hMG and hCG additionally. The life-table analysis of cumulative pregnancy rates following infertility therapy provides a relatively simple, powerful, and reliable tool for evaluating the effectiveness of therapy and its benefits. Patients should be advised that their chances of conception with AID approach that of normal fertile couples, provided that these patients persist in their treatment.     

The value of hysterosalpingography prior to donor artificial insemination.

The value of hysterosalpingography as a tool in the pretreatment evaluation of candidates for donor artificial insemination has been retrospectively evaluated. In 89 consecutive artificial inseminations by donor candidates, hysterosalpingograms were evaluated for genital tract abnormalities. In only four of these studies was there a failure of dye to spill into the peritoneal cavity. The low incidence of significantly abnormal hysterosalpingographic studies, and the failure of these studies to correlate with pregnancy outcome, strongly argues against the use of hysterosalpingography in the preliminary evaluation of the patient considered for donor artificial insemination.