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.     

Gamete intra-fallopian transfer (GIFT): a new technique for the treatment of unexplained infertility

The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertility, in 2 cases with infertility associated with mild endometriosis, in 1 case of hostile mucus and 3 cases in which phymosis of the ampulla and/or periadnexal adhesions were previously identified. In 7 couples GIFT was carried out after several AID cycles for husband azoospermia or severe oligospermia. Three different protocols were used for the controlled ovarian hyperstimulation. In all cases an adequate follicular growth was obtained and mature oocytes were recovered. At first attempt 12 ongoing pregnancies (1 triplet, 1 twin) were obtained with a present pregnancy rate of 48%.     

Gamete intrafallopian transfer in the treatment of infertility: the first series at the University of Palermo

Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artificial insemination with donor semen (AID), three women with mild endometriosis, three with periadnexal adhesions, one with hostile (not immunologic) cervical mucus, and one couple in which the male partner was affected by asthenospermia were treated by the gamete intrafallopian transfer (GIFT) technique. Three different protocols for controlled ovarian hyperstimulation were used, and an adequate follicular growth and oocyte maturation were achieved in all cases. Seventeen pregnancies were obtained, for a global pregnancy rate of 38.6%. Two pregnancies (11.7%) ended in clinical abortions, and one (5.8%) was a tubal pregnancy. Of the ongoing pregnancies, one is twin and two are triplets. Seven pregnancies (six ongoing, one abortion) were obtained in the UI group (26%), six (all ongoing) in the failed AID group (66.6%), two continuing pregnancies in the three patients with endometriosis (66.6%); the tubal pregnancy and one clinical abortion occurred in the group with adnexal adhesions. No pregnancies were obtained in the patient with hostile cervical mucus and in the couple with infertility presumably due to poor semen. These encouraging results and the simplicity of the technique suggest that GIFT could be an effective approach that could be programmed during a well-timed laparoscopy where persistent infertility exists in association with apparently normal fallopian tubes.     

Pregnancy outcomes using donor sperm insemination after failed in vitro fertilization with intracytoplasmic sperm injection cycles in couples with complex infertility disorders

OBJECTIVE: To evaluate alternatives for couples with severe male factor infertility who fail to conceive with IVF-intracytoplasmic sperm injection (ICSI). DESIGN: Outcomes of couples using artificial insemination with donor sperm (AID) after failed IVF-ICSI, assessing multiple risk factors affecting prognosis. SETTING: University infertility service. PATIENT(S): Nineteen patients with complex infertility disorders who failed IVF-ICSI and subsequently used AID (1 to 7 cycles). INTERVENTION(S): Artificial insemination with donor sperm was performed 36 hours after detection of an LH surge or hCG injection. MAIN OUTCOME MEASURE(S): Pregnancy outcomes were determined. RESULT(S): Seventeen pregnancies occurred in 16 women associated with AID for a pregnancy rate per cycle of 27.9% within a mean of 3.2 +/- 18 cycles. Live birth rate per cycle was 24.6%. CONCLUSION(S): A high pregnancy rate was achieved with AID in women who failed IVF-ICSI. Given the low cost and effectiveness of AID in this series, consideration of AID is a reasonable and effective option even in couples with poor prognosis who fail to conceive with IVF-ICSI.     

Repeat ectopic pregnancy. A twenty-year hospital survey

Seventy-two patients with repeat ectopic pregnancy including 3 women with three ectopic pregnancies each during the period 1965 to 1984 were studied. In the same period there was a total of 842 ectopic pregnancies, giving a repeat ectopic pregnancy incidence of 9.4%. In the last decade the incidence of repeat ectopic pregnancy was 10.4%, and in the first decade it was 7.0% (p less than 0.025). None of the women used an intra-uterine contraceptive device, among those with repeat ectopic pregnancy in the first decade, vis-à-vis 17 (30.4%) in the last decade. A history of infertility was common among the patients with repeat ectopic pregnancy. Between the two events there was a total of 17 deliveries in 13 patients. Four out of 24 potentially fertile women completed full-term pregnancies following their second ectopic pregnancy.     

The better prognosis in secondary infertility is associated with a higher proportion of ovulation disorders

To determine the reason for the higher pregnancy rate in couples with secondary infertility, the authors compared 237 infertile couples who had a previous pregnancy in the current partnership (secondary infertility) with 135 infertile couples in whom the woman had been pregnant only in a previous partnership and 925 couples with primary infertility. Couples with secondary infertility had the highest proportion of ovulation disorders (36%); these couples with secondary infertility and an ovulation disorder had the shortest duration of infertility (26 months). Cumulative pregnancy rates at 36 months were 56% in secondary fertility, 44% in primary infertility, and 42% in pregnancy in a previous partnership (P = 0.001). In this study, the better prognosis in secondary infertility may be related to the higher proportion of couples with ovulation disorders, who had a shorter duration of infertility. Abortion rates in the earlier pregnancies with current or previous partners were 37% and 30%, respectively; after the period of infertility, the abortion rates were 14% and 12%, respectively.     

Early pregnancy wastage after gamete manipulation

Summary. The outcome of 1034 pregnancies in women who conceived after referral for infertility management in seven treatment groups is detailed. The mean early pregnancy wastage (before 20 weeks gestation) was 27% and ranged from 18% after AID (artificial insemination by donor semen) to 33% after IVF-ET (in-vitro fertilization and embryo transfer). These differences were not due to maternal age which was similar in all groups (means between 29.7 and 32.7 years). Excluding the AID group, there was a high rate of ectopic pregnancy which was significantly higher after GIFT (gamete intrafallopian transfer) and was only partly related to underlying tubal disease. Blighted ova was the main category of early pregnancy loss and was highest after AIH (artificial insemination by husband's semen). There was a higher rate of biochemical pregnancies after GIFT, PROST (pronuclear stage tubal transfer) and IVF-ET. Our findings confirm a high pregnancy wastage rate in subfertile women and highlight deficiencies in the sperm separation, gamete handling and IVF/embryo culture techniques.     

Early pregnancy wastage after gamete manipulation

The outcome of 1034 pregnancies in women who conceived after referral for infertility management in seven treatment groups is detailed. The mean early pregnancy wastage (before 20 weeks gestation) was 27% and ranged from 18% after AID (artificial insemination by donor semen) to 33% after IVF-ET (in-vitro fertilization and embryo transfer). These differences were not due to maternal age which was similar in all groups (means between 29.7 and 32.7 years). Excluding the AID group, there was a high rate of ectopic pregnancy which was significantly higher after GIFT (gamete intrafallopian transfer) and was only partly related to underlying tubal disease. Blighted ova was the main category of early pregnancy loss and was highest after AIH (artificial insemination by husband's semen). There was a higher rate of biochemical pregnancies after GIFT, PROST (pronuclear stage tubal transfer) and IVF-ET. Our findings confirm a high pregnancy wastage rate in subfertile women and highlight deficiencies in the sperm separation, gamete handling and IVF/embryo culture techniques.     

Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicenter study

Among 2,106 couples registered in 12 Canadian infertility clinics, 470 (22.3%) were classed as unexplained infertility after a uniform evaluation of the male ejaculate, ovulation, and tubal patency. The unexplained group included more older female partners; 44% were over 30 years of age at registration in the participating clinics, compared with 36% in other infertility diagnostic groups. The mean duration of infertility was 40.1 months, and the cumulative pregnancy rate was 36.6 +/- 2.9% at 2 years after registration. When the variables were examined with the use of proportional hazards analysis, each additional month of duration of infertility reduced the expected prognosis by 2%, and a history of pregnancy in the partnership improved the prognosis by 80%. Among couples with 3 years or more duration of infertility (cumulative pregnancy rate, 27.5 +/- 3.9%), an additional year in the age of the female partner when conception was first attempted (mean, 26.8 years) reduces the prognosis by 9%.     

The expectancy of pregnancy for "normal" infertile couples

The prognosis of unexplained infertility was studied for 47 couples. The cumulative rate of pregnancy was 65%, with 81% achieving a full-term pregnancy. The type and duration of infertility, the age of the woman, and the previous use of contraceptives did not significantly modify the results. This study indicates that a complete investigative protocol should include laparoscopy. It also suggests caution in the application of untried empirical treatments to normal infertile couples.     

宫腔镜电切术治疗完全中隔子宫双宫颈阴道纵隔64例生殖预后分析

目的 探讨宫腔镜下子宫中隔电切除术对完全中隔子宫、双宫颈、阴道纵隔患者的治疗效果。方法 2004年9月至2013年8月浙江大学医学院附属妇产科医院完全中隔子宫、双宫颈、阴道纵隔住院患者64例,均行宫腔镜下子宫中隔电切除术及阴道纵隔切除术,分为反复流产组（26例）和不孕组（38例）,电话或门诊随访妊娠结局。结果 反复流产组25例妊娠,累计妊娠31次,自然流产率由术前83.1%（54/65）下降为41.9%（13/31）,足月产率、早产率和活产率分别为35.5%（11/31）、19.3 %（6/31）和54.8%（17/31）,与术前比较差异均有统计学意义（P<0.05）;不孕组18例妊娠,妊娠率47.4%（18/38）,其中12例足月分娩。研究对象中早产及足月产共32例,早产率28.1%（9/32）,足月产率71.9%（23/32）。研究对象胎盘粘连、植入发生率21.9%（7/32）,产后出血发生率25.0%（8/32）。结论 宫腔镜下子宫中隔电切除术可提高完全中隔子宫、双宫颈、阴道纵隔患者的妊娠率及生殖预后。     

Ectopic pregnancy and infertility following treatment of infertile couples: a follow-up of 929 cases.

A follow-up analysis was made of 929 infertile couples, with special attention paid to ectopic pregnancy. The conception rate was 46%, and 9% of the pregnancies were ectopic. Previous ectopic pregnancy, an industrial occupation and smoking reduced the fecundity and increased the risk of ectopic pregnancy. Tubal damage as a verified reason for infertility and its treatment also increased the risk of ectopic pregnancy. Stepwise logistic regression analysis showed the strongest association with ectopic pregnancy to exist in the case of women with a previous ectopic pregnancy (9.9-fold risk) rather than women with primary infertility. Treatment of tubal damage by salpingostomy entailed a 6.0-fold risk and treatment by other methods a 2.8-fold risk. Women working in industry had a 3.5-fold risk of ectopic pregnancy compared with those in other professions.     

Risk factors for pregnancy loss apparent at conception in infertile couples

Charts of 206 consecutive pregnancies occurring in couples seen because of infertility were analyzed in an attempt to identify factors, apparent at the time of conception, which may impose risks on pregnancy outcome. These factors were compared in 34 spontaneous abortions and 172 full-term pregnancies. Although the mean age was similar in both groups, women 35 years or older had a significantly higher incidence of spontaneous abortion than younger women. Menstrual history, gravidity, and parity and incidence of previous induced abortions were not different in the spontaneous abortion and term groups. Data collected from basal body temperature charts suggested a slightly higher risk for spontaneous abortion in women with previous anovulatory cycles. The mean follicular phase in the conception cycle was 16 days in both groups. However, a twofold increase in abortion rate was noticed in conceptions with follicular phases shorter than 12 days or longer than 16 days, in comparison with those with follicular phases of 13-15 days' duration. The mean daily temperature increment in the early luteal phase was the same in both groups. No relation between sperm count or motility and spontaneous abortion was observed. Different treatment modalities during the conception cycle had no effect on abortion rate, except for a trend toward lower spontaneous abortion incidence in women who received only prednisone.     

Artificial insemination: a comparison of pregnancy rates with intrauterine versus cervical insemination and washed sperm versus serum swim-up sperm preparations

A four-cycle artificial insemination protocol was undertaken, with luteinizing hormone (LH) timing, to compare washed sperm and serum swim-up sperm preparations and cervical and intrauterine insemination. Of the 75 patients entered into the protocol series, 63 finished all 4 cycles. During the treatment period, 24 patients became pregnant, 20 of whom were donor (AID) pregnancies (out of 52 patients) and 4 were husband (AIH) pregnancies (out of 11 patients). Seventy-five percent of the pregnancies were intrauterine, whereas only 25% were from cervical inseminations. Sixty-two percent of the pregnancies were due to serum swim-up sperm preparations, and 38% were due to washed sperm preparations. The data indicate substantially higher pregnancy rates can be obtained with intrauterine insemination and suggest that additional studies are necessary to determine if the method of sperm preparation significantly influences pregnancy rates.     

Is conception in infertile couples treatment-related? A survey of 309 pregnancies.

309 couples with infertility of 1 to 11 years duration in whom pregnancies occurred during examination or treatment were evaluated. The couples were classified into diagnostic groups according to the main cause of their infertility; anovulatory, mechanical, male, cervical, unexplained, combined. Pregnancies were divided into treatment-related and nontreatment-related. Analysis of results revealed that whereas in infertile patients with a defined cause of infertility, the treatment-related pregnancy rate was 73.1%, in the unexplained infertility group the incidence of treatment-related pregnancies was only 6.6%. We concluded that a meticulous fertility survey should be carried out in each infertile couple in order to detect a specific cause impeding fertility, but if such a cause cannot be found, reassuring of patients and decreasing their anxiety is more effective in inducing pregnancy than nonspecific therapy.     

Laparoscopic findings in twenty-five failures of artificial insemination

The laparoscopic findings, treatment, and follow-up of 25 patients who failed artificial insemination donor (AID) were retrospectively evaluated. A high incidence (72%) of abnormal pelvic findings was encountered. Endometriosis was found in 60% and pelvic adhesions in 12% of the patients. The incidence of these two entities was not significantly different from their incidence in patients with unexplained infertility in the same institution (44% for endometriosis and 36% for adhesions). After surgical or medical treatment, a pregnancy rate of 22.2% (16.6% for endometriosis and 66.6% for pelvic adhesions) was achieved in patients with positive pelvic findings; in the group with negative pelvic findings, a pregnancy rate of 20% was achieved. The value of diagnostic laparoscopy in AID failures is discussed in the light of the findings presented and the relatively low rate of post-treatment pregnancy.     

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 impact of spermatic vein ligation on the male factor in in vitro fertilization-embryo transfer and its relation to testosterone levels before and after operation

Criteria for improved semen quality after varicocele operations are not clear, as they do not express sperm fertilization capacity, its most important qualification. Twenty-two couples, 12 with mechanical female infertility (group I) and 10 with normal female fertility (group II), in whom the husband had subfertile semen in the presence of varicocele, and who had failed preoperative in vitro fertilization-embryo transfer (IVF-ET) attempts, were readmitted for the IVF-ET procedure following the repair of varicocele. In group I, a 20% pregnancy rate was achieved after the operation, while no pregnancies occurred before surgery. In group II, four pregnancies (40%) were achieved after operation. Plasma testosterone (T) levels demonstrated a significant increase in 50% of the patients in both groups after surgery, resulting in a concurrent improved fertilization, cleavage, and pregnancy rates.     

Changes in American A.I.D. practice during the past decade

We conducted a survey of donor artificial insemination (AID) practices within the United States. The survey document was sent to 360 practitioners listed by national infertility organizations as performing AID. In addition, we queried 100 practices that had responded to a similar survey in 1978. AID was actually performed during the survey year by 167 of the 282 respondents. Relatively few practices (23%) inseminated more than 10 patients per month. Donor payments increased from a mean of $25 to $40 over that period. A significant increase in the use of frozen semen was found. A majority of practices (52%) used a combination of basal body temperature and urinary LH to time inseminations. The fraction of practitioners who inseminated unmarried women increased substantially since the previous survey. The maximum number of pregnancies resulting from a single donor has not changed over the decade. However, on the average, a single donor is fathering fewer children. The percentage (39%) of practices that inseminate women because of genetic disease in the husband's family has remained about the same. Records of donors and AID children were maintained by 40% of the respondents, representing no change from the previous survey. Our data suggest that as many as 23,400 infants may have resulted from AID conceptions during the survey year. Further changes in the practice of AID can be expected as a result of the 1988 federal recommendations that all donor inseminations be undertaken with cryopreserved, quarantined semen.     

输卵管远端梗阻宫腹腔镜术后妊娠率影响因素分析及列线图模型的建立

目的探讨输卵管远端梗阻患者行宫腹腔镜术后影响其自然妊娠率的危险因素,并建立列线图模型,为患者提供个体化的妊娠指导。方法经排除及纳入标准后,回顾性研究2014年1月至2018年12月因输卵管性不孕在宁波市妇女儿童医院治疗患者554例,共有518例患者完成随访,统计患者术后自然妊娠率,对其术后妊娠率的影响因素进行单因素、多因素Cox回归分析并建立列线图模型。结果518例患者术后自然妊娠率为37.84%(196/518),异位妊娠率为6.18%(32/518)。术后12个月内妊娠人数占总妊娠人数的94.90%(186/196)。Cox多因素回归分析示患者年龄、不孕年限、输卵管通畅程度、输卵管病变程度是影响患者术后自然妊娠率的独立危险因素,利用R软件建立列线图模型。结论根据患者年龄、不孕年限、输卵管通畅程度、输卵管病变程度4个独立危险因素构建的列线图模型可以较为准确地判断患者术后自然妊娠概率,有助于临床更好地指导患者妊娠。