Pregnancy rates with fresh versus computer-controlled cryopreserved semen for artificial insemination by donor in a private practice setting

From late 1970 through December 1987, 580 women began 733 treatment programs (a total of 3405 insemination cycles) with fresh semen for artificial insemination by donor. The unadjusted pregnancy rate was 48.5% and the cumulative pregnancy rate after seven cycles by life-table analysis was 59.6% with a monthly fecundability of 11.9%. From 1988 to the present, 113 women have begun 115 treatment programs (a total of 371 insemination cycles) with cryopreserved semen for artificial insemination by donor. The unadjusted pregnancy rate to date is 18.3% and the cumulative pregnancy rate after seven cycles by life-table analysis is 48.6% with a monthly fecundability of 5.9%. This report shows that using cryopreserved semen for artificial insemination by donor will take somewhat longer to produce a pregnancy but the ultimate pregnancy rate will be similar to that with fresh semen for artificial insemination by donor.     

Computer-Assisted Sperm Analysis (CASA) parameters and their evolution during preparation as predictors of pregnancy in intrauterine insemination with frozen-thawed donor semen cycles

Objective

To study the potential of CASA parameters in frozen-thawed donor semen before and after preparation on silica gradient as predictors of pregnancy in IUI with donor semen cycles.

Study design

CASA parameters were measured in thawed donor semen before and after preparation on a silica gradient in 132 couples undergoing 168 IUI cycles with donor semen. The evolution of these parameters throughout this process was calculated. The relationship with cycle outcome was then studied.

Results

Clinical pregnancy rate was 18.4% per cycle. CASA parameters on donor semen before or after preparation were not significantly different between pregnancy and failure groups. However, amplitude of lateral head displacement (ALH) of spermatozoa improved in all cycles where pregnancy occurred, thus predicting pregnancy with a sensitivity of 100% and a specificity of 20%.

Conclusions

Even if CASA parameters do not seem to predict pregnancy in IUI with donor semen cycles, their evolution during the preparation process should be evaluated, especially for ALH. However, the link between ALH improvement during preparation process and pregnancy remains to be explored.     

Factors affecting pregnancy rates in a donor insemination program using frozen semen

The results of therapy of 226 women receiving frozen and fresh donor semen are reported. Overall, 45.6% of patients conceived with a monthly fecundability of 0.102. The effect of a variety of factors on fertility rates was analyzed in life-table analysis of 1000 cycles. Optimal pregnancy rates were obtained in couples with azoospermia (0.17) or no female infertility factors (0.2). Patients with ovulatory dysfunction treated with clomiphene also had optimal pregnancy rates (0.17 per cycle). Endometriosis reduced fecundability significantly (0.04 per cycle). There was no significant difference in pregnancy rates per cycle between fresh (0.12) and frozen (0.09) semen. Acceptable pregnancy rates were obtained with frozen semen therapy and in patients with treated ovulatory dysfunction.     

The efficiency of cryopreserved semen versus fresh semen for in vitro fertilization/embryo transfer

The efficiency of cryopreserved donor semen versus fresh donor semen in an in vitro fertilization/embryo transfer programme was evaluated. Thirty-nine in vitro fertilization/embryo transfer cycles were performed using fresh donor semen (group A) and 74 cycles were carried out using cryopreserved semen (group B). All patients anderwent a uniform controlled ovarian hyperstimulation using high doses of human menopausal gonadotropins. Oocytes were retrieved transvaginally under ultrasound imaging. Semen (fresh or frozen-thawed) were prepared for insemination by a washing technique. Each ovum was inseminated with 500,000–600,000 motile spermatozoa. No significant difference was noted between the two groups regarding female age, duration of infertility, and number of ova retrieved per aspiration. Even though the fertilization rate in group B was significantly lower than in group A (55.5±3.8 vs 70.4±3.5,P=0,008); pregnancy rates per embryo transfer were similar-39.3 and 38.5%, respecitively.     

Artificial donor insemination: fresh versus frozen semen; the patient as her own control

The efficacies of fresh versus cryopreserved semen in the treatment of male factor infertility by artificial insemination by donor (AID) semen were directly compared by using the patient as her own control. In any one cycle, either fresh or frozen semen was used. The type of semen preparation was randomly assigned for the first cycle and varied thereafter according to donor availability. The same donor was used for a given patient in six consecutive cycles. We treated 381 patients in this way. In 676 cycles fresh semen was used and 128 pregnancies were achieved. Fecundability, the chance of getting pregnant per cycle of exposure, was 18.9% with fresh semen. In 1200 cycles cryopreserved semen was used and 60 pregnancies occurred, for a fecundability of 5.0%. Therefore, in our clinic, fresh semen is more than three times as likely to induce pregnancy as frozen semen. The design that has been used in this therapeutic protocol provides a technique for internal quality control of the cryopreservation process and for the investigation of other variables potentially affecting the success rates with AID.     

Effect of diagnosis,age, sperm quality,and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination

OBJECTIVE: To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed. DESIGN: Fifteen-year prospective observational study. SETTING: Private infertility clinic. PATIENT(S): Three thousand, three hundred eighty-one cycles of husband or donor IUI. INTERVENTION(S): Ovulation induction with CC and IUI. MAIN OUTCOME MEASURE(S): Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR). RESULT(S): Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses. CONCLUSION(S): Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.     

Fertility rates in men with normal semen characteristics: spermatozoal testing by induction of the acrosome reaction and Wright-Giemsa staining for subtle abnormal forms

Little is known about the fertility potential of semen from men who fulfill the accepted criteria of normal semen quality. We examined retrospectively the fertility rates of semen donors with normal semen quality. Donor performance was evaluated in women who had no known infertility factors or had only ovulatory dysfunction corrected by clomiphene. Cycles of therapeutic donor insemination were monitored for ovulation, and pregnancy outcome was followed up. Pregnancy resulted from therapeutic donor insemination with 21 donors and did not result in pregnancy with five (the range of the percentage of cycles in which pregnancy occurred was zero to 31). The comparison of donor semen analysis characteristics with pregnancy rates indicated that the total number of motile spermatozoa per ejaculate correlated with pregnancy rate (P = .04). Cox proportional hazard regression analysis showed that when the value for percentage of abnormal forms was combined with the total number of motile spermatozoa, a significant negative association was found between abnormal forms and conception (P = .04). Experiments comparing semen from high-fertility donors (top quartile of pregnancy rate) and low-fertility donors (lowest quartile) demonstrated a greater proportion of spermatozoa with inducible acrosome reactions in the high-fertility group (P less than .05). A Wright-Giemsa stain used to detect subtle abnormal forms in spermatozoa did not discriminate between the groups. These data suggest that differences in fertility potential exist among donors, even though all may exceed the accepted criteria for normal semen quality. Differences in the ability of spermatozoa to capacitate or undergo the acrosome reaction may be a mechanism for diminished fertility in donors with normal semen characteristics.     

The relationship of tubal blockage, infertility of unknown cause, suspected male infertility, and endometriosis to success of in vitro fertilization and embryo transfer

The success of in vitro fertilization (IVF) and embryo transfer has been examined with regard to five categories of infertility over a 2-year period. Fertilization rates in vitro were highest in women with bilateral tubal blockage and women treated for endometriosis. There was a significant reduction of approximately 13% in the fertilization rate of couples with idiopathic infertility and women who had failed to conceive after 12 cycles of artificial insemination by donor. A further substantial reduction in the fertilization rate occurred when the husband had low quality semen, particularly when no abnormality was detected in the wife. Repeated IVF in couples with idiopathic infertility eventually resulted in fertilization. It is recommended that donor spermatozoa not be used for cases of idiopathic infertility, but it may be needed in cases of poor semen quality. There were no differences in the pregnancy rates following embryo replacement in any of the groups studied, nor was there any detectable effect of age on fertilization or pregnancy rates up to the age of 44 years.     

In vitro fertilization using cryopreserved donor semen in cases where both partners are infertile

The incidence of pregnancy after in vitro fertilization (IVF) was studied in a group of 38 couples (55 cycles) where both partners were infertile. Cryopreserved donor semen (IVF-D) was used in all cycles. Results were compared with those in a control group of couples where the husband's semen was considered normal and only the wife was infertile. No significant differences were found between the IVF-D and control groups in the incidence of fertilization (80% versus 72%), pregnancy per cycle (33% versus 29%), and abortion (18% versus 20%), despite the considerably lower percentage of motile spermatozoa in the IVF-D group. Forty percent of patients, each treated unsuccessfully with at least 12 artificial inseminations with donor semen, became pregnant after one or two IVF-D cycles. It is concluded that IVF with frozen donor semen is a beneficial treatment for couples where both partners are infertile.     

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.     

A continuous-step density percoll gradient for use in AIH and life table analysis of pregnancy rates

For use in artificial insemination with husband's semen (AIH), a continuous-step Percoll density gradient technique was used to wash and concentrate sperm from ejaculate. To evaluate usefulness, the pregnancy rates were analyzed by the life table method. 1. After washing by the continuous-step Percoll density gradient method, sperm density increased from 28.8 X 10(6)/ml (original semen) to 40.9 X 10(6)/ml and sperm motility improved from 52.4% (original semen) to 77.0% respectively. 2. A group of 119 infertile patients whose diagnosis involved oligoasthenozoospermia, cervical factor and unexplained infertility were selected for AIH. After 640 insemination cycles, 37 women conceived with a pregnancy rate of 31.1%. By using life table analysis, the cumulative conception probability rate reached 0.652 after 13 insemination cycles. 3. Cumulative pregnancy rates by diagnostic category were 0.494 in male factor and 0.745 in cervical factor after 12 cycles, respectively. 4. The poorest results were obtained in unexplained infertility with a cumulative pregnancy rate of only 0.355 after 12 cycles. 5. In the follow up study, 24 viable babies were born and seven (18.9%) resulted in spontaneous abortion in the first trimester. These results indicate that the continuous-step Percoll density gradient technique is useful for improving the pregnancy rate in AIH.     

Intrauterine insemination with controlled ovarian stimulation for treatment of infertility: an audit of a new IUI programme in a low resource setting.

This study is an audit of a new intrauterine insemination (IUI) programme in a low resource private fertility practice in southeast Nigeria. IUI was performed using a Wallace flexible catheter 1 day before or on the day of ovulation after ovarian stimulation with clomiphene citrate. The 18 couples treated had either male (16) or unexplained (2) infertility. The women were between 25 and 49 years and 13 (72.2%) of the couples had primary infertility while the duration of infertility ranged from 3 to 15 years. All the women had tubal patency confirmed by laparoscopy and dye test before undergoing IUI. The pregnancy rates per couple and per insemination cycle and the effect of maternal age and source of semen (partner or donor) were determined. The 18 couples had a total of 48 treatment cycles and five became pregnant (confirmed by early ultrasound scan) giving a pregnancy rate of 27.8% per couple or 10.4% per treatment cycle. The pregnancy rate was 41.7% per couple, 15.6% per treatment cycle for the donor group and 0% for the partner group (p<0.01). Poor sperm quality was responsible for the poor pregnancy outcome in the partner group. The pregnancy rate per couple was 36.5% in women<35 years compared with 14.3% in those>or=35 years (p=0.02). Similarly, the cycle pregnancy rate was significantly higher in women<35 years (16.0% vs 4.4%; p<0.02). There was one (20%) case of twin pregnancy and no miscarriage. Four of the women had a live birth (80%) at term and one had an intrauterine death following severe pre-eclampsia at 29 weeks' gestation. In conclusion, the overall couple and cycle pregnancy rates at our centre is comparable with the rates in many centres. Younger age and good quality semen are good indicators of a successful outcome. Infertile couples should therefore be evaluated early and recommended for this treatment option before advanced female age.     

Optimization of artificial inseminations with donor semen: a four-year experience

OBJECTIVE: Our aim was to analyse the results of a donor insemination program using ovarian stimulation, swim-up sperm preparation and intrauterine insemination proposed to women with a maximum age of 39. Incidence of several clinical and biological parameters on success rates was investigated. PATIENTS AND METHODS: Retrospective analysis of the results of 249 cycles performed in 106 couples during a four-year period is reported. RESULTS: Overall pregnancy rate of 28.1% and delivery rate of 22% per cycle were achieved, with a multiple pregnancy rate of 11.4%. Most of the pregnancies (84%) were obtained before the fourth insemination. Among the different parameters studied the total number of motile sperm inseminated was found to be the most important factor for success rate: pregnancy rate per cycle reached 40.4% if more than 1.5 million progressive sperm were inseminated vs. 24.7% if they were less than 1.5 million (P<0.05). DISCUSSION AND CONCLUSION: In precise conditions, outcome of inseminations with donor semen can reach satisfying pregnancy rates, being a valuable help for couples suffering of long-time infertility.     

宫颈管内与宫腔内供精人工授精妊娠结局的比较

目的比较分析宫颈管内和宫腔内供精人工授精(AID)妊娠结局的影响。方法对548个AID治疗周期进行回顾性分析,其中宫颈管内人工授精(ICI)200例360个周期,宫腔内人工授精(IUI)125例188个周期,对2种授精部位的AID妊娠结局进行比较。结果 ICI组的周期妊娠率为14.74%(51/346),其中自然周期妊娠率为18.54%(33/178),促排卵周期妊娠率为10.71%(18/168),流产率为11.76%(6/51);IUI组的周期妊娠率为28.49%(51/179),其中自然周期的妊娠率为32.04%(33/103),促排卵周期妊娠率为23.68%(18/76),流产率为5.88%(3/51);组间差异均有统计学意义(P0.05)。结论授精部位可能是影响AID成功妊娠的关键因素之一,采用IUI法可能会提高AID的妊娠率。     

Successful treatment of failed AID cases by use of gamete intra-fallopian transfer using donor semen (GIFT (D)).

Over a 13-month period in a newly opened assisted conception unit at the Women's Hospital, Liverpool, gamete intra-fallopian transfer using donor semen, GIFT (D) was offered to eighteen couples who had failed to conceive after numerous cycles of treatment with artificial insemination by donor semen (AID). The indication for the use of donor semen was either azo- or severe oligoaesthenospermia, and, in addition, the female partners have been exhaustively investigated with no major cause found to account for the couple's infertility. Using a basic clomiphene citrate and human menopausal gonadotrophin protocol it was possible to achieve a pregnancy rate of 56% per GIFT (D) cycle. As a consequence of these results it is now our policy to treat couples whose infertility is due to an unresolvable male factor with AID for 12 cycles only. If they have been unsuccessful in achieving a pregnancy after this time, they are offered GIFT (D).     

A comparison of intrauterine versus intracervical insemination in fertile single women

OBJECTIVE: To compare the efficacy of intrauterine insemination (IUI) and intracervical insemination (ICI) when used by fertile single women in a donor insemination program. DESIGN: Prospective randomized crossover study. SETTING: Donor insemination program (not an infertility clinic). PATIENT(S): Single fertile women choosing to inseminate with frozen donor semen. INTERVENTION(S): Clients received procreative counseling and screening and were then randomly assigned to begin office insemination with ICI or IUI. If additional insemination cycles were required, the clients used the method opposite their previous method of insemination until pregnancy was achieved. MAIN OUTCOME MEASURE(S): Monthly fecundity rate was compared between the two methods of insemination. RESULT(S): Sixty-two women contributed a total of 189 cycles, 94 by IUI and 95 by ICI. The monthly fecundity rate for IUI was 15%, as compared with 9% for ICI, (P=0.14). When the analysis was confined to cycles in which only one insemination was performed (64 IUI and 65 ICI cycles), the monthly fecundity rates were 14% for IUI and 5% for ICI (P=0.04). CONCLUSION(S): Intrauterine insemination with frozen donor sperm is more effective than intracervical insemination for single women without known fertility problems.     

A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm

Cryopreserved sperm have lowered fertility when compared with fresh sperm in artificial insemination by donor programs. The purpose of this study was to compare pregnancy rates following intrauterine insemination (IUI) and intracervical insemination (ICI) with cryopreserved sperm in a prospective trial using the patient as her own control. A total of 154 patients were randomized into alternating treatment cycles and underwent 238 cycles of IUI and 229 cycles of ICI. The pregnancy rate per treatment cycle was 9.7% following IUI and 3.9% following ICI. Treatment outcome was influenced by patient age, ovulatory status, and endometriosis. Pregnancy success correlated well with the post-thaw survival of sperm and the number of motile cells inseminated. In spite of having normal semen parameters, some donors were found to have markedly reduced sperm fecundity. We conclude that IUI with cryopreserved sperm can be an effective treatment for couples with infertility, genetic indications, or other reasons.     

Artificial insemination with cryopreserved donor semen: a decade of experience

Summary. Ten years'experience of artificial insemination with cryopreserved donor semen for 1023 courses in 783 women resulting in 572 pregnancies is reported. A simple approach with multiple inseminations timed on the basis of cycle length, temperature charts, mucus symptoms and signs was used. The life table pregnancy rate was 61% after 12 cycles of treatment and 75% after 24 cycles. Women had a significantly higher rate of pregnancy in second and subsequent courses of treatment, and the pregnancy rate for treatment beyond 12 cycles was significantly less successful. Women over 35 years of age were significantly less successful.     

Comparison of fecundability with fresh and frozen semen in therapeutic donor insemination

A series of 401 therapeutic donor insemination (TDI) cycles was analyzed for determining the effect on fecundability of fresh versus cryopreserved semen, the number of inseminations per cycle, recipient age, and the reproductive health of the TDI recipient. We followed a protocol in which inseminations were performed during the periovulatory period determined by urinary luteinizing hormone surge or ultrasound-timed human chorionic gonadotropin injection. The minimum standard for insemination with fresh or cryopreserved semen was a total of 40 X 10(6) grade 3 sperm. We found no decreased fecundability when using frozen semen, rather than freshly ejaculated specimens. The number of inseminations per cycle did not affect the pregnancy outcome after TDI. The reproductive health of the recipient had a significant effect on the pregnancy rate. Fecundability was 15.6% for healthy women, as compared with 6.7% for women with a diagnosis of moderate, severe, or extensive endometriosis, pelvic adhesions, tubal disease, or ovulatory dysfunction. To avoid transmission of human T-lymphotropic virus type III from sperm donor to TDI recipient, we have recently utilized an exclusively frozen TDI program. With well-timed inseminations of 40 X 10(6) grade 3 motile sperm, we have been able to attain pregnancy rates similar to those previously obtained with fresh samples.     

Artificial insemination with cryopreserved donor semen: a decade of experience

Ten years' experience of artificial insemination with cryopreserved donor semen for 1023 courses in 783 women resulting in 572 pregnancies is reported. A simple approach with multiple inseminations timed on the basis of cycle length, temperature charts, mucus symptoms and signs was used. The life table pregnancy rate was 61% after 12 cycles of treatment and 75% after 24 cycles. Women had a significantly higher rate of pregnancy in second and subsequent courses of treatment, and the pregnancy rate for treatment beyond 12 cycles was significantly less successful. Women over 35 years of age were significantly less successful.