Prospective randomized comparison of intrauterine and intracervical insemination with donor spermatozoa

From March 1990 to September 1993, 20 women underwent a totalof 89 cycles of intracervical inseminations with donor semen(ICI) and 23 women underwent 67 cycles of intrauterine inseminationswith donor semen (IUI). The women were assigned to the two groupsrandomly, but ensuring that the ages of the women and pathologiesof the male partner (azoospermia or severe oligozoospermia)were similar in the two groups. There was no significant differencebetween the characteristics of the two groups and the methodused to induce ovulation (HMG/HCG) was identical. Two semenstraws were used for each insemination cycle. Semen was preparedfor IUI on a Percoll gradient. Thirteen clinical pregnancieswere obtained in the IUI group (19.4% of the attempts) and sixin the ICI group (6.75%). After six cycles of insemination,75.4% of the women of the IUI group obtained a pregnancy, ascompared to 35% in the ICI group. These good results may bedue to the method of induction of ovulation, but also to thetechnique itself, increasing the number of motile spermatozoaat the site of fertilization. The time taken to obtain a pregnancyis thus shorter with IUI than with ICI, and the number of semenstraws required is smaller. In-vitro fertilization (IVF) shouldbe proposed after six failures by IUI.