Artificial insemination of husband's sperm

Deep Learning Based Evaluation of Spermatozoid Motility for Artificial Insemination

We propose a deep learning method based on the Region Based Convolutional Neural Networks (R-CNN) architecture for the evaluation of sperm head motility in human semen videos. The neural network performs the segmentation of sperm heads, while the proposed central coordinate tracking algorithm allows us to calculate the movement speed of sperm heads. We have achieved 91.77% (95% CI, 91.11-92.43%) accuracy of sperm head detection on the VISEM (A Multimodal Video Dataset of Human Spermatozoa) sperm sample video dataset. The mean absolute error (MAE) of sperm head vitality prediction was 2.92 (95% CI, 2.46-3.37), while the Pearson correlation between actual and predicted sperm head vitality was 0.969. The results of the experiments presented below will show the applicability of the proposed method to be used in automated artificial insemination workflow.

The role of sperm creatine kinase in the assessment of male fertility

The lack of reliable methods to assess sperm fertilizing potential has been a long-standing problem for infertile couples and for their physicians. The most widely used tests, the measurements of sperm concentrations, motility, velocity and morphology in the ejaculate, are of limited utility. Indeed, following intrauterine insemination, a treatment that compensates for low motile sperm concentrations, there were no significant differences found in semen parameters among those who did or did not achieve pregnancies. Other available assays probing for selected sperm functions, such as membrane integrity, acrosome enzyme activity, bovine cervical mucus penetration test, zona-free hamster oocyte penetration test and sperm binding to various carbohydrates,10–13 have all failed thus far to consistently predict male fertility. It became increasingly obvious that there was a need to identify cellular markers of sperm quality and fertilizing potential.

Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm

OBJECTIVE

To compare World Health Organization threshold values for normal sperm with the initial sperm quality necessary for successful IUI.

DESIGN

Retrospective study.

SETTING

Private fertility clinic.

PATIENT(S)

One thousand eight hundred forty-one couples undergoing 4,056 cycles of IUI.

INTERVENTION(S)

Intrauterine insemination.

MAIN OUTCOME MEASURE(S)

Relation of initial sperm quality to fecundity.

RESULT(S)

Progressive motility and total motile sperm count were the initial sperm characteristics most closely related to pregnancy on discriminant analysis. The per-cycle pregnancy rate averaged 11.1% during the first three IUI cycles. Pregnancy rates were > or = 8.2% per cycle when the initial sperm values were a concentration of > or = 5 X 10(6)/mL, a total count of > or = 10 X 10(6), progressive motility of > or = 30%, or a total motile sperm count of > or = 5 x 10(6). Minimal increases in fecundity occurred when initial values were greater than these threshold levels. The lowest initial values that resulted in pregnancy were a concentration of 2 x 10(6)/mL, a total count of 5 x 10(6). motility of 17%, and a total motile sperm count of 1.6 X 10(6). Pregnancy rates were <3.6% when initial values were between the threshold levels and the lowest levels.

CONCLUSION(S)

The sperm quality that is necessary for successful IUI is lower than World Health Organization threshold values for normal sperm. Intrauterine insemination is effective therapy for male factor infertility when initial sperm motility is > or = 30% and the total motile sperm count is > or = 5 X 10(6). When initial values are lower, IUI has little chance of success.

Relationship between creatine kinase levels and clinical diagnosis of infertility

PURPOSE

The creatine kinase level indicates sperm maturity and correlates with the spermatozoal fertilizing potential. The relationship between creatine kinase levels in subfertile men and their clinical diagnosis was examined.

METHODS

Patients with unexplained infertility (n = 34), varicocele (n = 20), postvasectomy reversal (n = 7), or cancer (n = 22) were included in this prospective clinical study. The control group consisted of healthy normal donors (n = 15).

RESULTS

The median and interquartile range values of creatine kinase for each group were as follows: normal donors, 0.061 U/10(8) sperm (0.056 to 0.076 U/10(8) sperm); idiopathic male factor, 0.119 U/10(8) sperm (0.061 to 0.190 U/10(8) sperm); varicocele, 0.392 U/10(8) sperm (0.209 to 1.494 U/10(8) sperm); postvasectomy reversal, 0.589 U/10(8) sperm (0.425 to 4.043 U/10(8) sperm); and cancer, 0.068 U/10(8) sperm (0.047 to 0.168 U/10(8) sperm). Sperm creatine kinase levels were significantly higher in patients with varicocele compared to normal donors (P = 0.0001), cancer patients (P = 0.0002), and men with idiopathic infertility (P = 0.0009). Sperm concentration and creatine kinase level were inversely correlated in patients (r = -0.7, P < 0.001) but not in normal donors.

CONCLUSIONS

Semen quality is poorer in subfertile patients with clinical varicocele and postvasectomy reversal than in cancer patients and patients with idiopathic male infertility. That the creatine kinase levels in cancer patients were similar to those of normal donors suggests that the final phase of spermatogenesis may not be altered in men with cancer; thus semen from these patients should be banked to ensure fertility after cancer treatment.

Spontaneous pregnancy in couples waiting for artificial insemination donor because of severe male infertility

OBJECTIVE

To assess the spontaneous fertility in couples with severe seminal conditions while waiting for artificial insemination donor.

STUDY DESIGN

Prospective follow-up during a period of 24 months.

SETTING

University Medical School.

PARTICIPANTS

There were 285 couples in which the male had a very severe seminal pathology: 166 azoospermia, 86 oligozoospermia and 33 severe asthenozoospermia.

OUTCOME MEASURES

Pregnancy rates after being included on waiting list.

RESULTS

The spontaneous pregnancy rate was 3.2% (9/285), per month spontaneous pregnancy rate being 0.13%. Spontaneous pregnancy rate was 0% in azoospermia (0/166). versus 7.6% (9/119) in non-azoospermia cases. Spontaneous pregnancy rate was 8.5% (4/47) in the group with less than 0.1 million motile sperm/cc, 6.5% (3/46) in the group between 0.1 and 1 million/cc and 7.7% (2/26) in the group with 1-2 million/cc.

CONCLUSION

In a 2-year follow-up, pregnancy rate among non-azoospermic couples before undergoing artificial insemination was 7.6%. Extramatrimonial pregnancy (based on anamnesis and sperm analysis) seemed to be uncommon. Even in cases with less than 0.1 million of motile sperm/cc there was not a negligible spontaneous pregnancy rate.

Failure of artificial insemination of husband's semen in the treatment of male infertility

In the management of infertility, in case semen quality is found insufficient and could not be improved by medical means, handling the available spermatozoa in the most beneficial way has been aimed. Thus, artificial insemination with low quality semen has become a therapeutic alternative. In this study homologous artificial insemination has been used to treat infertility caused by oligoasthenospermia. Eighteen couples have been treated for 58 cycles by intrauterine or paracervical insemination using cervical cups. During the same period 42 cycles with timed vaginal intercourse have been assessed. Though no pregnancies could be obtained following artificial insemination, one pregnancy occurred during no-treatment cycles.

Therapeutic intrauterine insemination improves with gonadotropin ovarian stimulation

Therapeutic intrauterine insemination (IUI) is frequently used as a first line of treatment of infertility. The reported results vary, depending on the indication and the use of ovulation simulation protocols. In the present study, we review the experience at the Jones Institute for Reproductive Medicine in Virginia from January 1989 to January 1991. The patients were preferentially treated with ovulation induction with gonadotropins. With the addition of gonadotropin stimulation, the total and term pregnancy rates per cycle were 14% and 11%, respectively, including all etiologic factors. These rates were improved over the 3% and 2.6% rates reported in our previous study in which ovarian stimulation was not generally used. In male factor patients, the term pregnancy rate was 9%, higher than the 4% term pregnancy rate reported in our previous study. In the present series, morphology was the only severely impaired parameter. The term pregnancy rate was 11% for patients with ovulatory dysfunction, 10% for those with cervical factor, and 10.5% for those with unexplained infertility.

Treatment of immunological infertility by sperm washing and intrauterine insemination

The purpose of this study is to review our experience with sperm washing and intrauterine insemination as a method to reduce the presence of sperm antibodies in serum of couples with immunological infertility. Our results support the premise that sperm washing and intrauterine insemination can diminish the level of sperm-bound immunoglobulins and can improve the chance of conception in a selected group of couples with a diagnosis of immunological infertility. Patients with > 50% attachment of IgG, IgA, or both antisperm antibodies in this study had a greater chance of achieving a pregnancy. The high level of antibody attachment seen in our study appears to represent true immunological infertility and therefore is more likely to respond to therapy that reduces antibody attachment and bypasses cervical mucus.

Effects of kallikrein on sperm motility, capillary tube test, and pregnancy rate in an AIH program

From 1984 to 1986, 172 couples were enrolled in an artificial insemination homologous (AIH) program, because of negative postcoital test, fair PT, positive PT with unexplained infertility, and impotentia coeundi. Patients were randomly assigned to the following procedures: AIH with native semen (N, n = 68), washed sperm (V, n = 50), semen mixed with kallikrein (K, 5 IE/ml semen, n = 45), and timed intercourse. The overall pregnancy rate (PR) was 22% per couple (13% inseminations, 9% spontaneous). PR from insemination (spontaneous) was 13% (8), 13% (13), 23% (0) in PT negative, fair, and positive patients, respectively, and 18% (9), 13% (7), and 11% (9) in AIH groups N, V, and K. Among in vitro studies with K added semen, an improvement of sperm motility was demonstrated in half of the specimens. In the capillary tube test (CTT), with wives' cervical mucus, a deterioration was more frequently seen than an improvement after 2 h, independent of the early effect of K in semen, K induced changes of CTT were less pronounced when donors' cervical mucus was used. The results of the in vitro studies offer an explanation for the low PR in the AIH program with K.

Therapeutic intrauterine insemination (TII)--controversial treatment for infertility

The literature on therapeutic intrauterine insemination (TII) is confused because of lack of homogeneity in case selection, differences in executing the procedural steps, and the manner of evaluating and reporting results. This review compares results from Norfolk with those in the English literature. Special emphasis has been placed on separately analyzing each step of the procedure and presenting results of different authors in a comparable fashion. Including all etiologic factors and types of cycles, the term pregnancy rate per cycle was 3% for Norfolk, 2.6% to 6.2% elsewhere. Patients receiving TII in stimulated cycles did significantly better than those receiving TII in natural cycles, in terms of total pregnancy rate per cycle (p = 0.002). In male factor infertility, term pregnancy rate per cycle was 1.1% in Norfolk, 4.7% to 6.2% elsewhere (perhaps because of stricter criteria in Norfolk). In cervical factor infertility, term pregnancy rate per cycle was 4.5% in Norfolk, 2.7% to 11% for others. For unexplained infertility, Norfolk had 5.8% term pregnancy rate per cycle for natural cycles, 8.3% for stimulated cycles. Best published prospective results were 23% for stimulated cycles. TII seems to have a very low efficiency rate judging from term pregnancy rates per cycle. There are clear data indicating the need for redefining the indications.

Pretreatment of sperm with human follicular fluid for borderline male infertility

To test the usefulness of human follicular fluid (FF) in treating male infertility, we incubated washed sperm specimens from 31 couples undergoing intrauterine insemination (IUI), for male and/or unexplained infertility, with either FF or Ham's F-10 medium (Gibco, Grand Island, NY), in alternating cycles in a randomized manner. Semen specimens from 28 men were incubated with either medium or FF. Incubations with FF have increased sperm penetration assay (SPA) scores from 24.8 +/- 17.3 to 34.3 +/- 13.6 (P less than 0.01). Incubation with heat-inactivized FF also has increased SPA scores, although to a lesser extent than noninactivized FF. Seventeen pregnancies occurred in the 31 couples treated by IUI (54.8%), 16 of them in FF-treated cycles (51.6%) and one in "control" IUI cycles (3.2%, P less than 0.01). All pregnancies occurred within four treatment cycles. Thus, IUI after sperm wash and preincubation with FF may be suggested for four to six cycles to couples with male factor and/or unexplained infertility who are reluctant to resort to artificial insemination by donor or adoption, before attempting the more costly and complex in vitro fertilization-embryo transfer procedure.

Artificial insemination with husband's sperm (AIH): techniques for sperm selection

Artificial insemination with husband's sperm (AIH) attempts to treat infertile couples by solving their particular infertility problems. This review is concerned with detailing and evaluating the experiences of different authors with AIH in infertile couples, types of insemination, and indications for insemination, with emphasis on techniques for sperm selection and separation: glass-wool filtration, separation on albumin columns, washed sperm, swim-up method, and spermatozoa selection in Percoll gradients.

Treatment of refractory infertility by transcervical intrauterine insemination of washed spermatozoa

One hundred thirteen couples with either male factor, cervical factor, endometriosis, or idiopathic infertility of at least 3 years' duration were treated by intrauterine insemination (IUI) of washed motile sperm. Of the 68 women who became pregnant or completed at least three cycles of insemination, the overall pregnancy rate was 38.2%, with a mean of 1.7 treatment cycles per pregnancy. The average pregnancy rate per treatment cycle was 11.4%. Women who did not become pregnant underwent an average of 4.7 treatment cycles. Importantly, only two pregnancies occurred independent of treatment in 113 couples. In the male factor group, the pregnancy rate was 42.9% (n = 21). In women with a cervical factor, 34.5% became pregnant (n = 29); in idiopathic infertile couples or women suffering from endometriosis, there was a pregnancy rate of 38.9% (n = 18). The presence of sperm antibodies in either the male or female partner significantly lowered the pregnancy rate (6.7%) when compared with couples without sperm antibodies (50.0%). The authors conclude from these observations that IUI with washed sperm is a successful mode of therapy, especially in the case of males with asthenozoospermia.

Homologous artificial insemination for oligoasthenospermia: a randomized controlled study comparing intracervical and intrauterine techniques

Homologous artificial insemination (AIH) is used to treat infertility caused by oligoasthenospermia, despite the lack of controlled studies confirming its benefit. This prospective randomized controlled trial was undertaken to determine whether intracervical (IC-AIH) or intrauterine (IU-AIH) homologous artificial insemination improves pregnancy rates in couples with infertility attributable to oligoasthenospermia alone. Twenty couples were randomized to receive IC-AIH or IU-AIH. Sixty-three insemination cycles were completed. During the same study period, 35 cycles with timed vaginal intercourse alone were assessed. Four pregnancies occurred, all following timed vaginal intercourse. No pregnancies resulted from IC-AIH or IU-AIH. This suggests that neither IC-AIH nor IU-AIH is of benefit when oligoasthenospermia is the cause of infertility. Pregnancies previously attributed to AIH may also have been conceived as a result of vaginal intercourse. This confounding effect on the results of AIH should always be considered.

The value of artificial insemination with husband's semen in infertility due to failure of postcoital sperm-mucus penetration--controlled trial of treatment

Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density less than 1 x 10(6)/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4.7 (SE 3.8)% and without treatment was 6.6 (SE 3.9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.

Continuous-step density gradient centrifugation for the selective concentration of progressively motile sperm for insemination with husband's semen

To increase the fertilizability of sperm for use in artificial insemination with husband's semen, it is effective to concentrate progressively motile sperm from whole ejaculated semen. The simple procedure, a continuous-step density gradient technique, was developed to selectively concentrate progressively motile sperm. The ejaculated semen was placed on 6.0 ml of 80% Percoll solution, and the density gradient was formed by mixing the semen and Percoll with an L-shaped rod for two or three strokes. After centrifugation at 400 x g for 30 min, progressively motile sperm were concentrated in the sediment, whereas the immotile sperm and other types of cells remained in the upper part of the density gradient. In most specimens sperm motility was improved by more than 80% regardless of the original motility. Thus, the fertility index (sperm concentration/ml x percentage of motility x 10(-8)). was increased to 7.7 +/- 3.7 times (n = 15).

Intracervical versus intrauterine insemination: correlation of outcome with antecedent postcoital testing

Thirty-four infertile women alternated cycles of intracervical insemination (ICI) with whole ejaculate homologous semen (mean, 3.2 cycles/patient) versus intrauterine insemination (IUI) with washed sperm (mean, 3.4 cycles/patient). Twenty of the 34 women had prior postcoital tests consistently demonstrating less than or equal to 3 motile sperm per high-powered field (HPF). Six of those 20 conceived during IUI cycles (30.0%); 0 conceived during ICI cycles (P = 0.06, Mantel-Haenszel chi-square test). The pregnancy rate per IUI cycle was 6/72 (8.3%), compared with 0/66 (0.0%) per ICI cycle, a statistically significant difference (P = 0.04, Fisher's exact chi-square test). Fourteen of 34 women had prior postcoital tests consistently demonstrating greater than or equal to 5 motile sperm per HPF. One of the 14 conceived during an IUI cycle (7.1%), and 2 conceived during ICI cycles (14.3%), a difference that was not significant. The pregnancy rate per IUI cycle was 1/42 (2.4%), compared with 2/42 (4.8%) per ICI cycle (not significant). IUI may be helpful in the management of infertility associated with relatively poor postcoital tests (less than or equal to 3 motile sperm per HPF) but not with relatively good postcoital tests (greater than or equal to 5 motile sperm per HPF).

Intrauterine insemination with husband's washed sperm

Methods used for artificial insemination with the husband's semen (AIH) have undergone continuous revision in the hope of increasing the pregnancy rates obtained. We report our methodology using technology developed for in vitro fertilization to prepare sperm for intrauterine insemination. Our overall pregnancy rate is 30%. In this preliminary study several parameters are compared with the pregnancy rates achieved.

The split ejaculate: assessment of fertility potential using two in vitro test systems

Semen samples (split & whole ejaculates) were obtained from 12 normal men (group A) and 8 oligospermic infertile men with sperm concentrations of less than 20 x 10(6) sperm/ml (group B). All samples were evaluated by standard semen analysis, bovine cervical mucus penetration assay (CMPT), and, in all cases with sufficient sperm, in the human spermatozoa zona-free hamster in vitro penetration assay (SPA). In group A the motile sperm concentration was significantly higher in the ejaculated material of the first two contractions (fraction I or FI) than in the remainder of the ejaculate (fraction II or FII) (p less than 0.02). No significant differences were observed in sperm penetration into zona-free hamster ova or bovine cervical mucus by sperm from FI, FII or the whole ejaculate. Motile sperm concentration was significantly correlated with sperm penetration into bovine cervical mucus (r = 0.65, p less than 0.01), but not into zona-free hamster ova (r = 0.01 NS). In the samples collected by group B, the mean sperm concentration and motile sperm concentration were higher in the first (FI) than in the second (FII) fractions of the split ejaculate or the whole ejaculate (p less than 0.05). No significant differences were found among the FI, FII and the whole ejaculate semen samples for penetration of sperm into bovine cervical mucus. Sperm concentration and motile sperm concentration were significantly correlated with sperm penetration into bovine cervical mucus (r = 0.58, p less than 0.01 and r = 0.57, p less than 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Intrauterine insemination: the University of Minnesota experience

Forty-five patients initiated intrauterine insemination between October 1981 and August 1983. Indications for insemination included poor semen (count less than 20 X 10(6)/ml and/or motility less than 40%), poor cervical mucus, presence of sperm antibodies, unexplained poor postcoital tests, or various combinations of the above. During this time period, 374 inseminations were performed in 163 cycles and resulted in eight pregnancies in the 45 patients receiving artificial insemination by homologous donor, for an overall pregnancy rate of 17.4%. The fact that five of the pregnancies occurred in the first insemination cycle and two in the second cycle was felt to indicate a cause-and-effect relationship. A trial of intrauterine insemination in selected patients would appear to be warranted.

Treatment of infertile patients by intrauterine insemination of washed spermatozoa

Thirty-five couples with a variety of infertility problems were treated by a sperm-washing and intrauterine-insemination method. The husband's semen was washed with a modified Biggers, Whitten, and Whittingham's medium to obtain a seminal plasma-free, highly concentrated sperm suspension for intrauterine insemination. Couples receiving these inseminations were evaluated by semen analysis, zona-free hamster egg penetration test (EPT), post-coital test (PCT), antisperm antibody test (ASAT), and other appropriate infertility tests to determine the possible cause of infertility. The pregnancy rate as a group was 17%, while the spontaneous rate was found to be only 7%. Patients with a poor PCT result had a good success rate (25%) especially if the male's fertilizing ability appeared normal in the EPT (50% success). This treatment did not help men with poor EPT results or reduced sperm concentration (5% and 0% success). By excluding unsuccessful patients attempting less than three months, the calculated conception rate for this treatment is 33%. No infection or other serious complications were reported. It is concluded that this method is an uncomplicated and effective treatment for certain infertility patients. The patients most likely to be assisted by this method can be identified by using the EPT, PCT, and ASAT, and these patients should be treated for a minimum of three cycles.

The prognosis of male subfertility: a survey of 1025 men referred to a fertility clinic

A retrospective survey of 1025 consecutive men referred to a male fertility clinic was carried out: 180 (18%) produced a pregnancy while attending the clinic. There was an overall inverse relationship between age and the production of pregnancy, although the majority of pregnancies were in the partners of men aged 25 to 39 at referral. The proportion of pregnancies rose from 4% for men presenting with azoospermia to 27% for those with initial sperm counts of 11 to 20 million/ml. The relationship between production of pregnancy and sperm density was inconsistent for men with sperm densities above 20 million/ml. There was no significant difference in the sperm motility at referral between those who did or did not produce a pregnancy. Success was highest for men whose duration of infertility at referral was between 2 and 3 years. The importance of these findings to the investigation of infertile men is discussed.

Semen parameters in 114 fertile men

We studied the quality of semen in 114 fertile men (their wives were in the first trimester of pregnancy), aged 31.9 +/- 5.7 yr. The results (mean +/- S.D.) were as follows: number of spermatozoa, (72 +/- 61.6) X 10(6)/ml; motile spermatozoa, 56.6% +/- 13.5; spermatozoal velocity, 34.2 +/- 4.3 microns/s; motility index, 19.5 +/- 5.6 microns/s; normal forms, 51.7% +/- 13. It was found that the percentage of motile spermatozoa and the index of motility decrease progressively, at a rate of about 5-10% per hour. In contrast, in the majority of cases, sperm velocity increases during the first 4 h. Low significant correlations was found between percentage of motility and spermatozoal velocity the first hour after ejaculation. Furthermore, moderate significant correlations were found between number of spermatozoa/ml, percentage of motility and normal forms. Finally, low significant negative correlation was found between number of spermatozoa/ml and spermatozoal velocity.

In vitro sperm capacitation and transcervical intrauterine insemination for the treatment of refractory infertility: phase I

Fourteen couples with long-standing infertility, associated with cervical mucus insufficiency, male subfertility, or unexplained infertility, participated in a therapeutic trial. The female partners, who were all ovulatory, were given human menopausal gonadotropin from day 2 of the menstrual cycle (controlled ovarian hyperstimulation). When plasma estradiol concentrations reached 1000 to 2000 pg/ml, human chorionic gonadotropin was given. Approximately 32 hours and again 70 hours thereafter, a masturbation specimen of the husband's sperm was capacitated in vitro and inseminated transcervically into the uterine cavity. Five women (35%) conceived following a single cycle of treatment. Four of the pregnancies are currently progressing normally; one ended in a spontaneous miscarriage in the early first trimester. The potential role of in vitro sperm capacitation and transcervical intrauterine insemination in the treatment of refractory infertility unrelated to female organic pelvic disease is discussed.

Pregnancy following use of the cervical cup for home artificial insemination utilizing homologous semen

Sixty-one couples with infertility from 1 to 11 years were instructed in the use of the cervical cup for artificial insemination using homologous semen in the privacy of their own homes. There have been 36 reported pregnancies in 32 of these couples. Among women with primary infertility, the pregnancy rate was 43%; it was 67% for those with secondary infertility and 53% overall. Sperm counts and percent motility, as well as postcoital test results, however, failed to be indicative of eventual ability to conceive. Regardless, among couples with documented infertility, this method provided over half of the couples with at least one pregnancy. Additionally, the technique is simple, inexpensive, without significant risk or discomfort, and can be carried out by a couple at their convenience and in privacy.

The correlates of fertilizing capacity in normal fertile men

An investigation has been carried out in normal fertile men on the correlates of fertilizing capacity as defined by the zona-free hamster egg penetration test. The results demonstrate that the apparent fertility of these men is compatible with a wide range of intrinsic sperm quality as reflected by penetration rates ranging from 14% to 90% and differences in the minimum concentration of motile spermatozoa required to initiate penetration. These differences in sperm function could not be correlated with any of the conventional parameters of semen analysis or any of a large number of sperm movement characteristics analyzed by time-exposure photomicrography, with two exceptions: (1) the percentage of progressively (greater than 25 micron/sec) motile spermatozoa exhibiting an amplitude of lateral head displacement (Ah) of less than 10 micron, which was positively correlated with penetrating capacity (P less than 0.01), and (2) the percentage of progressively (less than 25 micron/sec) motile spermatozoa exhibiting an Ah of greater than 10 micron, which was negatively correlated with penetration rate (P less than 0.05). The information obtained in this study should provide a useful basis against which to compare the properties of spermatozoa in cases of suspected infertility.

Spontaneous abortion incidence in the treatment of infertility

Analysis of published series indicates that, irrespective of the method of data collection, close agreement exists on empirically derived incidences of spontaneous abortion in North American populations, provided that age, previous abortion history, and gravidity are controlled. The normal incidence of clinically apparent abortion among first pregnancies in women under age 30 years is in the range 8.3% to 11.0%. A comprehensive analysis of published series on pregnancies after infertility treatment indicates that only three therapeutic methods are attended by an abortion incidence that approaches this asymptote: ovulation induction with bromocriptine in hyperprolactinemic anovulation (11.8%; n = 1,233 pregnancies); artificial insemination with donor semen for azoospermia (11.4%; n = 326 first pregnancies); and operation for endometriosis (9.3%; n = 768 pregnancies). Abortion incidences accompanying other modes of therapy are higher. Because increased abortion incidence is not generally recognized as a specific reproductive difficulty in infertile couples, as are the other two: i.e., refractory infertility despite technically adequate therapy and ectopic pregnancy, plausible physiologic mechanisms for abortions in specific categories of disease or treatment type are described and discussed in detail. Moreover, abortion incidence is proposed to be a sensitive and objective parameter with which to assess distortions in human reproductive physiology, especially when competing methods of infertility treatment have overall pregnancy outcomes that are thought to be similar.

Artificial insemination with husband's semen: prognostic factors

This retrospective review of 38 couples has considered 148 cycles of artificial insemination with husband's semen (AIH) and 178 cycles of natural insemination with husband's semen (NIH). The indication for AIH in every case was that postcoital testing had revealed less than 15 motile sperm/high-power field of endocervical mucus. Conception through AIH occurred in 12 cases; 1 couple conceived by NIH. The rate of conception per cycle was significantly higher in the AIH cycles than in the NIH cycles (P < 0.005). No man with both low density (less than 25 million spermatozoa/ml) and low motility (less than 50%) on semen analysis produced a pregnancy through AIH. Couples demonstrating more than 15 motile sperm/high-power field (on examination of cervical mucus 2 hours after AIH) were more likely to conceive through AIH than couples demonstrating less than 15 motile sperm. The role of AIH is discussed.