Therapeutic Donor Insemination: Results and Causes of Nonfertilization**Presented at the Twenty-Sixth Annual Meeting of The Pacific Coast Fertility Society, October 18 to 22, 1978, Scottsdale, Ariz

Semen analysis data from fresh and cryopreserved donor ejaculates: comparison of cryoprotectants and pregnancy rates

Patients (155) were selected at random for fresh or cryopreserved semen and inseminated on the predicted day of ovulation. Semen analysis was performed using a microcomputerized multiple-exposure photography system. Frozen semen was used with either glycerol or TEST-yolk (TEST-buffered 20% egg yolk with 10% glycerol) as the cryoprotectant. Cryopreservation resulted in significant decreases in all semen parameters measured. Of these, velocity appeared to be the least effected. TEST-yolk provided significantly more protection against a reduction in velocity compared with glycerol. A total of 18, 17, and 27 patients conceived using fresh, glycerol, or TEST-yolk-preserved semen, respectively. For these same groups, a cumulative pregnancy rate of 52.9%, 27.1%, and 68.5%, respectively, was observed (not significant). The total number of motile sperm per insemination used for fresh artificial inseminations resulting in conception (132.4 X 10(6] was significantly greater than the number used for successful glycerol- and TEST-yolk-preserved semen (approximately 24 X 10(6]. These results demonstrate that although the number of motile sperm of cryopreserved ejaculates are dramatically reduced compared with the fresh counterparts, if a minimum criteria for ejaculate quality is established, the use of cryopreserved semen can offer a viable, effective, and relatively safe alternative to artificial insemination by donor with fresh semen.

The effect of hormones on the sex ratio of infants following artificial insemination

Data have been reviewed on the sex ratio of infants following artificial insemination (AI). It is concluded: In cases where AI is preceded by hormone treatment the sex ratio is lower (P less than 0.002) than in cases at the same centre where there is no hormone treatment. Part of the association of sex ratio with cryostorage of semen detected by other workers seems secondary to an association of both with hormone treatment. It is not clear whether, in addition, cryostorage has an independent effect on sex ratio. AI (in the absence of hormone treatment) raises the sex ratio, apparently to different degrees in different clinics. It is noteworthy that hormone treatment in AI has the same effect as hormone treatment with natural insemination--to reduce the sex ratio. This is interpreted as evidence for the hypothesis that gonadotrophin has a pre-conceptional sex-selective effect.

Acrosome-reacting capacity of frozen-thawed human semen: relation to hamster ova penetration

Interspecies egg penetration requires completion of capacitation and acrosome reaction of the spermatozoa. The ability of frozen-thawed human semen to accomplish this reaction was studied, and its relation to the zona-free hamster egg penetration was investigated. The percentage of reacted cells in the population of live spermatozoa estimated by the triple-staining technique was found to be greater in frozen than in fresh samples. However, the egg-penetrating ability of cryopreserved semen remained significantly low. Individual differences in the ability to undergo the acrosome reaction and its relation to penetration are discussed.

Timing and frequency of artificial insemination in women under menotropin therapy

The timing and frequency of AID were reviewed in 36 women who received menotropin therapy. One hundred thirteen treatment cycles were reviewed with AID done once per cycle in 39, twice per cycle in 63, and three times per cycle in 11 cases. The pregnancy rate was 19.5% per treatment cycle, with 21 of the 36 patients (58%) conceiving. No difference in pregnancy rate was found with single or multiple inseminations when AID application included the day of hCG administration. Evidence is presented that suggests that frequently the fertilizing sperm may have resided in the woman for over 30 hours before fertilization occurred.

Comparison of glycerol and a zwitter ion buffer system as cryoprotective media for human spermatozoa. Effect on motility, penetration of zona-free hamster oocytes, and acrosin/proacrosin

This study compared the cryoprotective effect of glycerol with that of a zwitter ion buffer system (TESTCY). Spermatozoa that are cryopreserved in the presence of glycerol possess a somewhat higher progressive motility immediately after thawing than those preserved in the presence of TESTCY. However, after a 1-hour incubation in glycerol-free medium, the progressive motilities of the glycerol- and TESTCY-treated spermatozoa become essentially identical. After 2 hours in culture medium, TESTCY-treated spermatozoa possess a higher motility than glycerol-treated spermatozoa, indicating that TESTCY is a better preservative than glycerol for the long-term motility of human spermatozoa. The fertilizing potential of the cryopreserved spermatozoa was assessed by their ability to penetrate zona-free hamster oocytes in vitro. Spermatozoa that are cryopreserved in the presence of TESTCY produce three- to four-fold higher penetration rates than glycerol-treated, cryopreserved spermatozoa. Cryopreservation in the presence of TESTCY also results in a higher stability of the acrosin/proacrosin system than when the spermatozoa are preserved in glycerol, since about two- to three-fold higher levels of proacrosin are retained. These results indicate that TESTCY is a better cryopreservative for human spermatozoa than glycerol.

Artificial insemination by donor: a review of 12 years' experience

Twelve years' experience of AID in a non-NHS clinic is reviewed. Of 381 women treated, 230 became pregnant at least once; 308 pregnancies were achieved in 450 courses of treatment (68%) resulting in 263 live births (85%). For women aged over 35 years the pregnancy rate was 47%. Timing of insemination and treatment with clomiphene are described. The use of fresh or frozen semen and future developments are discussed.

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.

The influence of ovulatory dysfunction and timing of insemination on the success of artificial insemination donor (AID) with fresh or cryopreserved semen

The influence of ovulatory dysfunction and timing of insemination on the success of AID with either fresh or cryopreserved semen was investigated. A total of 238 patients were inseminated, resulting in 170 pregnancies during 1201 insemination cycles, an average of 5.0 cycles per pregnancy. Pregnancy rates were similar in those patients receiving either fresh or cryopreserved semen, but the number of cycles required for pregnancy to occur was doubled in the latter group. Ovulatory dysfunction further delayed the number of cycles before conception. The poorest results occurred in those patients with ovulatory dysfunction receiving cryopreserved semen. The timing of insemination was more important in patients receiving cryopreserved semen than those receiving fresh semen. With cryopreserved semen, pregnancy was not likely to occur unless the insemination was performed on the day of ovulation. These data suggest that frozen semen is less efficacious than fresh semen, a difference that is compounded by the presence of ovulatory dysfunction in the recipient. It is possible that an increase in the frequency of insemination from every other day to daily may improve the results of AID with cryopreserved semen.

Artificial insemination by frozen donor semen: results of multicentre Australian experience

A total of 5461 insemination cycles with frozen donor semen has been analysed for 8 of the larger AID services in Australia. Cumulative pregnancy rate, calculated by life-table analysis, showed that 50% of all patients are pregnant after 6 cycles of insemination and 64% of all patients are pregnant after 12 cycles of insemination. Pregnancy rate was significantly higher in the first 3 cycles, declined in the next 3 cycles and was further reduced in the last 6 cycles of insemination. An average of 10% of all insemination cycle were anovular, but the proportion of anovular cycles was significantly lower in the first 2 cycles of insemination. There was no significant difference in cumulative pregnancy rates over the first 6 cycles of insemination in clinics using cervical mucus scoring or LH assay for detection of ovulation. An average of 12% of all pregnancies obtained by AID resulted in miscarriage.

Penetration of the zona-free hamster egg by human sperm

Human sperm become capable of penetrating zona-free hamster eggs after preincubation in an appropriate culture medium. This observation has led to the development of an assay for characterizing the fertilizing capacity of human spermatozoa. In the present study, the incorporation of sperm by zona-free hamster eggs was quantitated, and several parmeters that contribute to penetration were evaluated. The importance of the motile sperm concentration was established; no penetration was seen at concentrations lower than 6 x 10(5) motile cells/ml, whereas above this level the mean number of incorporated sperm per egg was linearly related to concentration. Freeze-thawed sperm, although capable of penetrating zona-free hamster eggs, did so with lesser frequency than did fresh sperm at equal concentrations of motile sperm. Kinetic experiments indicated that eggs were maximally penetrated after 5 hours of exposure to capacitated sperm and that the cessation in sperm incorporation seen at this time resulted from egg-related changes that occurred during aging in vitro. A protocol for evaluating "fertilizing capacity" of human sperm samples was outlined incorporating the findings from the present study. Using these conditions, reproducible penetration levels were obtained when several ejaculates obtained from the same donor over a 3-month interval were tested at similar motile sperm concentrations.