Comparison of fallopian tube sperm perfusion and intrauterine tuboperitoneal insemination: a prospective randomized study

OBJECTIVE

To evaluate the results of two different methods of insemination: fallopian tube sperm perfusion (FSP) with 4 mL of inseminate and intrauterine tuboperitoneal insemination (IUTPI) with 10 mL of inseminate.

DESIGN

Prospective randomized clinical study.

SETTING

Private infertility center.

PATIENT(S)

Two hundred seventy-six couples, undergoing 403 cycles, with unexplained infertility, mild or moderate male infertility, or mild or moderate endometriosis.

INTERVENTION(S)

Patients were assigned randomly to either FSP (group A, n = 138) or IUTPI (group B, n = 138) treatment. Both groups followed the same mild ovarian stimulation protocol.

MAIN OUTCOME MEASURE(S)

Ninety-five overall pregnancies: 35 in group A (FSP) and 60 in group B (IUTPI).

RESULT(S)

The pregnancy rate per cycle (presence of gestational sac with heart beats) was 17.6% in group A (n = 199) and 29.4% in group B (n = 204). These differences were statistically significant (P < .007). The odds ratio of getting pregnant, per patient, in group B was 2.26 (95% confidence interval 1.36-3.77) compared with group A.

CONCLUSION(S)

The results of this study indicate that IUTPI may prove to be a useful technique in the treatment of unexplained infertility, mild or moderate male infertility, and mild or moderate endometriosis. Three attempts of IUTPI may be beneficial before moving on to more invasive and expensive methods of assisted reproduction techniques.

[Postmortem sperm procurement--juridical and Halachic aspects]

The ability to fertilize human ova with sperm retrieved soon after death has been utilized in Israel and in other countries. However, postmortem sperm procurement (PMSP) has significant Halachic, juridical and ethical implications with regard to both the action of sperm and its implications for mother and offspring. In specific situations, and with reliable supervision aimed at preventing sperm interchange, Halacha may allow the procedure, while the juridical approach in such a situation is not as yet well established. As for Halacha, even if a son is born, the widowed mother will still be obligated by the Halacha of yibum (marrying the deceased husband's brother). The child's rights as heir, aspects of implications for its future life, or even social aspects of PMSP, all are factors to be seriously considered before PMSP is performed, without bias by temporary emotions. Thus, PMSP should be reserved for only very special circumstances, and only after consultation with the appropriate medical, Halachic, juridical and ethical experts.

Intrauterine insemination: evaluation of the results according to the woman's age, sperm quality, total sperm count per insemination and life table analysis

We report on 332 infertile couples who underwent 1115 cycles of intrauterine insemination (IUI) with washed husband's semen. The indication for IUI was an abnormal post-coital test due to either a male or cervical infertility factor. The mean number of IUI cycles per patients was 3.4, the overall pregnancy rate 18.7%, and the pregnancy rate per cycle 5.6%. The cumulative pregnancy rate calculated by life table analysis showed that 16.0% of pregnancies occurred in the first three treatment cycles, while the cumulative pregnancy rate was 26.9% by the sixth cycle. The outcome of the therapy was adversely affected if the woman's age was > 39 years and/or total motile sperm count per insemination was < 1 x 10(6). No pregnancy occurred in women older than 44 years or in cases with a total motile sperm count before semen preparation of < 1 x 10(6).

Insemination of HIV-negative women with processed semen of HIV-positive partners

Many HIV-discordant couples want to have children so much that they are willing to abandon condom-protected sexual intercourse irrespective of the risks. Previous testing in our laboratory showed that gradient centrifugation followed by a swim-up procedure effectively removed HIV-1-infected cells from the semen of HIV-seropositive men. 85 HIV-discordant couples were screened for fertility; 29 women were found suitable for a timed insemination course with the processed semen of their HIV-seropositive partner. None of the inseminated women seroconverted, and 17 pregnancies were achieved in 15 women. All 10 babies born to these mothers remain HIV seronegative. The findings may help in the counselling of such couples and also give them hope of having healthy babies.

Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte

Intracytoplasmic sperm injection (ICSI) is a promising assisted-fertilisation technique that may benefit women who have not become pregnant by in-vitro fertilisation (IVF) or subzonal insemination (SUZI) of oocytes. We have used ICSI to treat couples with infertility because of severely impaired sperm characteristics, and in whom IVF and SUZI had failed. Direct injection of a single spermatozoon into the ooplasm was done in 47 metaphase-II oocytes: 38 oocytes remained intact after injection, 31 became fertilised, and 15 embryos were replaced in utero. Four pregnancies occurred after eight treatment cycles--two singleton and one twin pregnancy, and a preclinical abortion. Two healthy boys have been delivered from the singleton pregnancies and a healthy boy and girl from the twin pregnancy.

Sperm retrieval for direct intraperitoneal insemination in a diabetic with retrograde ejaculation. A case report

Retrograde ejaculation is an uncommon form of male infertility. It may occur in diabetics from neuropathy involving the sympathetic fibers innervating the bladder neck. Treatment of infertility in these cases is with artificial homologous insemination. Several techniques for semen recovery from the bladder have been proposed. This paper describes a case of twin pregnancy following direct intraperitoneal insemination (DIPI) of semen retrieved from a diabetic man with retrograde ejaculation. Retrieval of semen was performed in this case by spontaneous voiding of urine after the introduction of a suitable medium into the bladder and before ejaculation. The quality of the semen was examined after spontaneous urination before DIPI. The poor quality of the spermatozoa induced us to introduce into the bladder a suitable medium before ejaculation and sperm recovery.

Superovulation with or without intrauterine insemination for the treatment of infertility

Patients undergoing human menopausal gonadotropin (hMG) superovulation were reviewed retrospectively to determine whether fecundity was greater for intrauterine insemination (IUI) than timed intercourse. Forty patients with unexplained infertility, American Fertility Society I or II endometriosis, luteal phase defect and/or cervical factor were treated with hMG alone or hMG plus IUI. Twenty-eight underwent 52 cycles of hMG/IUI, and 19 underwent 31 cycles of hMG. The probability of pregnancy after four cycles was significantly better in the hMG/IUI group (.90) than the hMG group (.37, P = .049). There was a 54.5% multiple pregnancy rate, and one patient was admitted to the hospital for hyperstimulation. When traditional therapy fails, hMG/IUI significantly increases the pregnancy rates as compared to hMG with timed intercourse in a "good prognosis" group of patients.