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Abstract
BACKGROUND In subfertile couples, couples who have tried to conceive for at least one year, intrauterine insemination (IUI) with ovarian hyperstimulation (OH) is one of the treatment modalities that can be offered. When IUI is performed a second IUI in the same cycle might add to the chances of conceiving. In a previous update of this review in 2010 it was shown that double IUI increases pregnancy rates when compared to single IUI. Since 2010, different clinical trials have been published with differing conclusions about whether double IUI increases pregnancy rates compared to single IUI. OBJECTIVES To determine the effectiveness and safety of double intrauterine insemination (IUI) compared to single IUI in stimulated cycles for subfertile couples. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase and CINAHL in July 2020 and LILACS, Google scholar and Epistemonikos in February 2021, together with reference checking and contact with study authors and experts in the field to identify additional studies. SELECTION CRITERIA We included randomised controlled, parallel trials of double versus single IUIs in stimulated cycles in subfertile couples. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS We identified in nine studies involving subfertile women. The evidence was of low quality; the main limitations were unclear risk of bias, inconsistent results for some outcomes and imprecision, due to small trials with imprecise results. We are uncertain whether double IUI improves live birth rate compared to single IUI (odds ratio (OR) 1.15, 95% confidence interval (CI) 0.71 to 1.88; I2 = 29%; studies = 3, participants = 468; low quality evidence). The evidence suggests that if the chance of live birth following single IUI is 16%, the chance of live birth following double IUI would be between 12% and 27%. Performing a sensitivity analysis restricted to only randomised controlled trials (RCTs) with low risk of selection bias showed similar results. We are uncertain whether double IUI reduces miscarriage rate compared to single IUI (OR 1.78, 95% CI 0.98 to 3.24; I2 = 0%; studies = 6, participants = 2363; low quality evidence). The evidence suggests that chance of miscarriage following single IUI is 1.5% and the chance following double IUI would be between 1.5% and 5%. The reported clinical pregnancy rate per woman randomised may increase with double IUI group (OR 1.51, 95% CI 1.23 to 1.86; I2 = 34%; studies = 9, participants = 2716; low quality evidence). This result should be interpreted with caution due to the low quality of the evidence and the moderate inconsistency. The evidence suggests that the chance of a pregnancy following single IUI is 14% and the chance following double IUI would be between 16% and 23%. We are uncertain whether double IUI affects multiple pregnancy rate compared to single IUI (OR 2.04, 95% CI 0.91 to 4.56; I2 = 8%; studies = 5; participants = 2203; low quality evidence). The evidence suggests that chance of multiple pregnancy following single IUI is 0.7% and the chance following double IUI would be between 0.85% and 3.7%. We are uncertain whether double IUI has an effect on ectopic pregnancy rate compared to single IUI (OR 1.22, 95% CI 0.35 to 4.28; I2 = 0%; studies = 4, participants = 1048; low quality evidence). The evidence suggests that the chance of an ectopic pregnancy following single IUI is 0.8% and the chance following double IUI would be between 0.3% and 3.2%. AUTHORS' CONCLUSIONS Our main analysis, of which the evidence is low quality, shows that we are uncertain if double IUI improves live birth and reduces miscarriage compared to single IUI. Our sensitivity analysis restricted to studies of low risk of selection bias for both outcomes is consistent with the main analysis. Clinical pregnancy rate may increase in the double IUI group, but this should be interpreted with caution due to the low quality evidence. We are uncertain whether double IUI has an effect on multiple pregnancy rate and ectopic pregnancy rate compared to single IUI.
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Affiliation(s)
- Lidija Rakic
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Elena Kostova
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ben J Cohlen
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, Netherlands
| | - Astrid Ep Cantineau
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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Liang JY, Li ZT, Yang XH, Huang ZC, Yang SF, Wang LH, Liu FH. [Time interval from the end of sperm processing to artificial intrauterine in semination with husband's sperm correlates to the rate of clinical pregnancy]. Zhonghua Nan Ke Xue 2015; 21:532-535. [PMID: 26242044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the influence of the time interval from the end of semen processing to artificial intrauterine in semination with husband's sperm (AIH-IUI) on the rate of clinical pregnancy. METHODS This study involved 191 AIH-IUI cycles with the same ovulation induction protocol. After Percoll density gradient centrifugation, we divided the sperm into four groups based on the incubation time: 0-19, 20-39, 40-59, and 60-80 min, and again into another four groups according to the total progressively motile sperm count (TPMC): (0-9), (10-20), (21-30), and > 30 x 10(6). We analyzed the correlation of the clinical pregnancy rate with the time interval from the end of sperm processing to AIH-IUI and with other influencing factors, such as maternal age, infertility duration, and semen quality. RESULTS The rate of clinical pregnancy was significantly higher in the 20-39 min group (18.3%) than in the 0-19, 40-59, and 60-80 min groups (12.7, 11.4 and 9.1%) (all P < 0.05). The (10-20) x 10(6) group achieved a remarkably higher pregnancy rate (16.7%) than the (0-9), (21-30), and > 30 x 10(6) groups (0, 11.4, and 8.3%) (all P < 0.05). Logistic multivariate analysis showed that the rate of clinical pregnancy was decreased with the increased age of the women (OR 0.89, 95% CI 0.83-0.94) but significantly elevated in the 20-39 min group (OR 2.11, 95% CI 1.34-3.13) and of (10-20) x 10(6) group (OR 2.06, 95% CI 1.32-3.46). CONCLUSION The time interval from the end of sperm processing to AIH-IUI is a most significant factor influencing the rate of clinical pregnancy of AIH-IUI.
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Kably Ambe A, Carrera Lomas E, Carballo E, Campos Cañas JA, Nuñez García M. [Intrauterine insemination results in the Specialized Center for Women's Care]. Ginecol Obstet Mex 2011; 79:280-284. [PMID: 21966816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND intrauterine insemination should be offered to couples with unexplained infertility, given its effectiveness and compared to in vitro fertilization and embryo transfer, is less invasive and requires less resources. It also should be offered to couples with male factor infertility in selected patients with induction of ovulation to increase the chances of pregnancy. OBJECTIVE to determine the rate of pregnancy with intrauterine insemination in couples with infertility. MATERIAL AND METHODS descriptive and retrospective study of 500 couples with female, male and combined infertility, primary or secondary, managed with homologous insemination, with controlled ovarian stimulation and programmed ovulation, in patients with at least one permeable salpinx, FSH <12 IU/L and > 5 x 10(6) mobile and normal sperm. Ultrasonografic follicular follow-up and ovulation triggering according to findings, performing insemination 36 hours after the shooting, with luteal phase support with progesterone. RESULTS 1.6 cycles on average, female infertility 65.8%, 21% male and combined 13.2%, age average 32 years of women and 36 years of man, average ovarian stimulation 8 days. Pregnancy in 19.5% of the patients, of these, 65.1% under the age of 35 years, 33.3% from 35 to 40 years and 1.5% older than 40 years. Pregnancy at term 77.08%, miscarriage 11.45% and unknown resolution at 11.45%. Twin pregnancy 14.61% and high fetal order 5.7%. Pregnancy with female infertility 64%, male 22.3% and combined 13.5%. Pregnancy with endometrial <8 mm 9.8%, 8-15 mm 86.4% >15 mm 3.6%. With trilaminar endometrium 72.3%, dense 12.5%, linear 0.5%. CONCLUSION The rate of pregnancy in intrauterine insemination hardly exceeds 20%. The determinants for this are the women age, type of infertility and endometrial characteristics. It was also noted high twin pregnancy and high fetal order.
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Affiliation(s)
- Alberto Kably Ambe
- Centro Especializado para la Atención de la Mujer, Hospital Angeles Lomas.
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Jee BC, Ku SY, Suh CS, Kim KC, Lee WD, Kim SH. Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles: a pilot study. Fertil Steril 2006; 85:1774-7. [PMID: 16677640 DOI: 10.1016/j.fertnstert.2006.02.070] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Revised: 02/10/2006] [Accepted: 02/10/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the clinical outcomes between letrozole and clomiphene citrate (CC) in gonadotropin-combined intrauterine insemination (IUI) cycles. DESIGN Prospective pilot study. SETTING One university hospital and two private infertility clinics. PATIENT(S) Ninety-three infertile couples eligible for superovulation and IUI. INTERVENTION(S) A letrozole dose of 2.5 mg/day (n = 66) or a CC dose of 100 mg/day (n = 27) was given on day 3-7 of the menstrual cycle, combined with human menopausal gonadotropin (hMG) at a dose 150 IU every other day starting on day 5. MAIN OUTCOME MEASURE(S) The number of mature follicles, serum estradiol (E2) and progesterone (P) levels, endometrial thicknesses on the day of human chorionic gonadotropin (hCG), and clinical pregnancy rates. RESULT(S) The patients' clinical characteristics were comparable between the two groups. The number of mature follicles (3.2 +/- 1.7 vs. 5.6 +/- 2.4) and serum E2 levels on the day of hCG (231.0 +/- 179.8 vs. 1,371.7 +/- 750.5 pg/mL) were significantly lower in the letrozole group. No significant differences were found in endometrial thickness measured on the day of hCG or clinical pregnancy rates (18.2% vs. 25.9%). The rate of patients with serum P levels > 1.0 ng/mL on the day of hCG was significantly lower in the letrozole group (4.5% vs. 25.9%). CONCLUSION(S) Letrozole produced a comparable pregnancy rate vs. CC in gonadotropin-combined IUI cycles. Our results should be confirmed in larger populations with proper randomization.
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Affiliation(s)
- Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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Jurema MW, Vieira AD, Bankowski B, Petrella C, Zhao Y, Wallach E, Zacur H. Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination. Fertil Steril 2005; 84:678-81. [PMID: 16169402 DOI: 10.1016/j.fertnstert.2005.03.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 03/07/2005] [Accepted: 03/07/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the optimal interval of ejaculatory abstinence for couples undergoing IUI. DESIGN Retrospective analysis. SETTING Reproductive endocrinology and infertility center. PATIENT(S) Infertile couples undergoing ovulation induction and IUI with partner's semen. INTERVENTION(S) Ovulation induction with clomiphene citrate and a single IUI procedure per cycle. MAIN OUTCOME MEASURES(S) Clinical pregnancy rates as a function of abstinence intervals. RESULT(S) Four hundred seventeen women underwent 929 cycles from June 1999 to October 2002 for a median of 4 IUI attempts per couple. The median ejaculatory abstinence interval was 4 days (range 0-30) with an overall pregnancy rate of 12% per cycle. Abstinence correlated positively with inseminate sperm count but negatively with motility. Variations in inseminate parameters did not correlate with pregnancy rates. However, abstinence intervals significantly affected pregnancy rates. The highest pregnancy rate was observed with an abstinence interval of 3 days or less (14%) and the lowest pregnancy rate seen with an abstinence interval of 10 days or more (3%). CONCLUSION(S) An abstinence interval of 3 days or less was associated with higher pregnancy rates following IUI. Prolonged abstinence decreases pregnancy rates, independent of other sperm parameters, perhaps as a result of sperm senescence and functional damage not readily identified by standard semen analysis. Abstinence intervals should be controlled for in studies examining pregnancy outcome in assisted reproduction.
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Affiliation(s)
- Marcus W Jurema
- Department of Obstetrics and Gynecology, Women and Infants' Hospital, Providence, Rhode Island 02905, USA.
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Abstract
The recent questioning of the validity of evidence used by the Royal College of Obstetricians and Gynaecologists in recommending ovarian stimulation with intrauterine insemination (IUI) as an effective treatment for couples with unexplained infertility, has re-ignited the debate on what the initial treatment for idiopathic infertility should be. The current best available evidence is used here with the conclusion that the initial treatment for idiopathic infertility should be IUI as opposed to IVF. This conclusion is reached using the results of randomized controlled trials wherever possible, live birth rates rather than pregnancy rates and taking into account efficacy; complications, especially multiple pregnancy rates; patient compliance and cost efficiency. None of these factors indicate that a change of policy to use IVF as first-line treatment in lieu of IUI for unexplained infertility is justified.
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Affiliation(s)
- Roy Homburg
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Free University Medical Centre, Amsterdam, The Netherlands
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Thépot F. [1997 results of medical assisted procreation with third party donations and autopreservation. CECOS French Federation]. Contracept Fertil Sex 1998; 26:476-80. [PMID: 9810117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
During the year 1997, the French Federation of CECOS recorded the results of the 23 CECOS centers and IFRAERES in Toulouse. 1620 first demands of procreation with sperm donors were registed (versus 1,690 in 1996) but only 3,235 patients received at least one donation in the year, 22% less than 1996. From 10,935 cycles (AID or IVFD), 1,333 pregnancies were obtained, scoring the identical amount in terms of pregnancies as in 1996 but with less 30% in terms of cycles. The analysis of the 1,298 deliveries of the 1996 pregnancies show a malformation rate of 1.9%. 419 male volunteers came forward as sperm donors (5% more than 1996). In gamete autocryopreservation, the number of semen preservation is globally increasing (11.2% more than 1996), mainly because the capacity of a better reutilization with ICSI.
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Affiliation(s)
- F Thépot
- Laboratoire de Biologie de la Reproduction et de Cytogénétique, CHU d'Amiens
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van der Westerlaken LA, Naaktgeboren N, Helmerhorst FM. Evaluation of pregnancy rates after intrauterine insemination according to indication, age, and sperm parameters. J Assist Reprod Genet 1998; 15:359-64. [PMID: 9673879 PMCID: PMC3455020 DOI: 10.1023/a:1022576831691] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Our purpose was to evaluate intrauterine insemination results obtained in our clinic and identify prognostic factors for the chance of pregnancy. METHODS A retrospective study of data from 1989 to 1996 was undertaken. Only first attempts were included in this study, except for the part on the cumulative pregnancy rates. Couples with either one-sided tubapathology, hormonal dysfunction, idiopathic infertility, or andrological indication were selected. All women were stimulated with clomiphene citrate. Five hundred sixty-six couples who underwent 1763 cycles were included in the study. RESULTS The overall pregnancy rate for first pregnancies was 6.9% per cycle and 21.4% per patient. For first intrauterine insemination attempts this was 8.8% per cycle/patient, varying between 5.0% for andrological indication and 10.6% for tubapathology, 10.0% for idiopatic indication, and 10.3% for hormonal indication. These differences were not significant. Age did not have a significant effect either, although there were no pregnancies observed in women 40 years or older. The number of inseminated spermatozoa significantly affected the pregnancy rate: < 2 million, 4.6%; > or = 2 to < 10 million, 3.9%; and > or = 10 million, 11.3%. CONCLUSIONS Unless semen characteristics are insufficient, intrauterine insemination is a useful treatment for infertile couples.
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Abstract
During 774 spontaneous cycles and 87 cycles of assisted reproduction, the conception rates were evaluated in 48 infertile couples in whom unilateral cryptorchidism was the causal factor. In spite of adjuvant therapy of the male partner, the spontaneous conception rate was very low (1% per cycle). Intra-uterine insemination (IUI) and conventional in vitro fertilization (IVF) resulted in similar success rates of 6.1 and 8.7% per cycle/attempt respectively. After intra-cyto-plasmic sperm injection (ICSI), 46.7% pregnancies were obtained per attempt, and sperm requirements for the latter treatment to be successful were lower than for IUI. It is concluded that subfertility in men with unilateral cryptorchidism is severe, conventional IVF has little advantage, but ICSI is highly successful.
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Affiliation(s)
- A M Mahmoud
- Assiut University Hospital, Department of Dermatology and Andrology, Egypt
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Rasmussen KL. [Intrauterine insemination]. Ugeskr Laeger 1995; 157:1209-10. [PMID: 7701670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Cignitti M, Costa M, Chiarelli A, Papi A, Pini A, Ciavattini A, Garzetti GG, Romanini C. [Homologous intrauterine insemination: our experience]. Ann Ostet Ginecol Med Perinat 1992; 113:119-23. [PMID: 1299154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sixty-five couples with male infertility or unexplained infertility or infertility due to cervical factor underwent 156 cycles of homologue intrauterine insemination. The overall pregnancy rate was 16.5% with 2.4 mean value of insemination cycles for each couple. The highest pregnancy rate was observed in cases of cervical factor infertility. The mean age of patients who had pregnancy was 30 years (overall mean value 34 years) and the mean time of sterility was 3 years (overall mean value 4.4 years).
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Affiliation(s)
- M Cignitti
- Istituto di Clinica Ostetrica e Ginecologica, Università degli Studi di Ancona
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Holland-Moritz H, Krause W. [Use of sperm cryopreservation by tumor patients]. Hautarzt 1990; 41:204-6. [PMID: 2162809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Impairment of spermatogenesis can be expected after cytostatic treatment or radiation for cancer. To improve fertility prognosis, semen samples are usually deep-frozen and stored in liquid nitrogen prior to such a therapy. However, after therapy this deep-frozen sperm is seldom used. Of 47 patients for whom we started cryopreservation of semen during the years 1983-1988, 20 men were no longer interested in further storage within 2 years, so that the deposits were destroyed. Up to now, none of the 27 samples still existing has been used for artificial insemination or in vitro fertilization (IVF). Possible reasons for this are discussed.
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Gerhard I, Roth B, Eggert-Kruse W, Runnebaum B. Effects of kallikrein on sperm motility, capillary tube test, and pregnancy rate in an AIH program. Arch Androl 1990; 24:129-45. [PMID: 2327823 DOI: 10.3109/01485019008986873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- I Gerhard
- Department of Gynecological Endocrinology, Women's Hospital, University of Heidelberg, FRG
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Sato H, Kaneko S, Kobayashi T, Oda T, Ohno T, Iizuka R. Improved semen qualities after continuous-step density gradient centrifugation: application to artificial insemination and pregnancy outcome. Arch Androl 1990; 24:87-93. [PMID: 2327816 DOI: 10.3109/01485019008986863] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For increasing sperm fertilizability in artificial insemination, it is effective to concentrate progressively motile sperm from whole ejaculate. We developed the continuous-step density gradient for the selective concentration of progressively motile sperm. The present procedure was applied to intrauterine artificial insemination. Infertile couples (n = 152) whose diagnoses involved oligoasthenospermia, cervical factor, and unexplained infertility were selected for artificial insemination with washed and concentrated sperm. Successful pregnancies (47) were obtained, with an overall pregnancy rate of 31% in the program. Sperm processing by this procedure improved pregnancy rates in couples with the sole diagnosis of oligoasthenospermia or cervical factor. In the patients in whom other fertility problems coexisted, however, it was essential to treat female fertility problems. Continuous-step density gradient centrifugation is effective in increasing the pregnancy rate in artificial insemination.
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Affiliation(s)
- H Sato
- Department of Obstetrics and Gynecology, Tachikawa Kyosai Hospital, Tokyo, Japan
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García Flores RF, Vázquez Méndez J, Andrade JG. [Artificial insemination with the husband's semen (A.I.H.)]. Ginecol Obstet Mex 1987; 55:59-63. [PMID: 3154363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kaempfer SH, Hoffman DJ, Wiley FM. Sperm banking: a reproductive option in cancer therapy. Cancer Nurs 1983; 6:31-8. [PMID: 6549929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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