Donor Intrauterine Insemination Research Articles

P-051 Results of Intrauterine Insemination (IUI) with donor semen in women with poor ovarian reserve

Abstract Study question If we have a woman with a poor ovarian reserve, will she have a lower chance of pregnancy after a cycle of IUI? Summary answer A woman with a poor ovarian reserve has a lower chance of pregnancy, although in donor IUI we have an acceptable rate of pregnancy. What is known already Actually, the better predictor to define a poor ovarian reserve is a low antimullerian hormone (AMH). AMH is a well-known predictor of ovarian reserve, which allow to predict a response after an in vitro fecundation (IVF) cycle. Nevertheless, we also know that a low AMH does not mean to be not able to get pregnant. Few studies have compared different markers of ovarian reserve as predictors of pregnancy after an IUI cycle, and those which have done it have conflictive results. Maternal age seems to be strongly linked with the chance of pregnancy. Study design, size, duration We designed a retrospective cohort study with longitudinal follow-up upon the patients who undergo an IUI cycle in a public hospital of third level (Hospital Virgen del Rocio, Seville, Spain). We included 1059 cycles of IUI (383 with conjugal and 676 with donor semen) between 2015 and 2021. These cycles belong to 390 patients (64 with poor ovarian reserve and 326 with normal ovarian reserve). Participants/materials, setting, methods We collected data from clinical history which is completed during the visit of the patients. Cohort was stratified between patients with a low AMH (<1.1 ng/ml) and normal AMH (>1.1 ng/ml). We used this cut point following the definition of our regional guideline that includes when we can practice fertility treatments. Our main variable was pregnancy rate, defining pregnancy as an echography at 7 weeks with at least one embryo with cardiac activity. Main results and the role of chance When we compared pregnancy rate between normal ovarian reserve against poor ovarian reserve, we did not find statistically significant results in conjugal IUI independently that we compared by cycle (11.2% in normal ovarian reserve vs 3.8% in poor reserve (p = 0.2)) or by couple (27.97% in normal ovarian reserve vs 8.3% in poor ovarian reserve (p = 0.1)). We found differences with the same comparison in donor IUI by cycle (20.2% normal reserve vs 6.8% in poor reserve (p = 0.001)) and by couple (56.83% in normal ovarian reserve vs 21.15% in poor reserve (p = 0.001)). Nevertheless, pregnancy rate in IUI was similar to what we will get with an IVF cycle with only one oocyte. We compared pregnancy rate between normal ovarian reserve patients who undergo a conjugal IUI cycle, with low reserve patients who undergo a donor IUI cycle. When we compared by cycle normal ovarian reserve patients had 11.2% pregnancy rate, while poor ovarian reserve patients had a 6.8% (p = 0.1). When we compared by couple normal ovarian reserve patients had a pregnancy rate of 27.97% while poor ovarian reserve patients had a 21.15% (p = 0.3). Actually, our regional guide excludes poor ovarian reserve woman of an IVF cycle in the public system. Limitations, reasons for caution We had the proper limitations of an observational retrospective study. As we are a public center, we must follow our regional guide which defines whether we can do a treatment or not. Wider implications of the findings Patients with a poor ovarian reserve have a lower pregnancy rate during IUI with donor semen. Nevertheless, this rate could be acceptable especially when we cannot offer them an IVF cycle in public healthcare. Trial registration number Not applicable

P-768 Is it time for a consensus on key performance indicators for cycles involving donation and surrogacy?

Abstract Study question As there are no agreed standards for bench marking in cycles involving donation and surrogacy, how do we measure performance for these treatment types? Summary answer Until an international consensus is undertaken, we must define benchmarks using both in-house and published data from the Human Fertilisation and Embryology Authority (HFEA) register. What is known already Treatment cycles involving donor gametes or surrogacy have increased exponentially in recent years (Horsey, 2023; HFEA, 2020). Key performance indicators (KPIs) are critical for monitoring treatment effectiveness and safety. The Vienna Consensus (2017) is the accepted standard against which clinics should measure performance. However, the publication does not include data on cycles involving donation and surrogacy. In the absence of agreed standards, it is difficult for clinics to measure efficacy for these patient groups. Defining benchmarks for such cohorts is particularly challenging as the gametes used in donation and surrogacy treatment types may come from both fertile and sub-fertile populations. Study design, size, duration Retrospective analysis of anonymised United Kingdom (UK) data, published by the HFEA, from 2014 to 2018, was performed. Outcomes for 26290 donor intrauterine insemination (DIUI), 12262 in vitro fertilisation (IVF), 11341 intracytoplasmic sperm injection (ICSI) and 12453 frozen embryo transfer (FET) cycles, all using donor gametes, were included in this study. In cycles where surrogacy was indicated, gamete origin could not be determined, preventing the data from being included in this study. Participants/materials, setting, methods Using the complete HFEA data set, the average live birth rate, for each treatment type (excluding surrogacy), was calculated. This average was considered the target benchmark when comparing the average live birth rates at the clinic. Each quarter, a rolling 12 months of in-house retrospective data was used to assess clinic performance. Warning and action limits were set using standard deviations calculated using the 5 averages obtained from each year of HFEA data included. Main results and the role of chance The average live birth rates determined using the HFEA data, to be used as benchmarks for performance, were as follows; DIUI (13.7%), IVF (42%), ICSI (37%) and FET (36%). It is noteworthy that live birth rates reported by the HFEA were per embryo transfer (ET), rather than per embryo, meaning more than one live birth could be reported per ET. Discrepancies in outcome reporting meant that the national clinical pregnancy rate could not be determined for all treatment types, nor could fertilisation rate. Therefore, the clinic used in-house data to set benchmarks, action, and warning limits for these donor KPIs. Our findings whilst mining the national published data were that no cycle outcomes had been published beyond 2018, meaning these data may not be reflective of current national rates. Also, the national averages calculated will have been affected by individual clinic success rates. Knowing each clinic’s average would create a larger range, from which real world standard deviations could be determined, resulting in more meaningful warning and action limits. Such data was unavailable. The result being that, whilst UK national data is publicly available, it is flawed and insufficient for creating robust benchmarks that clinics can measure themselves against. Limitations, reasons for caution No national data, beyond 2018, is available for use in bench marking. Waiting for live birth data will delay any actions prompted by under-performance. Individual clinic success rate will have impacted the national average. Both fertile and sub-fertile populations will be included in both data sets. Wider implications of the findings The available UK data cannot be used to set robust benchmarks for donor or surrogacy KPIs. Small and new clinics are therefore unable to adequately measure their performance. With the increasing uptake of treatments involving donation and surrogacy, it is time for an international consensus on expected outcomes. Trial registration number not applicable

Motherhood in Female Same-Sex Couples: Reception of Oocytes from Partner (ROPA method): Review Article

The evolving concept of "family" reflects contemporary social changes, influenced by historical and cultural shifts. This review explores unconventional family models, focusing on same-sex families, particularly female same-sex couples. As advancements in assisted reproductive techniques (ART) empower these couples, the Reception of Oocytes from Partner (ROPA) method gains popularity. ROPA involves active participation of both partners in conception, with one as the oocyte provider and the other as the gestational mother. This review delves into clinical, ethical, and psychosocial aspects of ROPA, comparing it with other ART options like donor intrauterine insemination (DIUI) or in vitro fertilization (IVF). A comprehensive bibliographic search conducted in 2023 forms the basis of this exploration. Historical perspectives on ART's acceptance for same-sex couples, legislative changes, and global variations in donor anonymity are discussed. The ROPA method's procedural details, including donor selection and the roles of the genetic and gestational mothers, are outlined. The review also emphasizes the impact of donor anonymity laws on decision-making. Roles and responsibilities in the ROPA method are explored, with a focus on the reciprocal and reverse ROPA approaches. Medical indications, potential benefits, and the impact on obstetric risks are scrutinized. The review concludes with insights into motherhood in female same-sex couples, highlighting the prevalence of children raised in such families across diverse regions in the United States. This comprehensive examination aims to provide practitioners and patients with valuable insights into the clinical, ethical, and psychosocial dimensions of the ROPA method, fostering a better understanding of its advantages in comparison to other ART options.

P-059 Sperm DNA fragmentation (SDF) after cryopreservation and sperm selection: implications for clinical pregnancies and live births after intrauterine insemination with donor sperm

Abstract Study question Can SDF assessment pre-cryopreservation, post-thaw and after post-thaw sperm selection predict clinical outcome in a heterologous intra-uterine donor insemination program (IUI)? Summary answer SDF increased post-cryopreservation in donor sperm and after post-thaw density gradient without affecting clinical pregnancy, live birth and miscarriage rates. What is known already Sperm cryopreservation is effective for preservation of male fertility and facilitates the storage of donor semen, while infectious disease screening can be completed and confirmed negative. Sperm viability and motility are the most vulnerable parameters during the freeze-thaw process. Inherent reactive oxygen species may induce SDF via oxidative stress. Controversial results are reported regarding induction of SDF after cryopreservation due to differences in cryo tolerance, methods of cryopreservation and methods used to evaluate SDF. Sperm selection post-thaw is indispensable to select a normal motile fraction for insemination. Again, results are controversial regarding influence on SDF levels after sperm selection post-thaw. Study design, size, duration This was a prospective, observational study. Between March 2015 and March 2019, eighteen potential sperm donors were screened via a three step plan – semen assessment, medical assessment and serological blood tests. In accordance with the Belgian legislation (2007), a sperm donor was matched to obtain a maximum of 6 pregnancies in acceptor women/couples, allowing for more than one offspring/woman or couple. A total of 106 acceptors were matched for heterologous intra-uterine insemination. Participants/materials, setting, methods Semen samples were collected after 2-7 days abstinence and standard semen parameters analyzed within 60 mins after ejaculation. Within the same time frame SDF test was performed using TUNEL assay both before and after cryopreservation and after a two-step discontinuous density gradient centrifugation post-thaw. Samples were cryopreserved by the conventional slow freezing method using sperm freeze solution. A yield of ≥ 2 M progressive spermatozoa post-thaw after selection was sufficient to contemplate IUI. Main results and the role of chance Mean female age at first cycle was 33.9 ± 4.1 years and donor age 28.5 ± 5.6 years. Out of 429 cycles, 100 (23.3%) resulted in clinical pregnancy. Excluding three ongoing pregnancies, we counted 75 live births (17.6% of cycles or 77.3% of pregnancies), while 21 pregnancies ended in miscarriage (4.9% of cycles or 21.6% of pregnancies) and 1 resulted in stillbirth. Progressive motility (59.3 ± 12.5%) decreased significantly after cryopreservation (30.0 ± 13.2%; p < 0.001), but increased post-thaw after density gradient centrifugation (61.6 ± 16.0%; p < 0.001). On the contrary, SDF (12.0 ± 5.9%) increased post-cryopreservation (26.3 ± 14.5%; p < 0.001) and further increased after sperm selection (34.9 ± 22.1%; p = 0.04). Using multilevel mixed-effects logistic regression (Odds ratio [95%CI]), we found that female age significantly influenced clinical pregnancy (0.911 [0.847-0.981]; p = 0.01), live birth (0.894 [0.834-0.959]; p = 0.002) and miscarriage rates (1.180 [1.033-1.347]; p = 0.015). There was no significant age-adjusted effect of SDF post-thaw after density gradient selection on clinical pregnancy (1.007 [0.994-1.021]; p = 0.30), live birth (1.001 [0.988-1.014]; p = 0.84) or miscarriage (1.021 [0.997-1.046]; p = 0.08). Median time-to-live birth was 4 cycles. Analyses of time-to-live birth with mixed-effects Cox models revealed no significant association with progressive motility; SDF before or after cryopreservation and after sperm selection post-thaw. Limitations, reasons for caution Results concern a small donor population, with high normal semen parameters and should therefore be extrapolated cautiously to subfertile men with normal and subnormal semen parameters. Wider implications of the findings In a donor IUI program with strict selection on conventional sperm parameters, differences in SDF before and after cryopreservation and gradient centrifugation do not change IUI outcomes, although cryopreservation and centrifugation increase SDF. Findings could be useful for the optimization of sperm freezing and selection in different assisted reproductive procedures. Trial registration number not applicable

Order from chaos: a case report of a healthy live birth from a genetically “chaotic” embryo

To report a case of a healthy, live birth resulting from a "chaotic" embryo (at least 6 chromosomal aneuploidies) after preimplantation genetic testing for aneuploidy (PGT-A). Case report. University-affiliated fertility clinic. A same-sex couple with infertility due to failed donor intrauterine insemination and past implantation failure with invitro fertilization (IVF)/intracytoplasmic sperm injection using donor sperm. Frozen single embryo transfer of a "chaotic" embryo after genetic counseling and informed consent. Live birth of a healthy infant. Controlled ovarian hyperstimulation and transvaginal oocyte retrieval in a 35-year-old female yielded 10 mature oocytes that underwent intracytoplasmic sperm injection with anonymous donor sperm and invitro culture for 6 days. A single embryo underwent trophectoderm (TE) biopsy at the blastocyst stage and was cryopreserved. PGT-A revealed a "chaotic" test result. After genetic counseling and proper informed consent, a frozen single embryo transfer of this "chaotic" embryo resulted in a successful pregnancy and live birth of a healthy male infant. The reproductive potential of embryos with a "chaotic" TE biopsy result is unknown, but herein, we report a healthy, live birth from a "chaotic" embryo. We recommend that patients and providers faced with disposition decisions regarding "chaotic" embryos seek genetic counseling, consider rebiopsy, or consider transfer with informed consent.

P-116 Clinical predictors of live birth rate (LBR) in donor-intrauterine insemination (D-IUI) cycles

Abstract Study question Which clinical parameters can predict LBR in D-IUI cycles? Summary answer Only age returned as a clinical predictor of D-IUI LBR. Total motile sperm count for insemination (TMSC) and stimulation protocol may help clinicians optimise LBR. What is known already D-IUI cycles are a popular treatment option for patients requiring male gamete donation. For both patient and clinician, identification of parameters that can guide clinical decision-making during fertility treatment is important to optimise clinical outcomes. To date, few studies have investigated D-IUI cycle parameters with live birth as the primary outcome. Moreover, previous studies can be limited from lack of control of covariates, as well not accounting for data skewing from inclusion of multiple cycles per patient. Study design, size, duration A retrospective analysis of 1925 D-IUI cycles in 638 patients between 2018-2020 at a single UK-based centre was performed. All donors were recruited by the London Sperm Bank as per the HFEA regulations. Inclusion criteria for donor sperm quality were all samples that met the WHO criteria. Exclusion criteria were cycles where live birth outcome was unknown. Participants/materials, setting, methods Patients underwent natural or stimulation cycle. Stimulation included clomiphene or letrozole, gonadotrophins +/- GnRH agonist, an hCG trigger or LH-monitoring to time insemination and micronised vaginal progesterone for luteal support. Insemination was scheduled 24 hours following surge detection/trigger administration. TMSC is presented per 0.5ml vial, which is post-preparation sample for insemination. T-test for continuous variables and Fisher’s Exact test for categorical variables were performed. For multivariate analysis, a generalised mixed effects logistic regression was performed. Main results and the role of chance Median cohort age was 36 ± SE 0.1, median TMSC was 14x106 ± SE 0.2x106. Of recipients, 53% were same sex couples, 41% were single women, 6.3% were heterosexual couples. There was no significant difference in TMSCs between cycles that produced a live birth and those that did not (14x106 and 13.9x106 respectively, P = 0.1). Dividing TMSC into 5x106 increments demonstrated that small increases in LBR per cycle occurred between 2.5-25x106. On average, LBR increased by 1.3% with each increment up to 25x106, reaching 15%. Beyond this, no further increase in LBR was observed. However, these incremental increases were not statistically significant (P = 0.6). Gonadotrophin stimulation (without agonist) achieved significantly higher LBRs than all other protocols (17.1%, P < 0.001). This persisted when stratifying by age (<35; 30%, 35-37; 29%, 38+; 12.6%). A mixed effects logistic regression model demonstrated that only age returned as a significant negative predictor of LBR (aOR 0.9, 95% CI 0.86-0.94, P < 0.001). There was no effect of TMSC on LBR (aOR 1.0, 95% CI 0.99-1.02, P = 0.7). Gonadotropin stimulation was associated with over double increased odds of achieving a live birth, which came close to significance (aOR 2.29, 95% CI 0.98-5.4, P = 0.06). Limitations, reasons for caution The choice of management regimen could have been influenced by uncontrolled factors, introducing bias in this retrospective study. Other semen parameters were not included in the multivariate analyses which could, in turn, have affected live birth outcome, which should be considered. Wider implications of the findings These findings demonstrate that increasing TMSC may be associated with small rises in LBR up to 25x106 in D-IUI cycles. While gonadotrophin stimulation appeared most effective, only age was shown to be an independent predictor of LBR. Collectively, these parameters may assist clinicians in optimising LBR in D-IUI cycles. Trial registration number None

Effect of Sperm Selection by Magnetic-Activated Cell Sorting in D-IUI: A Randomized Control Trial.

Clinical outcome in assisted reproduction techniques (ARTs) is mainly influenced by the quality of gametes used. It is known that a high percentage of sperm DNA fragmentation (DNAf) decreases the success of ART clinical results. Therefore, techniques such as magnetic-activated cell sorting (MACS) help to improve results in cases of patients with a high percentage of DNAf. Cryopreservation of sperm in donor intrauterine insemination (D-IUI) treatments increases sperm DNAf, so patients using these sperm samples can benefit from using this technique. This prospective randomized national multicenter study analyzed clinical outcomes of 181 D-IUI treatments. MACS was performed after density gradient centrifugation (DGC) in 90 thawed semen donor samples (MACSG), whereas only DGC was performed in 91 thawed semen donor samples (CG). To our knowledge, this is the first study analyzing the effect of MACS on D-IUI cycles. Our results show no significant differences in gestation, live birth, or miscarriage rates between the two groups. We believe that further studies with a larger sample size are needed to evaluate the application of MACS in combination with standard IUI donor sperm preparations in fertility clinics.

Cumulative Live Birth Rates Following Insemination With Donor Spermatozoa in Single Women, Same-Sex Couples and Heterosexual Patients

(Abstracted from Reprod Biomed Online 2020;41:1007–1014) Changes in social attitudes and increasing accessibility of fertility treatment have contributed to an increase in single women and same-sex couples using these services. The majority of the time, these patients are not infertile and favor donor intrauterine insemination (IUI-D), the least invasive and simplest treatment.

Cumulative live birth rates following insemination with donor spermatozoa in single women, same-sex couples and heterosexual patients

Research questionWhat is the cumulative live birth rate (LBR) following donor intrauterine insemination (IUI-D) treatment in a large, retrospective, single-centre cohort of single women, same-sex couples and heterosexual patients? DesignOutcomes from 8922 treatments performed in 3333 consecutive women (45% single, 43% from same-sex and 12% from heterosexual couples) were analysed in a 13-year retrospective study from a private, HFEA-regulated UK centre between January 2004 and December 2016. ResultsA total of 795 live births resulted in an overall delivery rate of 8.9% per cycle, including 24 (3%) twins. Age-specific crude and expected cumulative LBR calculated in four age groups (<35, 35–37, 38–39 and 40–42 years) were 29, 23, 21, 12% and 66, 49, 54, 28%, respectively. A plateau was reached after six cycles, beyond which there were few additional live births. There was no significant difference in cumulative LBR between single women and same-sex couples. In a multivariate analysis, female age (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.90–0.93; P < 0.0001), previous live birth following IUI-D (aOR 2.15; 95% CI 1.69–2.73; P < 0.0001) and mild stimulation (aOR 1.27; 95% CI 1.09–1.48; P = 0.02) had a significant effect on outcome, but relationship status or cycle rank did not. ConclusionsThese results indicate there is little benefit performing more than six cycles of IUI-D in all women up to 40 years old, including those from same-sex relationships, while only three attempts seem reasonable in those aged 40–42 years. These results do not reflect current clinical guidelines in the UK. The authors found that consecutive IUI cycles, especially with mild stimulation, were an efficient treatment in all indications.

Cryos Symposium on Assisted Reproductive Technology

The Cryos Symposium took place on 3rd May 2019 in Aarhus, Denmark, and gave the invited audience from all over the world the latest news and scientific research within the field of assisted reproductive technology. Experts gave educational lectures on important topics within ethics, legislation and donor children, donor sperm and eggs, and genetics, which are the main focus areas of the Cryos International Sperm and Egg Bank. The first speaker was Dr Françoise Shenfield from University College London, London, UK, on ethics and cross-border reproductive care. Next was Prof Susan Golombok, University of Cambridge, Cambridge, UK, who spoke about mother–child relationships and children’s psychological adjustment, which was followed by Ms Emma Grønbæk, a 22-year-old student from Aarhus, Denmark, who shared the personal story of her life as a donor child. Prof Steven J. Ory, Florida International University, Miami, Florida, USA, then presented the International Federation of Fertility Societies’ Surveillance (IFFS) 2019 report: Global Trends in Reproductive Policy and Practice, 8th edition, followed by Mr Ole Schou, the founder of Cryos, who talked about the legal right of every child to know his or her legal parents and spoke of the necessity to change the United Nations Convention on the Rights of the Child. Male infertility was next on the agenda, as Prof Allan Pacey, University of Sheffield, Sheffield, UK, listed five important points to take into consideration regarding male infertility. One of the points raised was the prevalence of sexually transmitted infections, such as human papilloma virus (HPV), which set the stage for Prof Willem Ombelet, Genk &amp; Hasselt Institute for Fertility Technology, Genk, Belgium, to give his lecture on his book titled ‘Intra-Uterine Donor Insemination: Evidence-Based Guidelines for Daily Practice, 1st edition.’ Prof Peter Humaidan, The Fertility Clinic, Skive Regional Hospital, Skive, Denmark, gave his lecture on the many exciting aspects associated with egg freezing, and the Director of European Operations in Cryos, Mrs Saghar Kasiri, talked about the advantages and disadvantages of frozen versus fresh eggs. Prof Joyce Harper, University College London, London, UK, brought up the fact that at least 24 million people around the globe have researched their family tree using online DNA testing databases, leading on to a lecture on genetic screening programme developments within gamete banks by Dr Lone Bruhn Madsen and Lead Clinical Geneticist Dr Henriette Roed Nielsen from Cryos. The symposium ended with Prof Wybo Dondorp, Maastricht University, Maastricht, Netherlands, giving a lecture on expanded genetic carrier screening.

Understanding the Reproductive Experience and Pregnancy Outcomes of Lesbian Women Undergoing Donor Intrauterine Insemination.

The study purpose was to evaluate the reproductive experience, specifically cycle characteristics and treatment outcomes, of lesbian women. In addition, we aimed to determine whether there are differences in pregnancy outcomes when comparing lesbian women undergoing ovulation induction (OI) versus natural cycles with donor intrauterine insemination (IUI), as well as lesbian and heterosexual women undergoing the same assisted reproductive technology treatment. This was a retrospective cohort study including women who underwent an IUI with cryopreserved sperm between 2006 and 2018. The primary outcome of interest was clinical pregnancy (CP) rate. A total of 216 lesbian women (451 natural cycles and 441 OI cycles) and 584 heterosexual women (1177 natural cycles and 1238 OI cycles) were included in the study. Thirty percent of lesbian women had a hysterosalpingogram as part of their initial workup. Approximately 40% of lesbian women who underwent OI/IUI had previously undergone at least one natural cycle/IUI. There was no significant difference in CP rate when comparing lesbian women and heterosexual women undergoing natural or OI/IUI, or when comparing lesbian women who underwent natural versus OI/IUI cycles. However, there was a significantly higher multiple gestation rate among lesbian women undergoing OI compared with those undergoing natural cycles (11.8% vs. 0%, p = 0.01). This large study showed that while pregnancy outcomes were similar between groups, the multiple gestation rate was higher in lesbian women undergoing OI compared with lesbian women undergoing natural cycles.

Implementation of an expanded carrier screening test for recessive genetic disorders in a donor intrauterine insemination program

Implementation of an expanded carrier screening test for recessive genetic disorders in a donor intrauterine insemination program

Family planning for same sex female couples: defining the role of ovulation induction in donor intrauterine insemination cycles

Family planning for same sex female couples: defining the role of ovulation induction in donor intrauterine insemination cycles

Standards in reporting cryopreserved donor sperm characteristics: should they be reported post-thaw or post-wash?

An increase in the reliance on imported donor samples has been the consequence of a continued shortage of UK donors. Disputes can arise between suppliers and purchasers if the sperm quality is not as expected, yet there appears to be no requirement for the standardization of methods for sperm processing or analysis. Following analysis of 102 donor intrauterine insemination cycles, this study demonstrates that the motile sperm concentration is significantly (P < 0.05) reduced after the necessary removal of cryoprotectant before insemination. Suppliers of donor spermatozoa should therefore provide information on standards used for sperm assessment and whether analysis is performed before or after washing in order that purchasers are better informed about the quality of the end product they are committed to buying.

Deficiencies in reporting results of lesbians and gays after donor intrauterine insemination and assisted reproductive technology treatments: a review of the first emerging studies.

At a time when increasing numbers of lesbians and gays consider parenthood using reproductive assistance in infertility centers, the present review aims to summarize the results obtained so far by lesbians after intrauterine insemination (IUI) and in-vitro fertilization (IVF) using donor spermatozoa (D-IUI and D-IVF, respectively) and gays entering into gestational-surrogacy programs. Data show that gays display normal semen parameters and lesbians exhibit no specific causes of female infertility except perhaps for polycystic ovary syndrome (PCOS) and some PCOS-related factors. Pair-bonded lesbians entering into D-IUI programs, tend to have higher pregnancy and delivery percentages following spontaneous or induced ovulation than single or pair-bound heterosexual women. The only single study reporting success percentages of lesbians after D-IVF provides, however, puzzling results. In particular, pair-bonded lesbians have lower pregnancy and live-birth percentages than pair-bonded heterosexual women in fresh D-IVF cycles but percentages are similar in frozen/thawed D-IVF cycles. Like in lesbians after D-IUI, surrogate women recruited by pair-bonded gays/single men tend to have higher pregnancy percentages and lower miscarriage percentages than surrogate women recruited by heterosexual couples. Notably, all the reports reviewed in the present study are methodologically flawed because of sampling bias, small sample sizes and inadequate use of statistical methods to control for the effects of influential covariates including age, smoking habits, previous gynecological problems, hormonal stimulation type and protocol, and number of prior treatment types and pregnancies/deliveries. Clinicians, reproductive biologists and editors of fertility/infertility journals should make efforts to prevent these deficiencies in future data reporting.

Stimulated and unstimulated intrauterine insemination: a retrospective review to optimize pregnancy rates and improve pre-treatment counseling

Quality assessment of cycle specific factors and clinical personnel that may influence pregnancy rates (PR) in infertility patients undergoing partner or donor intrauterine insemination (IUI). We hypothesized that seeking prognostic factors would allow optimization of protocols and counseling to obtain the best PR, lower multiples, and limit cancellations.

A novel and inexpensive thawing device for use in general clinical settings

Intrauterine insemination (IUI) with donor semen is an important option for many patients seeking infertility treatment. While a simple procedure, these IUIs are most commonly offered in ART centers due to a perceived need for laboratory support and standardized conditions. However, with only around 450 infertility programs in the country, many patients do not have ready access to an infertility specialist for this type of entry level infertility treatment. The present study presents a novel semen thawing device (NSTD) which provides a highly controlled thawing environment with minimal input from an operator which would allow generalist to perform donor IUI procedures in a controlled and successful fashion.

Markers of sperm function characterize donors with better fertilization potential, independently of sperm concentration and motility, according to world health organization criteria

Descriptive semen analysis may not be the most accurate method for predicting an individuals fertility potential. In this study, we examined sperm function tests in combination with routine semen analysis parameters and pregnancy outcome (donor intrauterine insemination IUI) to characterize donors with better fertilization potential.

Cumulative livebirth rates (CLBR) in intrauterine insemination (IUI) using donor's sperm related to women's age: a retrospective study in 7.122 cases

OBJECTIVE: The aim of this study was to describe the cumulative livebirth rates (CLBR) in IUI cycles using donor sperm, also evaluating the influence of women's age on the results. DESIGN: Retrospective cohorts study. MATERIALS AND METHODS: We analyzed 7.122 donor IUI cycles underwent on 3137 patients from 1998 to 2009. CLBR and 95% confidence intervals (CI) were estimated by Kaplan–Meier method and curves according to the cycle number. Tarone-Ware and Breslow tests used to compare among curves. Data were analyzed globally, and stratified according to 5 different women's age groups (20-29, 30-34, 35-37, 38-39, 40-45). All women showed a normal fertility work-up including hysterosalpingography. Sperm preparation was performed by density gradient. RESULTS: Overall results showed 26.8%(CI25.8-27.8) of pregnancy rate, 20.4%(CI19.5-21.3) of livebirth rate and 12.9%(CI11.4-14.4) of multiple pregnancy rate. The CLBR increased progressively, from 22.6%(CI21.1-24.1) in the 1st, 38.4%(CI36.5-40.2) in the 2nd, 48.9%(CI46.8-51.0) in the 3rd, 72.6%(CI69.3-75.8) in the 6th and reaching plateau in the 8th cycle (81.2%(CI75.9-86.6). We confirmed an age-related decrease in the success rates, observing a significant decrease in women aged 38-39 from the 1st (14.5%(CI11.1-17.9)), 2nd (26.3%(CI21.6-30.1)), 3rd (35.9%(CI30.3-41.5)), and reaching plateau after the 6th cycle (59.4%(CI4.1-71.7)). This age related effect was more dramatic in women aged 40-45, where only (6.4%(CI3.9-8.9)) in the 1st, (13.9%(CI9.9-17.9)) in the 2nd, (21.2%(CI15.7-26.6)) in the 3rd, and reaching the maximum level in the 5th cycle, with only (36.6%(CI25.9-47.3)) CLBR. CONCLUSION: CLBR provide representative information about the expected success after donor IUI, in order to counsel patients and practitioners about the adequacy of repeating a cycle after failure, or changing to complex assisted reproduction techniques such as IVF. Prognosis decreased significantly in women older than 37, being more important above 40 years old.

Intrauterine insemination

Intrauterine insemination (IUI) with or without ovarian stimulation is a common treatment for infertility. Despite its popularity, the effectiveness of IUI treatment is not consistent, and the role of IUI and in vitro fertilization (IVF) treatment in practice protocols has not been clarified. Medline searches were done by individual topics (utilization, procedures, effectiveness of partner but not donor IUI and related endocrine issues). Effectiveness of IUI was evaluated in relevant randomized controlled trials, using meta-analysis and meta-regression where necessary. Stimulated IUI is ineffective in male infertility and the effect on other diagnoses is small. With clomiphene citrate and IUI, the most common IUI protocol, pregnancy rates average 7% per cycle. FSH ovarian stimulation and IUI treatment is only modestly better than observation only with pregnancy rate 12% per cycle but multiple birth rates averaging 13%. Mildly stimulated (1-2 follicles) cycles might reduce the cost and multiple birth rates but may require more cycles of treatment. Prevention of premature luteinizing hormone surges and luteal phase support do not appear to be major requirements in IUI cycles. IUI treatment requires ovarian stimulation to achieve modest results, but the high multiple pregnancy rates mean that it is no more than a poor substitute for IVF treatment. More trials are needed on IUI treatment with mild stimulation and on the order of IUI and other treatments.