Intrauterine Program Research Articles

92. Outcomes of an Immediate Postplacental Intrauterine Device Placement Program in Adolescents and Young Adults

92. Outcomes of an Immediate Postplacental Intrauterine Device Placement Program in Adolescents and Young Adults

Longitudinal impact of a residency-based postplacental levonorgestrel intrauterine device insertion program: Expulsion rates in years 1, 2, and 3

ObjectiveTo evaluate expulsion rates in the first 3 years of an academic postplacental levonorgestrel intrauterine device (LNG-IUD) insertion program. Study designRetrospective case series, January 2016 to December 2018. We measured LNG-IUD expulsion rates by 12 weeks postpartum. ResultsOf 235 LNG-IUD insertions, in years 1, 2, and 3, expulsion rates were 11/39 (28%), 9/94 (10%), and 15/102 (15%) (p = 0.03). After vaginal delivery, manual insertion was associated with a higher expulsion rate than ring-forceps (10/28 [36%] vs 17/105 [16%], p = 0.04). ConclusionsLNG-IUD expulsion rates decreased after program year 1, suggesting program maturity may be associated with a lower expulsion risk.

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

P–127 Does sperm quality really matter for conceiving through an intrauterine insemination program? A retrospective analysis of 5920 attempts taking into account repetition of cycles

Abstract Study question Are parameters of sperm quality part of the prognosis factors for an infertile couple to obtain a live birth when entering an intrauterine insemination program considering repetition of attempts? Summary answer Paradoxically, a lower sperm morphology independently predict quick live birth through IUI, as well as younger female age, lower D3 FSH, and higher triggering estradiol. What is known already Many studies have highlighted different prognosis factors for obtaining a live birth after IUI involving: male parameters (semen),female parameters (age, parity, ovulation, tubal, and endometriosis status, history of pelvic surgery),couple parameters (duration of infertility, number of previous attempt),IUI parameters (follicle number, endometrial thickness, estradiol at triggering, day of IUI, number of spermatozoa inseminated). However, most of these studies have included small number of attempts, semen parameters were either not collected or assessed with heterogeneity, and repetition of attempts (although iconic for IUI) was not considered, allocating inappropriate weight to cycles which failed in conceiving. Study design, size, duration We retrospectively studied the entire cohort of IUI attempts carried out with partner’s sperm at our center between 09/09/2003 and 01/17/2017. We included all male, female, couple and IUI parameters available. Each basic semen analyzes included have been carried out by a restricted number of skilled andrologists from our center. The closest semen assessment performed before IUI was considered as male parameter. IUI attempts were considered repeated unless a live birth or IUI abandonment occurred. Participants/materials, setting, methods Our primary outcome was live birth occurrence. We included 2228 couples having performed 5920 IUI attempts, with 636 live births obtained. A mixed logistic regression model was used to take into account IUI repetition before obtaining a live birth. A survival analysis using Cox model, with IUI rank as time variable, live birth as endpoint, and taking into account recurrences was carried out to determine which parameter best predict a quick live birth through IUI. Main results and the role of chance Included women were 33.7 ± 4.6 years old in mean. Baseline semen assessment was available for 64% of couples. Muti-variate analysis showed that live birth was more frequent when: Femal factors: age was young (33 to 38yo, OR 0.76 [0.60;0.96], >38 yo OR 0.49 [0.35;0.67], p = 0.0001), FSH ≤ 8.0 (OR 0.59 [0.45;0.79], p = 0.0002), AMH > 8.9ng/mL (OR 0.59 [0.45;0.79], p = 0.0001), endometriosis was absent (OR 0.56 [0.36;0.88], p = 0.0109), the patient already delivered (OR 1.36 [1.06;1.74], p = 0.0034) Male factors: sperm motility ≤26.0% (OR 0.71 [0.53;0.96], p = 0.0062), sperm vitality ≤72.0% (OR 0.65 [0.47;0.90], p = 0.0032), sperm typical form ≤ 25.0% (OR 0.51 [0.34 ; 0.78], p = 0.0016), IUI attempt factors: total dose of gonadotropin > 495.0 (OR 1.54 [1.26;1.88], p = 0.0001) follicle number > 2 (OR 1.23 [1.69;2.21], p = 0.0296), Estradiol at trigerring > 215.0pg/ml (OR 1.90 [1.53;2.36], p = 0.0001), Endometrial thickness >9.6mm (OR 1.43, p = 0.0024), day of IUI >13 (1.53 [1.24;1.89], p = 0.0001). Using Cox model, couples obtained quickly a livebirth if: woman age was below 33yo: For 33 to 38 yo, OR 0.37 [0.25;0.54], p = 0.0001, >38yo OR 0.19 [0.11;0.32], p = 0.0001 D3 FSH<8 (if above, OR 0.55 [0.34;0.90], p = 0.0160) - Sperm typical form ≤25.0 (if above, OR 0.34 [0.20;0.58], p = 0.0001) Triggering estradiol >215.0pg/ml, OR 1.99 [1.51;2.63], p = 0.0001) Limitations, reasons for caution Baseline semen assessment was missing a bit more when cycles were successful, so that a bias connot be excluded. This weird result concerning semen parameters which appear to lower the live birth rate when they are good should thus be considered with caution. Wider implications of the findings: Good baseline semen parameters do not appear as primordial for obtaining an IUI live birth, and were even found deleterious. However, thresholds highlighted in the present study were high, i.e. of limited clinical mean, and semen below them to remain normal. After confirming, explanations should be investigated: excessive acrosome reaction. Trial registration number Not applicable

Intrauterine endogenous high glucocorticoids program ovarian dysfunction in female offspring secondary to prenatal caffeine exposure

Ovarian dysfunction has an intrauterine origin, and prenatal caffeine exposure (PCE) could lead to abnormal follicle counts in offspring after birth. However, the effect of PCE on offspring ovarian function and its mechanism of intrauterine programming have not been reported thus far. In this study, pregnant Wistar rats were intragastrically administered caffeine (30 and 120 mg/kg·d) at gestational days 9–20 (GD9–20). Certain tests were performed on the blood, ovaries and hypothalamus of female offspring at different time points. PCE female offspring had ovarian dysfunction in adulthood compared with the control. Further results showed that in utero ovarian morphological development and estradiol synthesis were inhibited but rapidly increased during puberty in the PCE group. The histone 3 lysine 27 acetylation (H3K27ac) level of the insulin-like growth factor 1 (IGF1) promoter region and its expression were decreased in the ovary, which was due to exposure to high levels of fetal blood corticosterone, and the H3K27ac level of IGF1 and its expression shifted to increase after birth with a decrease in serum corticosterone levels. Chronic stress led to increased serum corticosterone levels in adult offspring, whereas ovarian morphological development, the H3K27ac level of IGF1 and its expression, and estradiol synthesis were significantly inhibited. Moreover, the activity of the hypothalamic-pituitary-ovarian (HPO) axis was increased in the early postnatal period of PCE offspring, and chronic stress reversed these changes. In the KGN cell line, it was found that cortisol could promote the translocation of the glucocorticoid receptor (GR) into the nucleus and upregulate histone deacetylase 10 (HDAC10) to inhibit the H3K27ac level of IGF1 and its expression and estradiol synthesis. In summary, PCE is associated with ovarian dysfunction in female adult offspring, and the potential mechanism is related to intrauterine high glucocorticoid exposure by activating the GR and recruiting HDAC10 to affect ovarian glucocorticoid-IGF1 axis programming and to inhibit estradiol synthesis.

Effects of spray-dried plasma protein in diets of early lactation dairy cows on health, milking and reproductive performance

Spray-dried plasma (SDP) proteins are recognized as safe, high-quality feed ingredients for livestock due to their immune modulatory components, including immunoglobulins, bioactive peptides and growth factors. The objective of this study was to investigate the effects of feeding a SDP product during the first 200 d of lactation on milk production and reproduction performance in dairy cows. Nine hundred ninety-eight Holstein cows, 260 d pregnant, were enrolled in a completely randomized design. Before calving, cows were fed a late gestation ration containing blood meal (BM; 13.3 g/kg of DM; Control; n = 503) or SDP (16.0 g/kg of DM; 250 g SDP/d; n = 495) replacing BM on N basis. After calving, Control cows were randomly distributed in two pens and fed a lactation ration containing 15.6 g/kg BM (DM basis). Cows on SDP were randomly distributed in 2 pens and fed a lactation ration that contained 18.3 g/kg SDP (DM basis. 400 g/d of SDP), which replaced BM. Cows were milked three times per day and milk production and composition were monitored monthly at one milking. First service consisted of a timed AI protocol applied to all cows that were > 44–50 DIM. Following AI, cows were examined daily for return to estrus or for confirmation of pregnancy by rectal palpation at 35–41 and 70–76 d after AI. At 72–78 DIM, cows not pregnant were enrolled into an intrauterine progesterone program. Cows fed SDP had greater milk yield (P < 0.01; 16.8 vs 16.4 kg/milking) and milk fat (P < 0.05; 35.5 vs 34.7 g/kg), but there were no differences in milk protein or in milk SCC between Control and SDP cows. Milk yield improvement in SDP cows was evident during the second month of lactation and onwards. No differences in pregnancy rate, overall conception rate, days at which pregnancy occurred or body condition score were observed between treatments. In conclusion, supplementation with SDP in dairy cows slightly increased milk yield and milk fat content without affecting reproductive parameters.

Validating semen processing for an intrauterine program should take into consideration the inputs, actions and the outputs of the process.

To validate semen preparation via density gradient centrifugation, we took into account the input via the semen sample, the action generated by technical and equipment characteristics and the output measured by the level of performance. Longer periods of abstinence reduced % yield, but increased viscosity and incomplete samples collected had no effect. Under controlled technical and equipment characteristics, precision and reproducibility were validated for density gradient. Additionally, as a good laboratory practice, internal and external quality control measures were implemented to guarantee the level of performance. Inseminating motile sperm count is an important predictive parameter for IUI success. In our group of patients, a yield of an absolute lower limit of 2 million motile spermatozoa was sufficient to contemplate IUI. Pregnancy rate of 13.8% where >2 million rapid progressive spermatozoa were inseminated was significantly higher than the pregnancies (4.4%) obtained with <2 million rapid progressive spermatozoa. This percentage was even higher than the national data registered for IUI (12.2%). To make IUI an attractive first-line treatment, standardization and proper validation of semen preparation procedure are mandatory.

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

The role of superoxide dismutase on pregnancy rates of women undergoing intrauterine insemination

Background: Recently, assisted reproductive technology has been widely accepted as a well-established procedure to treat infertility. Unfortunately, the success rate is still below expectations, whereas the rate of infertility has risen steadily. Intrauterine insemination procedure is the highest performed compared to other procedures, but the success rate is still lowest, around 10%. One cause of failure has been thought to occur due to lack of oocytes and embryos protection from cleaning of oxygen radicals. Reactive oxygen species negatively affect the maturation and interaction of gamete, fertilization, as well as acceleration of pathological states of the reproductive tract. On female reproduction, an antioxidant is essential for the maturation and quality of oocyte, implantation, placentation, fetal growth, and development of the organ. Concentrations of antioxidants have an important role in the reproduction, and interventions to reduce the influence of reactive oxygen species can improve the quality of embryos and their implantation.Objective: To determine the effect of antioxidants (superoxide dismutase [SOD]) in ovarian stimulation response and pregnancy rates in women undergoing intrauterine insemination.Material: Women undergoing intrauterine insemination procedures and who met the criteria of research were randomly and in double-blind divided into two groups, that is, SOD group and placebo group. During ovarian stimulation, 20 patients randomly selected were administered capsules containing 250 mg SOD (glisodin®, Kalbe Pharmaceutical, tbk.) twice a day, and the remaining 20 patients were given the same dose and color capsules containing placebo. Furthermore, ovarian activity and endometrial thickness were monitored by regular transvaginal ultrasound scans. A dose of 5000 U of hCG (Profasi, Serono Pharmaceuticals Ltd., UK) was administered when the leading cohort of follicles reached a diameter of 18–22 mm. Intrauterine insemination with prepared sperms was then performed 34–36 hours following hCG using Friedman catheter. Biochemical pregnancy is determined at day 15 after insemination with the cut-off point 25I U/mL. The data are compared between two groups and analyzed using SPSS 16 with a 95% confidence interval.Result: Forty women underwent intrauterine insemination cycles, with 20 cycles administered to each group, SOD and placebo. There were five (12.5%) positives for chemical pregnancies, four (80%) in SOD, and one (20%) in placebo. The pregnancy rates tend to be higher in the SOD group than in the placebo group, even though it was not significantly different (p = 0.151). The ovarian stimulation determined by the number of growing follicles and endometrial thickness showed that more follicles (≥ 6 follicles) were found in SOD group (n = 10, 58.8%) than in placebo (n = 7, 41.2%); however, it was not statistically significant (p = 0.075). Endometrial thickness of 10 mm or more is statistically significant (p = 0.017), which is higher (79.2%) in SOD compared with placebo (20.8%) and yields significantly (p = 0.0251) greater pregnancy rates (n = 4, 80%) than placebo (n = 1, 20%).Conclusions: SOD provides better stimulation response and increased pregnancy rates in intrauterine insemination program.

Couples dropping out of a reimbursed intrauterine insemination program: what is their prognostic profile and why do they drop out?

To evaluate whether baseline characteristics and prognostic profiles differed between couples who drop out from intrauterine insemination (IUI) and couples that continue IUI, and the reasons for couples dropping out from IUI programs. Retrospective observational cohort study. Fertility centers. Consecutive subfertile couples undergoing IUI. None. Characteristics and prognosis of ongoing pregnancy after IUI at the start of treatment of couples that dropped out compared with couples that continued treatment or achieved an ongoing pregnancy. We studied 803 couples who underwent 3,579 IUI cycles of whom 221 couples dropped out (28%). Couples dropping out completed 2.8 (SD ±1.4) cycles per couple compared with 4.5 (SD ±2.3) cycles per couple for those continuing treatment. Couples dropping out had a higher female age, longer subfertility duration, and higher basal FSH. Mean prognosis to achieve an ongoing pregnancy after IUI at start of treatment was 7.9% (SD ±2.4) per cycle for couples who dropped out and 8.5% (SD ±2.5) per cycle for couples continuing treatment. Of the dropouts, 100 couples (45%) were actively censored from the IUI program, 87 couples (39%) because of poor prognosis; 121 couples (55%) were passively censored from the program, of whom 62 (28%) dropped out owing to personal reasons; 59 couples (27%) were lost to follow-up. We found significant differences in prognostic profile between couples continuing treatment and couples dropping out, although these differences seem limited from a clinical perspective. We conclude that overestimation of ongoing pregnancy rates after IUI due to couples dropping out is limited.

Improved reproductive response of sheep in intrauterine insemination program with the use of royal jelly

The objective of the present study was to evaluate estrus and conception rates obtained with the use of progesterone (P 4 ) cream in intravaginal sponges in conjunction with equine chorionic gonadotropin (eCG) or eCG plus royal jelly (RJ) given at the time of sponge withdrawal. A total of 365 fat tailed ewes were assigned randomly to two treatment groups: insertion of intravaginal sponge containing 30 mg (LNP; n = 188) or 60 mg (HNP; n = 177) progesterone for 12 days. For each treatment, 300 or 600 IU of eCG were compared with 100 or 300 IU of eCG plus 500 mg of RJ to assess the effect on reproductive parameters of ewes inseminated laparoscopically in the anoestrus season. Ewes in each group were inseminated with fresh diluted semen (10 × 10 7 sperm per insemination dose). Inseminations were carried out 11 to 18 h after the first detection of estrus. Pregnancy diagnosis was done at approximately 55 days after insemination. For the 30 and 60 mg natural progesterone treated groups, estrous (22.3 versus 30.5%) and conception rates (50.0% for both treatments) did not differ significantly. Ewes that received 300 IU eCG plus 500 mg RJ had higher (P>0.05) conception rates (66.7 versus 47.6 and 40.0%) than those treated with only eCG (300 or 600 IU) at sponge removal. There was a significant (P≤0.05) delay in onset of estrus in ewes treated with 100 IU eCG plus 500 mg RJ when compared with the other treatment groups. Keywords: Royal jelly, equine chorionic gonadotropin (eCG), natural progesterone, artificial insemination, ewe

Reproductive response of ewes synchronized with different lengths of MGA treatments in intrauterine insemination program

A total of 415 fat tailed ewes were randomly assigned to two groups to assess the effect of duration of melengestrol acetate (MGA) (9 versus 12 d) administration on reproductive parameters associated with laparoscopic artificial insemination. At the end of MGA treatment, ewes in each group were subdivided and inseminated with one of two different insemination doses (10 × 10 7 or 20 × 10 7 sperm per 0.5 ml insemination dose) of fresh diluted semen. Inseminations were carried out 11–18 h after first detected estrus. Ewes were screened for their return to oestrus from 10 to 21 days post AI and inseminated at their returned oestrus. Pregnancy diagnosis was done from approximately 55 days after insemination in both synchronized and return estrus. For short (9-day) and long (12-day) term MGA treated groups, estrus rates were 62% versus 89% ( P < 0.0001), respectively. Ewes ( n = 115) that returned to estrus were inseminated (7–11 h after estrus detection) with fresh diluted semen at different doses (20 × 10 7 or 40 × 10 7 or 60 × 10 7 sperm per 0.5 ml insemination dose). Pregnancy rates were 41% and 44% for short term and long term MGA treated ewes, respectively. Pregnancy rate of ewes which returned to oestrus was 53.4%. There was a significant ( P < 0.05) increase in pregnancy rates (38–52% for 11–16 h; 63% for 17–18 h) when insemination was held at 17–18 h after first detected estrus following MGA treatments. Pregnancy rates were found to be similar in ewes inseminated with 10 × 10 7 (36%) or 20 × 10 7 (47%) motile spermatozoa at first AI, and 20 × 10 7 (44%) or 40 × 10 7 (59%) or 60 × 10 7(48%) at second AI. It was concluded that short term MGA treated ewes were recorded with lower estrus rates but was similar to pregnancy rates with long term MGA treatment. Acceptable pregnancy rates were achieved in MGA induced estrus when insemination is conducted at 17–18 h after estrus onset and with 20 × 10 7 sperm per insemination dose.

Corpus Luteum Morphology and Vascularization Assessed by Transvaginal Two-dimensional and Three-dimensional Ultrasound

Abstract Background Our aim was to describe the corpus luteum morphology by two-dimensional ultrasound correlated by its vascularization and volume by 3D ultrasound and study the possible relationship between serum progesterone levels and the corpus luteum morphology. Methods Thirty-eight women were included in an intrauterine insemination program (IUI) in Santa Cristina University's Hospital. All the patients were evaluated in mesoluteal phase, the day +7 after hCG administration, by two-dimensional and three-dimensional ultrasound. The volume and vascular indices of the corpus luteum were calculated off-line using virtual organ computer-aided analysis (VOCALTM) software. Results Four different morphologies were described in the corpus luteum: echo-positive, echo-negative or sonoluscent, mixed echogenicity or nonvisible. Corpus luteum with mixed echogenicity was the most frequent one with 37.5% (12 cases). The corpus luteum vascular indices change in each morphology type, but there was statistically significant association just in vascularization index between echo-negative and mixed echogenicity corpus luteum morphologies, with p = 0.034. The rest of vascular indices do not change in each morphology corpus luteum types. There was statistically significant difference in mean gray value between echo-negative and mixed echogenicity morphologies, with p = 0.007. There were no statistically significant correlations between the corpus luteum morphology and the corpus luteum volume of any of the different types. There either was no statistically significant correlation between the corpus luteum morphology and progesterone serum levels on day +7 postovulation. Conclusions The mixed echogenicity corpus luteum morphology has more vessels and more cell mass than echo-negative ones. Progesterone serum levels in mid-luteal phase has no influence in corpus luteum morphology and vascularization.

Doppler study of arterial and venous intraovarian blood flow in stimulated cycles.

To evaluate arterial and venous intraovarian blood flow in follicle stimulating hormone-stimulated cycles. This was a prospective study of 76 follicle stimulating hormone-stimulated cycles carried out in 39 infertile patients who were included in a timed intercourse or intrauterine insemination program in a referral center for assisted reproduction. Transvaginal color and pulsed Doppler measurements of the follicular and luteal phase resistance index, pulsatility index, peak systolic velocity and maximum venous velocity were made and serum progesterone levels during the mid-luteal phase were recorded. Velocimetric parameters were established and then used to classify ovarian function as having a normal ovulatory cycle, or a cycle in which there was either luteal phase deficiency or a luteinized unruptured follicle. In 52 normal ovulatory cycles, the luteal phase peak systolic and maximum venous velocities were significantly higher and resistance and pulsatility indices were significantly lower than those found in the follicular phase. In 15 women with luteal phase deficiency we did not find any differences in arterial velocimetric parameters when compared with normal ovulatory cycles. However, luteal phase maximum venous velocities were lower in the luteal phase deficiency cycles and there was a significant correlation between luteal phase maximum venous velocity and serum progesterone levels (r = 0.36). Luteinized unruptured follicle cycles (n = 9) did not show significant changes during the ovarian cycle and no 'luteal conversion' of the Doppler signal was identified. Follicle stimulating hormone-stimulated cycles in infertile patients can have a high percentage of abnormal functional responses that can be diagnosed only by sonographic assessment, Doppler and the appropriate hormonal follow-up. Arterial and venous intraovarian blood flow remain unaltered during luteinized unruptured follicle cycles and serum progesterone levels correlated with luteal phase maximum venous velocity, which makes Doppler a potentially useful non-invasive test to assess ovulation and luteal function.

Evaluation of the ZSC semen preparation method for “in-office” use in an intrauterine insemination program

Objective: Treatment of infertility has greatly increased the number of options available for both the infertile couple and the infertility specialist. For the male, improvements in sperm quality have involved the use of various techniques, which aim to recover only healthy spermatozoa that can be used for intrauterine insemination (IUI). In this study, we assessed the efficiency of the ZSCII method for “in-office” preparation of human spermatozoa for IUI.Materials and Methods: Specimens (n = 65) were collected at intercourse, evaluated, and processed via the ZSC method. The ZSC consists of a column with a conical cavity at the bottom where the semen is placed, and from where the sperm swim-up into the over-layered media and are recovered at the end of the procedure. Sperm measurements were assessed at semen collection, and after ZSC sperm preparation before IUI.Results: Semen measurements showed normal parameters at collection. Sperm quality improved significantly after the ZSC procedure was applied (P >0.03). Adequate numbers of motile spermatozoa were recovered (27.6 ± 4.3 × 106) for the IUI procedure. Also, the ZSC method was shown to be an easy and effective method for sperm preparation for “in-office” use in an IUI program.Conclusions: The ZSC technique yielded satisfactory total motile sperm numbers that makes it quite appropriate for preparing specimens from patients for IUI in an “in-office” setting. The total motile sperm data suggest that, with adequate ovulation induction and monitoring, along with proper semen placement at the time of the IUI, it could yield satisfactory fertilization and pregnancy rates.

Timed intercourse after intrauterine insemination for treatment of infertility

Objective: To compare the pregnancy rates, between intrauterine insemination (IUI) followed by timed intercourse and IUI only for treatment of the infertile couples. Study design: A prospective study of two different protocols of intrauterine insemination in two hundred and one infertile couples with a normal spermiogram was carried out. Of these, 101 couples were treated with IUI alone and 100 couples had both IUI and timed intercourse within a 12-18 h period. The pregnancy rates were compared between groups. Results: The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group ( P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40×10 6) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (≥40×10 6) (25.7% versus 22.7%, P=0.671). Conclusions: In IUI with low number of motile sperm inseminated, timed intercourse significantly increases the pregnancy rates over IUI alone in infertile couples with a normal sperminogram. This alternative treatment appears to be a practical, simple, and inexpensive addition that improves the pregnancy rate in patients receiving ovulation induction and intrauterine insemination program.

A large-scale program in laparoscopic intrauterine insemination with frozen-thawed semen in Australian Merino sheep in Argentine Patagonia

This report shows the results of a large-scale laparoscopic intrauterine insemination program on a flock of Australian Merino sheep in Argentine Patagonia. The study was carried out on a total of 1824 ewes (3-to-7-yr-old) and 480 ewe hoggets (19–20 months old) on 2 farms in the southeastern region of Santa Cruz Province, in April and May 1996. The animals, divided into 15 groups, were synchronized with vaginal sponges containing 60 mg medroxyprogesterone acetate for 14 d and injected with 200 IU PMSG upon sponge removal. Estrus was screened every 12 h by means of vasectomized marker rams. The animals were inseminated laparoscopically by the intrauterine route using 2 schemes: 1) at a fixed time (12 h) after estrus detection, or 2) at a fixed time (60 h) after sponge removal irrespective of estrus. Pregnancy was determined at 30 d by transrectal ultrasound imaging. The results showed that 1) the onset of estrus occurs most often between 24 and 48 h after sponge removal, 2) ewe hoggets undergo estrus significantly earlier than sexually mature ewes, 3) in those animals showing estrus, there appears to be no relationship between fertility (as assessed by pregnancy outcome) and time of estrus, 4) there is a significant association between the percentage of estrus occurrence and pregnancy rate, 5) fertility is significantly higher in ewes than in hoggets, 6) for practical purposes insemination at a fixed time after the onset of estrus has no advantage over that of to insemination at a fixed time after sponge removal. It is concluded that large-scale laparoscopic intrauterine insemination can be successfully applied in Australian Merino ewes and ewe hoggets in low-productivity areas such as that of Argentine Patagonia and that estrus detection is unnecessary when insemination is performed at 60 h after sponge removal.

Adjunctive agents in ovulation induction

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The effect of consecutive day inseminations on semen characteristics in an intrauterine insemination program

This study demonstrates a statistically significant decrease in semen volume, sperm concentration, and sperm motility in samples obtained on the 2nd day of consecutive day inseminations in an IUI program. This diminution in semen characteristics persists despite sperm washing. The effects of a second ejaculation on semen parameters in oligospermic and asthenospermic men were mixed. Thus, in general, sperm-washing procedures cannot overcome the natural reduction in semen quality produced by frequent ejaculations. Clinicians may wish to use this information in timing IUI cycle inseminations.