INTRAUTERINE INSEMINATION IN 1131 CYCLES
Intrauterine insemination with donor semen. An evaluation of prognostic faxtors based on a review of 1131 cycles. Mohammed Rohi Khalil MD, Per Emil Rasmussen MD, Karin Erb MSc, Steen Broch Laursen MSc, PhD, Sven Rex MD, Lars Grabow Westergaard MD, DMSci. The Fertility Clinic, Odense University Hospital, Odense, Denmark. Acta Obstet Gynecol Scand 2001; 80: 342-348.
ABSTRACT
Objective: To identify prognostic factors influencing the outcome of infertility treatment using intrauterine insemination with donor semen (IUI-D). Design: Retrospective study of all patients undergoing IUI-D between August 1st, 1990 and July 31st, 1998. Setting:University-affiliated infertility clinic. Patients: Three hundred five couples undergoing 1131 IUI-D treatment cycles. Main outcome measures: Type of hormonal treatment, number of follicles, length of follicular phase, endometrial pattern, female age, infertility diagnosis and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. Results: Throughout the nine year period the overall clinical pregnancy rate per cycle was 22.3% with an increase from 12.9% in 1990 to 34.6% in 1998. The multiple birth rate was 20.6%. The birth rate per couple was 61.1% after a mean of 3.2 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the sixth treatment cycle. The following parameters were positively and significantly correlated to a successful outcome of IUI-D: i) the first treatment cycle – compared to the following up to six treatment cycles; ii) number of mature follicles – more than one - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies with more than 3 mature follicles; iii) time of insemination after the 12Th day in the cycle; iv) insemination after ovulation and; v) female age under 30 years. Conclusions: IUI-D is a simple and inexpensive treatment giving acceptable pregnancy rates for up to six treatment cycles if at least 2 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, and ovulation has occurred at the time of insemination, which ought to take place after cd 12 with at least one million motile spermatozoa.

We often hear very different requirements from clinics regarding the required amount of sperm especially for IUI inseminations. Extensive research and result from years of successful use of our donor sperm in Scandinavian has shown that 2 million motile spermatozoa per ml. are sufficient:

The number of motile spermatozoa used for insemination were not predictive of IUI-D outcome as long as at least 2 million motile spermatozoa were used. This is in agreement with the results published by Pittrof et al. (6) – (Taken from the same article as above).

The straws will start to thaw after 5 seconds in open air, and therefore it is extremely important that they are transferred into liquid nitrogen as quickly as possible. To preserve quality it is important keep sperm in nitrogen at all time even during control of the specimen. We recommend that a sorting bucket is used even for transfer and control of straws. This will give the necessary time to control the deliveries and avoid accidental thawing.

All our samples are stored in CBS high security straws.

If spermatozoa are to be washed in any way, the thawed specimen must be diluted slowly using stepwise addition of culture medium (ideally a HEPES-buffered medium, to avoid pH shifts that could occur). For donor semen add 5-times volume of sperm buffer slowly drop-wise to begin with, and then in increasingly larger volumes as the sample is progressively diluted, and not exceeding 1/10 of the current volume of the diluted specimen. Optimum yields will be achieved using a SpermFilter gradient medium or equal product.

If spermatozoa are is inseminated intra-cervical or into the uterine cavity with IUI-ready straws then a dilution is not necessary.