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A mounting body of the literature suggests that environmental chemicals found in food and water could affect female reproduction. Many worldwide daily-used products have been shown to contain chemicals that could incur adverse reproductive outcomes in the perinatal/neonatal periods, childhood, adolescence, and even adulthood. The potential impact of Bisphenol A (BPA), Phthalates and Perfluoroalkyl substances (PFAS) on female reproduction, in particular on puberty, PCOS pathogenesis, infertility, ovarian function, endometriosis, and recurrent pregnancy loss, in both humans and animals, will be discussed in this report in order to provide greater clinician and public awareness about the potential consequences of these chemicals. The effects of these substances could interfere with hormone biosynthesis/action and could potentially be transmitted to further generations. Thus proper education about these chemicals can help individuals decide to limit exposure, ultimately alleviating the risk on future generations.

The objective of this study was to determine the clinical pregnancy rate with 2 inseminations compared to a single intrauterine insemination (IUI) in a given cycle using frozen-thawed donor sperm. This was a retrospective study at a university practice; patients were women using donor sperm. We conducted a comparison of single IUI, intracervical insemination (ICI) followed by an IUI on the next day, and double IUI (2 consecutive days); clinical pregnancy rate was the main outcome measure. The cyclespecific and total pregnancy rates were not significantly different between the 3 protocol groups (306 cycles). The average pregnancy rate over 3 cycles was 10.2% for IUI, 15.3% for ICI/IUI, and 13.7% for IUI/IUI (P 5 .47). After controlling for repeated measures per subject and age, gravidity, and use of Clomid, there was no significant difference between protocols. The ICI/IUI (odds ratio [OR] 5 1.70; 95% confidence interval [CI], 0.83-3.51) and IUI/IUI (OR 5 1.5; 95% CI, 0.52-4.33) protocols appeared more likely to result in a clinical pregnancy than the single IUI protocol. Current information on the optimal number of inseminations per cycle using donor sperm is limited. Our large study using 3 protocols found an increase in pregnancy rate with the addition of either an ICI or IUI to a single IUI protocol in a natural or Clomid cycle but did not meet statistical significance. Additional prospective studies are needed to better counsel patients using donor sperm.Key words: Donor sperm, intrauterine inseminations, intracervical inseminations, pregnancy rate, Clomid.J Androl 2012;33:375-380 D onor sperm insemination is the first line of treatment for couples with an azoospermic male partner, single women, and same-sex female couples. All donor sperm samples are cryopreserved, allowing for appropriate testing of the donors for infectious diseases. Intrauterine insemination (IUI) or intracervical insemination (ICI) of the frozen-thawed samples can then be performed to achieve pregnancy. The ICI procedure is less invasive, typically using unwashed sperm, and costs less compared to the IUI procedure. A meta-analysis of 7 prospective randomized studies comparing single ICI or IUI using frozen-thawed donor sperm showed that IUI had a significantly higher monthly fecundity rate (odds ratio [OR] 5 2.4; 95% confidence interval [CI], 1.5-3.8; Goldberg et al, 1999). These studies included both natural cycles and treated (clomiphene or injectable gonadotropins) cycles. More recently, a Cochrane systematic review reported significantly higher cumulative pregnancy rates (OR 5 3.37; 95% CI, 1.9-5.96) and live birth (OR 5 1.98; 95% CI, 1.02-3.86) after 6 treated cycles of frozen-thawed donor sperm IUI compared to ICI (Besselink et al, 2008).

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