A total of 110 consecutive women was studied prospectively at the time of transcervical embryo transfer following conventional in-vitro fertilization and intracytoplasmic sperm injection procedures. Microbiological cultures were performed on endocervical swabs and embryo transfer catheter tips. Positive microbial growths were observed from endocervical swabs in 78 (70.9%) women and from catheter tips in 54 (49.1%) women. The clinical pregnancy rates were 57.1% in the group of patients without growth and 29.6% in the group with positive microbial growth from catheter tips. As microbial contamination at embryo transfer may influence implantation rates, prospective studies are justified to determine whether eradication of endocervical micro-organisms is possible and whether their eradication will improve implantation rates.

Infertile couples seeking treatment will endeavour to obtain the highest standards of care at a conveniently located centre. The success rated of a centre would also be an important concern. The busier in-vitro fertilization (IVF) units (> 400 cycles per year) have substantially higher pregnancy rates than those carrying out < 300 cycles per year. We report our experiences at the IVF centre, Maternity Hospital, Kuwait of mimicking the high level of activity of a large IVF unit. Infertile couples were treated in groups of 30-35 every 4-6 weeks. Patients in each group had menstrual cycles synchronized to their luteal phase using progestogens. Thereafter they were down-regulated with gonadotrophin-releasing hormone agonist (long protocol). Oocyte retrieval and embryology activities were concentrated and completed in 7-10 days in each group. This episodic high level of activity was aimed at mimicking that of a busy large IVF centre, although continuous in the latter. The overall results in terms of fertilization cleavage, implantation and clinical pregnancy rates were similar to those obtained in large IVF units. The clinical pregnancy rate per cycle was 25.8-39.1% in IVF and 46.1% in intracytoplasmic sperm injection.

Two hundred and fifty infertile couples and 102 fertile controls were evaluated to determine the association between ABO blood group status and seminal blood group substances among infertile couples and expression of circulating antisperm antibodies. Antisperm antibodies occurred in 18.8 and 17.7% of the infertile men and women, compared to 3.9% in the fertile women (p < 0.01). The 23 ABO blood group combinations in the infertile and fertile couples revealed no significant association with infertility except the predominance of B+/O+ spouses in the fertile group (p < 0.03). Although 76.8% of the men were secretors of seminal blood group substances, there was no significant association with development of antisperm antibodies. This shows that ABO blood group is not directly associated with infertility nor antisperm antibody formation.

Selecting embryos for transfer on the basis of their morphology does not appear to reduce the risk of chromosomal abnormality in these couples.

The value of intra-uterine insemination (IUI) coupled with superovulation was studied in two groups of couples infertile because of male subfertility. IUI was carried out on 38 women during 78 treatment cycles after stimulation of ovulation with Clomid and human menopausal gonadotrophin (HMG) and on 29 women during 79 treatment cycles without stimulation. The pregnancy rate per patient (28.9%) and per treatment cycle (14.1%) was significantly higher in the stimulated group (p = 0.05 and p = 0.01, respectively). This could be attributed to a significantly higher number of follicles recruited (p < 0.001), since there was homogeneity between the two groups for other confounding factors. It is concluded that superovulation improves the pregnancy rate in couples with male subfertility treated with IUI.