Andrology: Strategies in frozen donor semen procreation

Abstract

Data were analysed from 710 couples who had been assessed to determine the effectiveness and the drawbacks of three different methods of insemination using frozen donor semen. Intracervical insemination (ICI) was the first method used when the women had no tubal disorder: 255 pregnancies were achieved in a total of 2558 cycles (10%). Intrauterine insemination (IUI) associated with ovarian stimulation resulted in 152 pregnancies over 966 cycles (16%). In-vitro fertilization (IVF) was proposed after approximately 12 insemination failures using either of the other methods or when the initial gynaecological examination had revealed abnormalities such as tubal occlusions; 48 pregnancies were obtained in 262 cycles (18.3%). The pregnancy rate using ICI was significantly higher when two inseminations were performed per cycle, compared with one insemination per cycle (12.3 versus 7%, P < 0.001). The number of motile spermatozoa per straw was correlated with the pregnancy rate when using ICI, rising from 9% with < 4 x 10(6) motile spermatozoa to 13.8% with 4-8 x 10(6) and 17.2% with > 8 x 10(6). No relationship was found between the number of motile spermatozoa and the pregnancy rate using IUI and IVF. The incidence of primary ovulatory disorder was higher among women whose husbands were oligozoospermic than among those whose husbands were azoospermic (19 versus 9%, P < 0.01), but ovarian stimulation improved the fecundity of subfertile women. The outcome of pregnancies was also analysed for the three methods. From these data, strategic plans have been proposed to maximize the pregnancy rate for women undergoing therapeutic donor insemination with frozen semen.

Optimization of IVF pregnancy outcomes with donor spermatozoa

“…Furthermore, there were no significant differences in the pregnancy rates observed comparing IVF cycles using cryopreserved donor to freshly ejaculated spermatozoa. These findings are also consistent with the results of prior studies [2,[5][6][7]. However, the negative findings must be interpreted with caution since this study did not have sufficient power to detect pregnancy rate differences less than 20% between cases and controls due to the limited number of IVF cycles using donor spermatozoa.…”

Frozen-thawed rhesus sperm retain normal morphology and highly progressive motility but exhibit sharply reduced efficiency in penetrating cervical mucus and hyaluronic acid gel

“…A strong positive correlation between post-thaw progressive motility and pregnancy outcome following intracervical insemination (ICI) has been demonstrated [39,40,41]. While IUI greatly improves pregnancy outcomes with cryopreserved sperm [42,43], conception rates still lag behind those achieved with fresh sperm IUI [14], presumably because sperm must still migrate through upper reproductive tract mucosal fluids and penetrate oocyte vestments.…”

“…While IUI greatly improves pregnancy outcomes with cryopreserved sperm [42,43], conception rates still lag behind those achieved with fresh sperm IUI [14], presumably because sperm must still migrate through upper reproductive tract mucosal fluids and penetrate oocyte vestments. As with ICI, post-thaw progressive motility can be predictive of success with IUI, although the strength of correlation appears to be less [41,44,45,46]. …”

Insémination artificielle avec sperme congelé de donneur

“…À partir de 36-37 ans il est observé une diminution de la fertilité féminine, justifiant le recours aux IA intrautérines. Ces données ont permis de proposer une stratégie en matière d'AMP avec don de sperme [9,10] :…”

“…Comparaison des IA intra-cervicales et intra-utérines avec sperme congelé de donneur[6][7][8] Nombre de spermatozoïdes mobiles par paillette en insémination artificielle (d'après[9]) tation du risque de grossesse multiple diminue l'intérêt de cette méthode. Au total 211 accouchements soit 80 % ont été observés chez ces 266 couples.…”