Abstract
Purpose: Our purpose was to investigate the role of the insemination technique used in an artificial insemination program with donor sperm (AID) in multiple pregnancy rates.
Methods: We carried out a retrospective nonrandom analysis of 300 pregnancies corresponding to 300 cycles in women from our Artificial Insemination Donor Sperm Program. All cycles were stimulated with gonadotropins. Single and multiple pregnancy cycles and intracervical and intrauterine pregnant cycles were compared.
Results: Intracervical insemination was performed in 173 cycles (58%), and intrauterine insemination in 127 (42%). Two hundred twenty-three pregnancies were single (74%), and 77 multiple (26%). In multiple pregnancy cycles, initial dose and mean total daily dose of gonadotropins, plasma estradiol levels, and number of follicles≥14 mm were significantly higher compared to those in single pregnancy cycles. Multiple pregnancy rate was significantly higher among pregnancies after intrauterine insemination (32%) than after intracervical insemination (21%).
Conclusions: The intrauterine technique of insemination in AID-stimulated cycles with gonadotropins is related to multiple pregnancy risk.
Key Words: artificial insemination, donor sperm, insemination technique, gonadotropins, multiple pregnancy
Full Text
The Full Text of this article is available as a PDF (360.4 KB).
References
- 1.American Fertility Society Revised new guidelines for the use of semen-donor insemination. Fertil Steril. 1988;49:211–211. [PubMed] [Google Scholar]
- 2.Silva PD, Meisch J, Schauberger CW. Intrauterine insemination of cryopreserved donor semen. Fertil Steril. 1989;52:243–245. [PubMed] [Google Scholar]
- 3.Keel BA, Webster BW. Semen analysis data from fresh and cryopreserved donor ejaculates: Comparison of cryoprotectens cryoprotectans and pregnancy rates. Fertil Steril. 1989;52:100–105. doi: 10.1016/s0015-0282(16)60797-5. [DOI] [PubMed] [Google Scholar]
- 4.Barrat CL, Chauhan M, Cooke ID. Donor insemination—a look to the future. Fertil Steril. 1990;54:375–385. doi: 10.1016/s0015-0282(16)53748-0. [DOI] [PubMed] [Google Scholar]
- 5.Urry RL, Middleton RG, Jones K, Poulson M, Worley R, Keye W. Artificial insemination: A comparison of pregnancy rates with intrauterine versus cervical insemination and washed sperm versus serum swim-up sperm preparations. Fertil Steril. 1988;49:1036–1038. doi: 10.1016/s0015-0282(16)59957-9. [DOI] [PubMed] [Google Scholar]
- 6.Byrd W, Bradshaw K, Carr B, Edman C, Odom J, Ackerman G. A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm. Fertil Steril. 1990;53:521–527. doi: 10.1016/s0015-0282(16)53351-2. [DOI] [PubMed] [Google Scholar]
- 7.Patton PE, Burry KA, Thurmond A, Novy MJ, Wolf DP. Intrauterine insemination outperforms intracervical insemination in a randomized, controlled study with frozen, donor semen. Fertil Steril. 1992;57:559–564. doi: 10.1016/s0015-0282(16)54900-0. [DOI] [PubMed] [Google Scholar]
- 8.Hurd WW, Randolph JF, Ansbacher R, Menge AC, Ohl DA, Brown AN. Comparison of intracervical, intrauterine, and intratubal techniques for donor insemination. Fertil Steril. 1993;59:339–342. [PubMed] [Google Scholar]
- 9.Peters AJ, Hecht B, Wentz AC, Jeyendran RS. Comparison of the methods of artificial insemination on the incidence of conception in single unmarried women. Fertil Steril. 1993;59:121–124. doi: 10.1016/s0015-0282(16)55626-x. [DOI] [PubMed] [Google Scholar]
- 10.Williams DB, Moley KH, Cholewa C, Odem RR, Willand J, Gast MJ. Does intrauterine insemination offer an advantage to cervical cap insemination in a donor insemination program? Fertil Steril. 1995;63:295–298. doi: 10.1016/s0015-0282(16)57358-0. [DOI] [PubMed] [Google Scholar]
- 11.Ripps BA, Minhas BS, Carson SA, Buster JE. Intrauterine insemination in fertile women delivers larger numbers of sperm to the peritoneal fluid than intracervical insemination. Fertil Steril. 1994;61:398–400. doi: 10.1016/s0015-0282(16)56540-6. [DOI] [PubMed] [Google Scholar]
- 12.Wang CF, Gemzel C. The use of human gonadotropins for the induction of ovulation in women with polycystic ovarian disease. Fertil Steril. 1980;33:479–486. doi: 10.1016/s0015-0282(16)44711-4. [DOI] [PubMed] [Google Scholar]
- 13.Pardo M, Barri PN, Bancells J, Coroleu B, Buxaderas R, Pomerol JM, Sabater J. Spermatozoa selection in discontinuous Percoll gradients for use in artificial insemination. Fertil Steril. 1988;3:505–509. doi: 10.1016/s0015-0282(16)59781-7. [DOI] [PubMed] [Google Scholar]
- 14.Makler A. A new multiple exposure photography (MEP) method in routine sperm motility analysis and for research purposes. Fertil Steril. 1980;33:160–166. doi: 10.1016/s0015-0282(16)44537-1. [DOI] [PubMed] [Google Scholar]
- 15.Dodson W, Hughes CL, Haney AF. Multiple pregnancies conceived with intrauterine insemination during super ovulation: An evaluation of clinical characteristics and monitored parameters of conception cycles. AM J Obstet Ginecol. 1988;159:382–385. doi: 10.1016/s0002-9378(88)80089-9. [DOI] [PubMed] [Google Scholar]
- 16.Shelden R, Kemmann E, Bohrer M, Pasquale S. Multiple gestation is associated with the use of high sperm numbers in the intrauterine insemination specimen in women undergoing gonadotropin stimulation. Fertil Steril. 1988;49:607–610. doi: 10.1016/s0015-0282(16)59826-4. [DOI] [PubMed] [Google Scholar]
- 17.Navot D, Goldstein N, Mor-Josef S, Simon A, Relou A, Birkenfeld A. Multiple pregnancies: Risk factors and prognostic variables during induction of ovulation with human menopausal gonadotropins. Hum Reprod. 1991;6:1152–1155. doi: 10.1093/oxfordjournals.humrep.a137501. [DOI] [PubMed] [Google Scholar]
- 18.Balasch J, Ballescá JL, Pimentel C, Creus M, Fábregues F, Vanrell JA. Late low-dose pure follicle stimulating hormone for ovarian stimulation in intra-uterine insemination cycles. Hum Reprod. 1994;9:1863–1866. doi: 10.1093/oxfordjournals.humrep.a138349. [DOI] [PubMed] [Google Scholar]
- 19.Balasch J, Tur R, Peinado A. The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO Group II anovulatory infertile women: Evidence from a large multicenter study in Spain. J Assist Reprod Genet. 1997;13:551–556. doi: 10.1007/BF02066607. [DOI] [PubMed] [Google Scholar]