An evaluation of semen analysis and in-vitro tests of sperm function in the prediction of the outcome of intrauterine AIH

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Abstract
Twenty-nine couples with an average of 5 years of infertility were selected for treatment by intrauterine insemination of washed semen (AIH). The criteria for selection were (i) the female partner showed no detectable fertility disorders by routine screening; (ii) the male partner showed subnormal semen quality on conventional semen analysis. Ovulation was stimulated uniformly with clomiphene citrate and precipitated with human chorionic gonadotrophin (HCG). Inseminations were performed 31–32 h post-HCG, with the day of HCG determined by ultrasound monitoring of follicular development. The fertilizing capacity of the male partners‘ spermatozoa was tested in vitro using donated human oocytes and/or the zona-free hamster oocyte penetration assay. Up to eight cycles of AIH were alternated with cycles of natural intercourse. While no pregnancies occurred in the group during normal coital cycles, the AIH pregnancy rate was 17% per couple, but only 3% per insemination cycle. Four further pregnancies were achieved spontaneously in couples from the study group within 3 years of completion of the AIH therapy and four patients became pregnant following subsequent GIFT or IVF treatments. Neither of the in-vitro tests was helpful in predicting the outcome of AIH, spontaneous pregnancy nor of subsequent assisted conception procedures.

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