Effects of four methods of sperm preparation on the motile concentration, morphology, and acrosome status of recovered sperm from normal semen samples.

PURPOSE: This prospective study compared the effects of four sperm preparation methods on semen samples with normal sperm parameters. The samples were obtained from husbands of infertile couples being evaluated at a fertility center in New York City. Twenty-nine of 51 men in the study (56.9%) had fathered a child within the past 2-5 years. Specifically, the study compared the effects of simple wash (unselective) and three selective methods--conventional swim-up, three-gradient Percoll separation, and swim-up from the Percoll-separated fraction--on the concentration, percentage motile, percentage normal (oval) morphology, percentage intact acrosomes, percentage motile sperm recovery, and motile sperm concentration in the processed samples. The same parameters were measured in the untreated ejaculate, resulting in five data sets. These data were analyzed by both comparison across the five sets and pairwise multiple comparisons between sets. RESULTS: The study showed that of the selective methods, conventional swim-up and Percoll separation yielded comparably optimal percentages motile sperm recovery and motile sperm concentrations. CONCLUSION: However, swim-up yielded a significantly higher percentage oval and percentage motile sperm than Percoll, while Percoll had a significantly higher percentage acrosome-intact. Swim-up after Percoll separation yielded the highest percentage motility and percentage oval but had the lowest motile sperm concentration with the lowest percentage acrosome-intact.

Importance of total motile oval count in interpreting the hamster ovum sperm penetration assay.

A prospective study relating computer-assisted semen analysis (CASA) and technician-determined morphology to sperm penetration assay (SPA) outcome in patients with unexplained infertility or male factor was undertaken on 190 males aged 28-45 to determine the value of total motile oval count (TMO), compared to concentration, motility, and morphology considered independently, in predicting the outcome of the SPA. Prewash sperm count ranged 20-1,328 x 10(6), motility 0-93%, morphology 25-78% oval (%OVAL), and SPA scores 0-100%. Multiple regression analysis yielded two statistical models that identified significant predictors for % penetration (%P). Only TMO in one model and %OVAL in an independent effects model showed statistically significant correlation (P < 0.0001) to %P for all subjects. Discriminant function analysis showed the TMO model 85.4% accurate in classifying %P both in the abnormal range (< 20%P) and in the normal range (> or = 20%P). The independent effects model correctly classified 93% in the abnormal group, but projected 72 false negatives in the 101 subjects with %P > or = 20%, correctly classifying only 28.7%. Relative risk analysis showed TMO as a stronger risk factor affecting SPA outcome than %OVAL. It is concluded from this study that below 20%P, both TMO and %OVAL appeared to be comparable as predictive factors. Additionally, the TMO model was equally predictive for SPA > or = 20%P, where the independent effects model showed only 28.7% accuracy. SPA outcome appeared to be more profoundly affected by a decrease in TMO than by a decrease in %OVAL alone.

A prospective study of intrauterine insemination of processed sperm from men with oligoasthenospermia in superovulated women.

The effectiveness of intrauterine insemination (IUI) was compared with that of intracervical insemination (ICI) in 49 infertile couples, in whom the major cause for infertility was oligoasthenospermia. All women had ovulation stimulated with either a clomiphene citrate (CC)-human gonadotropin combination or human gonadotropins alone. The ovulatory dose of human chorionic gonadotropin (hCG) was given after adequate estradiol levels were reached. The timing of inseminations was standardized--IUI was 28 hours after hCG and ICI was immediately after hCG administration. Only one insemination per month was performed with either IUI or ICI. The first treatment cycle was assigned randomly to be either IUI or ICI, and subsequent inseminations were alternated. A total of 182 cycles were completed, with 96 IUIs and 86 ICIs. Pregnancy occurred in eight patients, seven with IUI (14.3%) and one with ICI (2.0%); the difference is significant at P less than 0.05. The pregnancy rate per treatment cycle was 7.3% versus 1.2% (P less than 0.001). This study supports the use of IUI with processed sperm in the treatment of infertility due to oligoasthenospermia.

The initial experience with the use of a portable infusion pump in the delivery of human menopausal gonadotropins.

The initial experience with the use of a portable infusion pump for the delivery of human menopausal gonadotropins (hMG) in the therapy of ovulation dysfunction of women who failed to conceive following (1) either clomiphene citrate (five patients with polycystic ovary syndrome) or danazol (three patients with mild endometriosis) and (2) standard intramuscular hMG-human chorionic gonadotropin therapy is reported. In six of these patients this approach was used because of suboptimal response of serum estradiol levels to standard hMG therapy, and all six patients had an increase in estradiol response with infusion therapy; therapy duration and total dosage of hMG were similar in both treatment modalities. Sonography suggested stimulation of several follicles with infusion therapy. Advantages and disadvantages of the use of the infusion pump for hMG therapy are discussed. In conclusion, hMG therapy via the infusion pump is feasible. This mode of administration appears to lead to more satisfactory follicular development in selected patients. Multiple follicular stimulation is to be expected. Self-administration of medication is readily achieved by the educated patient. Further consideration and exploration of hMG infusion therapy is suggested.