Pregnancy rates after slow-release insemination (SRI) and standard bolus intrauterine insemination (IUI) - A multicentre randomised, controlled trial.

This multicentre, randomised, controlled cross-over trial was designed to investigate the effect of intra-uterine slow-release insemination (SRI) on pregnancy rates in women with confirmed infertility or the need for semen donation who were eligible for standard bolus intra-uterine insemination (IUI). Data for a total of 182 women were analysed after randomisation to receive IUI (n = 96) or SRI (n = 86) first. The primary outcome was serological pregnancy defined by a positive beta human chorionic gonadotropin test, two weeks after insemination. Patients who did not conceive after the first cycle switched to the alternative technique for the second cycle: 44 women switched to IUI and 58 switched to SRI. In total, there were 284 treatment cycles (IUI: n = 140; SRI: n = 144). Pregnancy rates following SRI and IUI were 13.2% and 10.0%, respectively, which was not statistically significant (p = 0.202). A statistically significant difference in pregnancy rates for SRI versus IUI was detected in women aged under 35 years. In this subgroup, the pregnancy rate with SRI was 17% compared to 7% with IUI (relative risk 2.33; p = 0.032) across both cycles. These results support the hypothesis that the pregnancy rate might be improved with SRI compared to standard bolus IUI, especially in women aged under 35 years.

A new method to process testicular sperm: combining enzymatic digestion, accumulation of spermatozoa, and stimulation of motility.

PURPOSE: In azoospermia processing of the TESE material often results in a sample of reduced purity. This prospective study was set up to clarify whether a combination of enzymatic digestion, density gradient centrifugation and stimulation of motility (where indicated) is a feasible option in TESE patients. METHODS: A total of 63 samples (showing spermatozoa) were processed by the present tripartite processing method. The resulting sperm sample of high purity was directly used for ICSI and subsequent cryopreservation when quality of the accumulated sperm sample allowed for it (n = 39 cycles). RESULTS: Compared to the control group blastocyst formation rate in the present tripartite processing technique was significantly (P < 0.01) higher (55.2 vs. 43.7%). Fertilization rates differed significantly (P < 0.001) between cases in which motile sperm could be used (58.4%) compared to ICSI with immotile sperm (45.0%). Clinical pregnancy rate per transfer was 40.0% (24/60) using fresh and 21.6% (8/37) with cryopreserved TESE material. The calculated live birth rates were 31.7 and 21.6%, respectively. Thirty-five healthy children were born. CONCLUSIONS: A comparison with a control group suggests that the present approach using standardized ready-to-use products is efficient and reliable. Presumably healthy live births further indicate the safety of the procedure.

Novel method for the cryopreservation of testicular sperm and ejaculated spermatozoa from patients with severe oligospermia: a pilot study.

OBJECTIVE: To investigate Volvox globator as an easy-to-handle vehicle and as a safe alternative for cryopreservation of functional motile sperm cells. DESIGN: Prospective, controlled, clinical pilot study. SETTING: Two in vitro fertilization (IVF) outpatient clinics for reproductive medicine. PATIENT(S): Fifteen patients with severe male infertility (density <100 motile sperm per milliliter) who were recruited from two IVF programs. The sperm cells were not intended for clinical use after thawing. INTERVENTION(S): In each case, a predetermined number (n = 8) of motile and morphologically intact sperm cells were injected into each Volvox sphere and then cryopreserved. The quality of the sperm cells and the handling of the Volvox spheres were verified. MAIN OUTCOME MEASURE(S): Postthaw recovery rate in cases of severe male infertility and the amount of motile sperm after thawing. RESULT(S): The postthaw recovery rate was 100%. At least 60% of the sperm cells were motile after thawing. CONCLUSION(S): The use of the spherical algae Volvox globator offers a promising, inexpensive, and easy approach to the cryopreservation of functional motile sperm cells. Volvox globator is an alternative in countries that prohibit the destructive use of oocytes, even after fertilization has failed.