Transmission of disease during artificial insemination.
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The progress of 80 couples who failed to conceive by donor insemination was followed through in vitro fertilization cycles using donor sperm. The outcome was better than that for couples undergoing IVF for tubal disease and significantly better than their chance with further cycles of donor insemination.
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A total of 5461 insemination cycles with frozen donor semen has been analysed for 8 of the larger AID services in Australia. Cumulative pregnancy rate, calculated by life-table analysis, showed that 50% of all patients are pregnant after 6 cycles of insemination and 64% of all patients are pregnant after 12 cycles of insemination. Pregnancy rate was significantly higher in the first 3 cycles, declined in the next 3 cycles and was further reduced in the last 6 cycles of insemination. An average of 10% of all insemination cycle were anovular, but the proportion of anovular cycles was significantly lower in the first 2 cycles of insemination. There was no significant difference in cumulative pregnancy rates over the first 6 cycles of insemination in clinics using cervical mucus scoring or LH assay for detection of ovulation. An average of 12% of all pregnancies obtained by AID resulted in miscarriage.
The cumulative probability of conception within 12 cycles of insemination with frozen-thawed donor semen increased from 59 to 70% by selecting the semen on the basis of its concentration of adenosine triphosphate (ATP) rather than on the basis of its motile sperm count. The success rate further improved to 83% by performing induction of ovulation in all recipients who did not achieve pregnancy within the initial 6 cycles.
We report the results of our ten-year experience in the Centre for Study and Conservation of Human Semen (CECOS) in Paris-Bicêtre. A total of 676 potential semen donors were interviewed by a geneticist and karyotyped; 6.0% were excluded, i.e. 2.6% for a cytogenetic reason and 3.4% for a genic reason. Our experience stresses the subjectivity and difficulty of the exclusion decision. It also shows how useful it is to take into account the recipient's familial pathology when choosing the donor. Finally, it reveals the importance of the geneticist's participation in the functioning of a centre.
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