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Sperm-mucus interaction and artificial insemination.

Artificial insemination techniques form an important part of the spectrum of modern infertility treatment, and together account for nearly half (43.8 per cent) of the treatment-related pregnancies in our comprehensive infertility clinic. Disorders of sperm-mucus invasion and survival are not uncommon but have been very frequently overlooked in the past. Assessment by post-coital tests with a minimum six hour post-coital delay and mucus penetration tests for those with negative post-coital tests should be part of every clinic routine. We believe that these tests pick up a range of problems, the most important of which is antisperm immunological infertility, which can be treated with a fair degree of success by intrauterine AIH. The demand for AID has increased appreciably on a world-wide scale and provision of AID facilities in this and other countries is inadequate. An AID service should ideally be part of every organized infertility service. The future of AID probably lies with frozen semen banks serving satellite clinics within their area.

Adult

Artificial insemination.

Artificial insemination with homologous (AIH) and heterologous (AID) samples is discussed. Specific emphasis is placed on the indications and timing of the procedure, the type of specimens available, the technique and the expected results. The legal and emotional ramifications of AID are discussed.

Clomiphene

Homologous artificial insemination.

Artificial insemination--homologous (AIH) treatment in 100 couples is presented. An uncorrected pregnancy rate of 13% was achieved therapeutically versus a 10% spontaneous pregnancy rate. An adjusted pregnancy rate for those who conceived or completed at least six cycles of treatment was 41%. A pregnancy rate of 8% was obtained in 25 cases of oligospermia (less than 20 X 10(6)/ml), 15% in 27 cases of decreased motility only (less than 45% active), 27% in 18 cases of unexplained poor postcoital tests and 28% in 18 couples with suspected or proven immunologic problems. The most important reason for lack of success in our series appeared to be failure to continue therapy for an adequate period, defined as a minimum of six cycles. Since indications for AIH are less well defined than for artificial insemination with donor (AID), pregnancy yields are less reliable as an indication of a causal relationship.

Cervix Uteri

Monitoring of artificial insemination.

Artificial insemination (ADI) has been carried out with donor semen since 1984. Following artificial insemination 14 women out of 27 became pregnant in 1984, 30 women out of 57 in 1985 and 33 women out of 56 until October 1, 1986. The cycles were monitored. Serum LH and oestradiol levels were determined every day from the 10th day of the cycle. Follicle size was monitored daily and cervical mucus was also examined every day. LH reaches the highest level at the time of ovulation. 17-Beta-oestradiol level increases parallel with the growth of follicle. Follicular growth can be best monitored by ultrasound folliculometry, providing 50-60% effectiveness.

Female

Fifteen years experience with artificial insemination.

Artificial insemination is today an accepted procedure in circumventing sterility. In recent years this procedure gained much popularity as the number of infants available for adoption steadily decreased due to the liberal abortion laws. A review of 15 years of practiced experience (senior author) is presented. In all described cases (168 women) artificial insemination was performed personally by the author. The high rate of success (80% of the presented cases) is attributed to a very meticulous and highly individualized approach to each case. Review of literature is presented.

Adolescent

Seasonal variation in estrous cycling in the mouse: implications for artificial insemination.

Artificial insemination in the C3HeB/FeJ inbred strain of mice has been shown to be more successful at the middle and end of the calendar year. The reasons are twofold: 1) an increase in the number of normal estrous cycles exhibited by females and 2) an increase in the tightness of the phasing of ovarian and vaginal events. The latter phenomenon was found to be the key to the success of artificial insemination, since it permitted the use of vaginal smears to predict accurately the time females could be expected to ovulate and, therefore, the appropriate time for artificial insemination. Seasonal variations in the frequency of estrous cycling also have been observed in SJL/J and B6D2F1/J females.

Animals

Equine artificial insemination.

Artificial insemination is an effective technique for improving utilization of the stallion while maintaining normal conception rates in the mare. However, procedures for collection, evaluation, and insemination of semen must be followed carefully to achieve good results. Techniques for preservation of equine semen in the liquid or frozen state could potentially allow for more widespread use of genetically superior stallions. Further acceptance of artificial insemination and the use of cooled or frozen transported semen by breed registries is needed before this will occur. More work is needed to perfect methods of semen preservation, even though semen from some stallions can be cooled or frozen quite successfully at the present time.

Animals

[Forensic medicine aspects of surrogate mothers and artificial insemination].

Artificial insemination solves the problem of childlessness in a way never before thought possible. There is now often a lack of guiding principles in law, and new ethical questions have arisen. It would appear that homologous insemination is the simplest. This is recognized by the church; by doctors, even for unmarried couples. Heterological insemination, on the other hand, is only rarely acceptable to married couples, and then subject to the limits of generation, the avoidance of half-brothers and sisters, and gamete mistakes, as well as any commercialization. The medical standpoint and other legal developments must be reconciled with these factors; particularly the possibility of cancelling the anonymity of the sperm donor and the right to appeal of the social father. As a general principle, the ruling premise should be to place the burden of risk on the parents. With in-vitro fertilization, the existence of surplus embryos is particularly problematic. It is becoming more and more common to regard life as commencing in the zygote and not in the nidation. Can the scientific experiments permitted under the new professional regulations-even with more complicated requirements-be reconciled with this? Consensus can be reached in rejecting surrogate motherhood, since the danger of commercialization is too great, and propagation possibilities are being opened up which, to our present understanding, are irresponsible.

Expert Testimony

The screening of donors enrolled in an artificial insemination program.

Artificial insemination is currently offered in Ontario to couples when infertility arises from a male factor. The majority of practitioners are using fresh sperm, but because of the threat of transmitted infection, a change to the use of frozen semen, which can be screened concurrently, is anticipated. Screening can prevent the transmission of both genetic and infectious disease and the principles of a possible program are outlined below. Elements of screening include a genetic history, blood count, selected biochemical and serological assays, and a semen analysis and culture. Because of the high cost and the few cases of genetic disease that will be prevented, routine karyotyping is not recommended. It remains to be seen whether changing the donor pool from an unscreened group of medical personnel to a screened sperm bank derived from the general population will provide increased protection for the mother and child.

Anemia, Sickle Cell

Filiation and secrecy in artificial insemination with donor.

Artificial insemination with donor (AID) forces the gynaecologist to face the problem of filiation with his patients. Here, the authors point out the pathogenic effect, both on the parents and the child, which may result from rigidly kept secret about 'AID filiation', and they discuss some conditions which could help to avoid this pathogenic effect, possibly allowing a non-traumatic revelation of his/her filiation to the child, in the future.

Confidentiality