Paul H. Kuneck

A randomized, prospective analysis of five sperm preparation techniques before intrauterine insemination of husband sperm

Abstract Objective: To evaluate pregnancy rates (PRs) in women undergoing artificial insemination with sperm alternately prepared by one of five techniques: sperm washing, Percoll gradient centrifugation, swim-up, swim-down, or refrigeration/heparin treatment. Design: Each treatment group alternated in a different order through the five sperm preparations. Pregnancy rates were compared for each sperm preparation. Setting: Two infertility centers, one located in an academic institution and the other a regional hospital. Patient(s): Three hundred sixty-three women undergoing 898 artificial inseminations with husband semen with a progressive motile sperm count of > 20 million sperm per mL were randomly placed in the five treatment groups. Main Outcome Measure(s): Pregnancy rates. Result(s): The overall ongoing PR per insemination was 9.7% (87/898), including 6.12% for natural cycles ( n = 196), 12.8% for clomiphene citrate-stimulated cycles ( n = 101), and 10.3% for gonadotropin-stimulated cycles ( n = 601). The highest ongoing PRs for sperm preparations followed the swim-up technique (13.2%, 26/197) and the Percoll gradient centrifugation technique (12.7%, 26/204). Conclusion(s): These data suggest that the swim-up and Percoll gradient preparations result in higher PRs than the wash, swim-down, and refrigeration/heparin techniques.

Delayed timing of intrauterine insemination results in a significantly improved pregnancy rate in female partners of quadriplegic men

OBJECTIVE To review pregnancy rates obtained with three protocols used during development of a successful therapy for infertility in couples in which the male partner had spinal cord injury. DESIGN Retrospective chart review. SETTING Private infertility center. PATIENT(S) Eleven quadriplegic men and their spouses undergoing intrauterine insemination. INTERVENTION(S) Protocol 1: Intrauterine insemination was performed 24 hours after the LH surge was detected in unstimulated cycles. Sperm were prepared by standard sperm washing. Protocol 2: Female partners were stimulated with clomiphene citrate and hCG. Sperm were inseminated 32-34 hours after hCG injection. Sperm preparation was by serum swim-up or density gradient preparation. Protocol 3: Identical to protocol 2, except the insemination was delayed to 38-40 hours after hCG injection. MAIN OUTCOME MEASURE(S) Pregnancy rates. RESULT(S) Five patients were enrolled into protocol 1 and underwent a total of 19 inseminations with no subsequent pregnancies. They then underwent protocol 2, but no pregnancies resulted from inseminations. Four of the original couples, along with six additional couples, underwent insemination in protocol 3. A total of 19 inseminations were performed, and 6 of the 10 patients (60%) became pregnant. The success of insemination at 38-40 hours after hCG administration was significantly better than that of the initial two protocols (P<.05). No differences were observed in sperm quality between protocol 2 and protocol 3. Overall, 73% (8 of 11) of the patients became pregnant. CONCLUSION(S) Intrauterine insemination 38-40 hours after the hCG injection results in an improved chance of pregnancy. These results indicate that many couples with spinal cord injury-associated male infertility can be treated with intrauterine insemination of sperm treated by serum swim-up, with a high probability of success.

A simplified coculture system using homologous, attached cumulus tissue results in improved human Embryo morphology and pregnancy rates during in vitro fertilization

Purpose:This study was undertaken to evaluate simplified methods of human embryo coculture using either attached or nonattached autologous cumulus tissue.Methods:Eight hundred one zygotes were cultured for 48 hr in a prospective, randomized trial comparing culture of embryos either with intact cumulus tissue, with cumulus tissue added to the droplet of culture medium, or without any cumulus tissue. In a follow-up study, embryo quality, pregnancy rates, and implantation rates were compared in 120 consecutive patients undergoing in vitro fertilization with a coculture system using cumulus tissue compared to a cohort of 127 patients undergoing IVF immediately preceding the institution of the coculture protocol.Results:Embryo morphology was significantly improved (P < 0.05) following culture with attached cumulus tissue (5.61 ± 0.29) and culture with added cumulus tissue (4.72 ± 0.31) compared to that of embryos grown in culture medium without cumulus tissue (3.95 ± 0.26). The clinical pregnancy rate improved from 39.4% (50/127) to 49.2% (59/120) following institution of a system of coculture with attached cumulus tissue.Conclusions:These data indicate that a simple coculture system using autologous cumulus tissue can result in improved embryo morphology, implantation rates, and clinical pregnancy rates during in vitro fertilization. This coculture system is simple, is non-labor intensive, and eliminates many of the risks which may be present in other embryo coculture systems.