A randomized, prospective analysis of five sperm preparation techniques before intrauterine insemination of husband sperm. A randomized comparison of the methods of sperm preparation for intrauterine insemination. Effect of sperm treatment with exogenous platelet-activating factor on the outcome of intrauterine insemination. Intrauterine insemination of washed spermatozoa for treatment of oligozoospermia.
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.
                Each treatment group alternated in a different order through the five sperm preparations. Pregnancy rates were compared for each sperm preparation.
                Two infertility centers, one located in an academic institution and the other a regional hospital.
                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.
                Pregnancy rates.
                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).
                These data suggest that the swim-up and Percoll gradient preparations result in higher PRs than the wash, swim-down, and refrigeration/heparin techniques. To compare the effectiveness of three methods of sperm preparation for IUI during superovulation of infertile women.
                Randomized assignment of one of three sperm preparation methods.
                University infertility practice.
                Infertile couples undergoing superovulation and IUI.
                The method of preparation of sperm for IUI during superovulation was assigned randomly to double centrifugation, multiple-tube swim-up, or Percoll density gradient.
                Total number and percent recovery of motile sperm, percent of recovered sperm with normal morphology, and cycle fecundity.
                No method of sperm preparation provided better cycle fecundity than the others despite differences in sperm recovery.
                Double centrifugation, multiple-tube swim-up, and Percoll density gradient sperm preparation for IUI yield similar cycle fecundity rates. To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on IUI clinical pregnancy rate.
                Prospective randomized study.
                Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece.
                Fifty-two couples with unexplained infertility, candidates for IUI.
                Sperm treatment with an exogenous mixture of PAF (final concentration, 10(-7) mol/L) in sperm-washing medium, direct swim-up technique of sperm preparation, a maximum of six IUI cycles per couple with or without PAF treatment.
                Clinical pregnancy rate (pregnancies confirmed by ultrasonography per hundred cycles).
                The overall clinical pregnancy rate after a maximum of six IUI cycles was significantly higher when sperm was treated with PAF compared with the rate after the direct swim-up technique (23.07% vs. 7.92%).
                Treatment of sperm with exogenous PAF might improve the clinical outcome of IUI in cases of unexplained infertility. Efficacy of intrauterine insemination (IUI) using washed spermatozoa for treatment of oligozoospermia was evaluated by a prospective randomized study in 50 couples, using LH-timed natural intercourse in the alternate menstrual cycles as a control. The quality of spermatozoa in terms of their concentration and motility before and after sperm washing was compared. Sperm motility increased significantly after sperm preparation but the number of sperm was reduced. Eight pregnancies occurred in 253 cycles of IUI with washed spermatozoa and clomiphene citrate-stimulated cycles (3.16% per cycle). Only one patient conceived in 242 LH-timed natural intercourse cycles (0.41% per cycle). Compared with LH-timed natural intercourse, IUI provided a significantly improved pregnancy rate. When the sperm count was < 5 x 10(6) per ml, no pregnancy occurred with the IUI method. Therefore, IUI is a of rather limited usefulness when the sperm quality is very poor. Few complications occurred after IUI, but included slight cervical contact bleeding and mild abdominal discomfort and/or cramps. In conclusion, IUI should be considered as a useful and relatively non-invasive therapeutic modality for treating caused by moderate oligozoospermia (> 5 x 10(6)/ml), when sexual intercourse fails.
There is insufficient evidence to recommend any specific semen preparation technique. Large, high quality randomised controlled trials comparing the effectiveness of a gradient, swim-up and wash and centrifugation technique on clinical outcomes are lacking. Further randomised trials are warranted.