Routine intrauterine insemination and the effect of spermatozoal washing as assessed by computer-assisted semen analyzer.

We present the results from 283 cycles of intrauterine insemination (IUI) performed on 237 patients. Their indications for treatment included cervical factor infertility, spermatozoal antibodies, idiopathy, poor postcoital test, and oligozoospermia. Pregnancies arose in all groups, with 28 pregnancies from natural cycles, and 17 from clomiphene citrate-supplemented cycles. A live birth rate per cycle of 12.7% (36/283) was achieved following nine miscarriages. A further 133 patients, with only cervical factor or idiopathic infertility, underwent 144 cycles of IUI in natural cycles; this more homogeneous group had their spermatozoal performance monitored by a computer-assisted semen analyzer (CASA) before and after spermatozoal washing for IUI. All factors in the spermatozoal profile changed significantly after washing. Twelve clinical pregnancies resulted from these 144 cycles of IUI, and a comparison was made between the spermatozoal profiles, as assessed by CASA, of conceptual and nonconceptual cycles. Post-wash spermatozoal concentration was slightly greater (P less than .1) in the conceptual cycles, whilst spermatozoal velocity was significantly less (P less than .005). The relevance of these findings to the definition of a "hyperactivational" state for human spermatozoa is discussed, and the general applicability of IUI as a "frontline" treatment for nontubal infertility is proposed.