In-vitro fertilization with donor sperm after failure of artificial insemination.

This retrospective study compares results of artificial insemination by donor (AID) and in-vitro fertilization (IVF) trials, and especially of IVF treatment with fresh donor spermatozoa in patients who were unsuccessfully treated on 18 occasions by AID using frozen semen. AID gives cumulative pregnancy rate of 54.6% after six trials. But after 18 trials, 22.4% of the patients were still not pregnant. Treating them with IVF gave a probability of pregnancy as good as in the other IVF patients, 53.9% after six trials. However, pregnancy loss rates differed resulting in cumulative normal pregnancy rates of 16.2% in AID cycles ranking from 19 to 24 compared with 41.8% when going to IVF. In 'ex-AID' women, significantly more follicles were punctured, but the number of oocytes obtained and fertilized, embryos replaced, and the incidence of pregnancy did not differ from the other patients. Considering separately the various infertility factors encountered in the patients, the pregnancy rates still did not differ between ex-AID women and the others. Changing from long-term failed AID to IVF is certainly acceptable and even more so with the newly introduced technique of trans-vaginal puncture. The female infertility factors involved in AID failure are corrected in IVF.