Sperm processing and intrauterine insemination for oligospermia.

The success of IVF has led to the adaptation of IVF sperm processing methods for WIUI. When WIUI is used for treating oligoasthenospermia, there is a theoretical advantage because an isolated population of only the most motile, capacitated sperm are placed directly into the wife's uterus. The cervix and its mucus are bypassed, which may provide a mechanical or biochemical advantage for semen from subfertile males. Removal of seminal plasma (and prostaglandins contained therein) prevents the painful uterine contractions that can occur when raw semen is placed directly into the uterine cavity. The disadvantages of WIUI are related to its expense, problems with precise timing of ovulation, and the frustration that can occur when inseminating personnel are not available whenever ovulation occurs on weekends or holidays. Only truly committed couples who will try WIUI for multiple cycles should be selected for this method of infertility treatment. Although male-factor infertility currently is one of the main indications for WIUI, the widely variable pregnancy rates reported with WIUI leave some doubt regarding its ultimate role in the treatment of this condition. Our own preliminary results with WIUI for treatment of asthenospermia, oligoasthenospermia, and "cervical factor" infertility are encouraging, although the numbers of patients are small. We anticipate that with further refinement of methods of sperm processing and with the newer improved methods of home monitoring of ovulation, these results may improve. Factors that determine pregnancy rates of WIUI for the treatment of oligoasthenospermia are numerous. The degree of oligospermia and/or asthenospermia, the cooperation and persistence of the couple through the required cycles of WIUI (drop-out rate), the method and meticulousness of sperm processing, the accuracy of monitoring ovulation, the availability of insemination personnel whenever ovulation occurs (even on weekends and holidays), and possibly the duration of infertility will all play a role in the ultimate success of WIUI programs. Couples selecting WIUI must be aware that it does not now offer a high pregnancy rate when used for treatment of male-factor infertility. The apparent increased pregnancy rate of WIUI compared with other methods of AIH may have resulted from modern methods of monitoring ovulation. Studies have not yet been performed to show whether comparable pregnancy rates would be obtained if similar methods of monitoring ovulation were used with cervicovaginal methods of AIH. We believe the only clear indication for WIUI now is an abnormal sperm-cervical mucus interaction.(ABSTRACT TRUNCATED AT 400 WORDS)