Effect of sperm treatment with exogenous platelet-activating factor on the outcome of intrauterine insemination. Comparative study on efficacy of three sperm-separation techniques. A randomized comparison of the methods of sperm preparation for intrauterine insemination. A randomized, prospective analysis of five sperm preparation techniques before intrauterine insemination of husband sperm.
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. To evaluate the comparative effectiveness of real-time sperm separation technique (Wang's tube method) and other two conventional methods in isolating high-quality sperm preparation, and to compare the spouse pregnancy rate in intrauterine insemination (IUI) with sperm preparations isolated by these methods.
                The effectiveness of the real-time sperm separation technique, the conventional swim-up and the Percoll discontinuous density gradient methods in isolating sperm preparations from 60 infertile patients (20 with apparently normal semen and 40, abnormal semen contaminated with microorganisms and other impurities) was evaluated and compared. The microorganisms to be removed included bacteria, virus, Chlamydia trachomaticum, Ureaplsama urealyticum, etc. The spouse pregnancy rates in IUI with sperm preparations isolated by these three techniques from 80 oligoasthenoteratospermic patients were also compared.
                The quality (including the percentages of normal form, normal-chromatin and motile sperm, and the grade of motility) of sperm obtained by the real-time sperm separation technique was much higher (P < 0.01) as compared with those by the other two methods. The Wang's tube method was also more effective in removing microorganisms and other impurities. The method provided a higher IUI pregnancy rate than the other two sperm separation techniques (P < 0.05).
                The real-time sperm separation technique is the most effective method so far available in isolating high-quality sperm samples to be used in assisted reproduction. 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 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.
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.