الفهرس 
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Abstract
.............................................................................................................durnmary & Conclusion
SUMMARY AND CONCLUSIONS
Recent advances in reproductive medicine and reproductive -technology have provided novel avenues for the treatment of infertility and have made the achievement of pregnancy possible in conditions previously thought to be irreversibly sterile.
Artificial insemination is the instrumental introduction of semen into the female genital tract. It has been used for many years as -a treatment modality for infertile couples. The first reported use of artificial insemination was reported by an English clinician John Hunter between 1775 and 1799. Untile 1886 artificial insemination had been limited to the use of the husband’s semen, but AID was first known at the end of the 19th century in 1890.
Indications of artificial insemination include : I-subnormal semen including oligospermia, asthenospermia, teratospermia, bacterial and debris contaminated semen, hypovolaemia, hypervolaemia and increased seminal viscosity and delayed seminal liquefaction. II-deposition failure : a wide range of causes can be plaimed such as :
A- Male factors :
1-Congenital or acquired penile malformation .
2-Erectile and ejaculatory disturbance .
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B- Female factors:
1-Failure of penetration.
2-Vaginismus.
111- Failure of sperm migration
I - Local vaginal circumstances.
2- Cervical factors including anatomical cervical factors, cervical mucus hostility and cervical mucus antibodies.
IV Other indications including unexplained infertility, sex preselection and seminal plasma allergy.
Artificial insemination has been performed using various techniques such as intravaginal, cervico-vaginal, intracervical, pericervical, intrauterine, intratubal and intraperitoneal insemination.
Preparation of semen aims at improving sperm quality prior to fl insemination. There are different techniques to stimulate sperm motility selecting, concentrating and preserving the motile spermatozoa
such as:
1-Concentration of spermatozoa by centrifugation, washing and
Millipore filter.
2-Selection of motile spermatozoa by split ejaculate, swim-up, glass wool column, albumin column, sephadex gel filtration, percoll gradient filtration, filtration through bovine cervical mucus and filtration through L4 membrane.
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...........................................................................................................................durnmary & Conclusion
3-The use of pharmacological agents such as kallikrein, caffeine , prostaglandins and L- argininne for in vitro improvement of sperm
quality.
4-Cryopreservation and cryobanking.
Artificial insemination being an interference with a major aspect of human life, fertility and sexuality is the source of numerous reactions and problems whether psychological, social, religious, ethical, legal or
medical.
Islamic law considers the procedure of artificial insemination ,--
Lf
husband acceptable and it can be practiced only if it involves husband and wife and if it is performed during the span of their marriage. But
the practice of AID is strictly condemned by Islamic law .
Most Christian religious authorities do not object assisted insemination and reject donor insemination.
Failure is the most frequent complication of artificial insemination. Others are minor and occur infrequently. These include pain and discomfort, infection, bleeding, immunological complications, abortion and pregnancy wastage, psychological complications and use of wrong
semen.
Intrauterine insemination refers to direct transfer of sperm to the intrauterine cavity. It represents an effective and safe procedure with minimal side effects for selected infertile couples. Intrauterine insemination has been found to provide an increased chance for
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...........................................................................................................................(Summary & Conclusion
pregnancy in patients with hostile or absent cervical mucus, subnormal semen, sperm antibodies and unexplained infertility. The reported pregnancy rates for IUI have varied from as low as 3% to as high
as 75 %
IUI of husband’s washed sperm is clearly deserving of further study
and if found to be effective, would provide another treatment option for many infertile couples.
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(Summary & Conclusion
The aim of this study was to evaluate the merits of intrauterine insemination with washed husband’s sperm compared to timed intercourse for the treatment of couples with cervical factor, unexplained infertility and male factor.
Ninty infertile couples participated in this study. These couples were divided into three groups, each group consisted of 30 couples : Group 1 : The cervical factor infertility group (hostile or absent
cervical mucus)
Group 11 : The unexplained infertility group.
Group III : The male factor infertility group with
oligoasthenozoospermic males (count < 20 x 106/ml and/or motility < 40%).
All couples were submitted for the routine infertility evaluation including, complete history taking, physical examination, pelvic ultrasound, semen analysis, basal body temperature chart, midluted phase serum progesterone, luteal phase endometrial biopsy, prolactin, thyroxin, and thyroid stimulating hormone levels in blood, examination of cervical mucus and sperm-cervical mucus interaction, hystrosalpingography and diagnostic laparoscopy.
The study was designed as a random sequential trial. Patients were initially randomly allocated to start her first cycle by either WI or timed intercourse and then treatment was alternated in subsequent cycles up to six cycles (3 IUI and 3 timed intercourse cycles).
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OU172172ary & 0012C11131.011
In all cycles ovulation was stimulated with clomiphene citrate 100 mg/day for 5 days starting from the fifth day of the cycle. Follicular growth was monitored by ultrasound until the leading follicle was 18 mm or more in mean diameter. By this time hCG 10.000 IU was given to the women and IUI was carried out 36 hours later in IUI cycles and intercourse was advised between 24 and 36 hours after hCG administration in timed intercourse cycles.
Preparation of semen was done by double washing and swim-up technique using Ham’s F10 medium. 0.3 to -.39 ml of the prepared semen suspension was slowly injected in the uterine cavity through a pediatric feeding catheter. Only single insemination per cycle was performed.
Pregnancy rates were calculated by the ultrasound evidence (i.e. only clinical not including biochemical pregnancies).
The Ninty couples completed 218 IUI cycles and 212 timed intercourse cycles.
The results of this study revealed the following
1- The pregnancy rate was significantly higher in IUI cycles than in timed intercourse cycles in all the three infertility groups.
The pregnancy rate was 21.1% per couple (8.7% per cycle) with IUI and it was 4.4% per couple (1.4% per cycle) with timed intercourse in all patients considered together.
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In the cervical factor infertility group, the pregnancy rate was 26.7% per couple (11% per cycle) with IUI and it was 3.3% per
couple (1.4% per cycle) with timed intercourse.
In the unexplained infertility group. The pregnancy rate was 20% per couple (8.8% per cycle) with IUI and it was 6.6% per couple (3.1% per cycle) with timed intercourse.
In the male factor infertility, the pregnancy rate was 16.7% per couple (6.5% per cycle) with IUI and it was 3.3% per couple (1.3% per cycle) with timed intercourse. All the five IUI conceptions occurred in the oligospermic (3) and in the asthenospermic (2) subgroups and no conception occurred in the oli goasthenozoospermic subgroup.
2-In IUI cycles higher pregnancy rate was achieved in the cervical factor infertility group followed by the unexplained infertility group followed by the male factor infertility group. After 3 IUI cycles the cumulative pregnancy rates were, 0.27, 0.218 and 0.169 in the cervical, unexplained and male factor infertility groups
respectively.
3-Pregnancy rate in IUI cycles was significantly higher than that in timed intercourse cycles in the first cycle only while in the second and in the third cycle, the difference in pregnancy rate between IUI and timed intercourse was not statistically significant.
4-12 out of 19 IUI conceptions (63.2%) occurred in the first cycle, 6 (31.6%) in the second cycle and only, (5.2%) in the third cycle.
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...............................................................................................................................Summar• & Cortefusion
5-The age of wives was slightly lower in pregnancy than in not pregnant but not statistically significant. The pregnancy rate was higher (39.3%) in the young age group (21-25 years)and the pregnancy rate was decreasing with increasing the wife’s age till it reach 0% when the age is 36 years.
6-The duration of infertility was significantly shorter in the pregnant than in the not pregnant women. The highest pregnancy rate (35.3%) was in the short duration of infertility (3-4.9 years) group and the pregnancy rate was decreasing with increasing the duration infertility till it reach 0% when the duration of infertility is 9
years.
7-No significant difference was found in the mean number of follicles or the mean day of hCG injection between pregnant and not pregnant women and the pregnancy rates did not significantly differ between cycles showing one, two or three follicles per
cycle.
8-The semen preparation by the swim up technique resulted in a highly significant decrease in the mean semen volume, in the mean sperm concentration and in the mean total number of progressively motile spermatozoa and resulted in a higher significant increase in the mean percentage with progressive motility. The mean recovery of progressively motile spermatozoa was 16 ± 4.6%.
9-No statistical significant difference was found in semen parameters between 1U1 pregnant and not pregnant patients in the cervical and unexplained infertility groups but in the male factor infertility
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...........................................................................................................................(Summary & Conclusion
group, the progressive motility and the total number of progressively motile spermatozoa were significantly higher in the IUI pregnant than in the not pregnant patients.
10-The treatment period required for MI conception ranged between 1 to 3 cycles (mean, 1.4 ± 0.6) and it did not differ between the
three infertility groups.
11-No complications related to the procedure of IUI. The only
complication was related to the pregnancy outcome.
Abortion occurred in 5 of the 19 IUI conceptions (2 in the cervical
factor, 1 in the male factor and 2 in the unexplained infertility group. and one abortion out of the 4 conceptions with timed intercourse occurred, it was in the unexplained infertility group.
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ournrnary if Conclusion
Conclusion :
from the findings of this controlled prospective study we conclude the following :
1-Intrauterine insemination with washed husband’s sperm proved to be simple, inexpensive, safe and worthwhile for couples with cervical, male or unexplained infertility.
2-Intrauterine insemination is more effective in the treatment of cervical factor infertility than in male or unexplained infertility.
3-IUI is of significant value only in the first few cycles of treatment.
4-Better success rate is obtained with IUI in young women with short duration of infertility.
5-Sperm preparation by washing and swim-up technique improves the sperm quality, specially the sperm motility and improves the incidence of conception and minimize the complication of JUL
Recommendation :
from the present study we recommend the following :
1- IUI must be applied to any couple with non tubal infertility before referral for the more invasive therapeutic procedures such as GIFT or IVF.ET.
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..........................................................................................................................................oummary& Conclusion
2-Reassessment should be undertaken if the patient is not pregnant after three cycles of treatment.
3-Further well controlled prospective investigations, including other aetiological groups and stimulation schedules, will enable us to better understand this technique and will reveal the concrete therapeutically possibilities that it can offer to alleviate infertility.