Comparison of different methods for the recovery of horse oocytes

The object of this study was to compare 4 different methods of oocyte recovery from mares; 1) transvaginal follicle aspiration in vivo; 2) follicle aspiration in vitro; 3) oocyte recovery by isolation of follicles in vitro and 4) follicle scraping in vitro. Oocyte recovery was highest after follicle scraping (71.1%) and follicle isolation and rupture (61.3%). Follicle aspiration in vitro and in vivo yielded oocytes on 31.2% and 19.3% of occasions, respectively. The output of different types of cumulus-oocyte-complexes was different among the methods; the portion of compact cumulus-oocyte-complexes was significantly higher with follicle scraping (50.7%) and follicle isolation (44.5%) than with aspiration in vivo (31.9%) and in vitro (23.7%). The recovery rate of oocytes from small follicles (<15 mm) was significantly higher than from larger follicles (P<0.05) using transvaginal follicle aspiration. The proportion of oocytes that were degenerate (exhibited shrunken, dense or visibly damaged ooplasm) ranged from 1.2% after follicle scraping, to 17.2% after aspiration in vivo. These results indicate that, for the recovery of horse oocytes in vitro, follicle scraping and follicle isolation give the highest recoveries of cumulus-intact oocytes.     

Clarithromycin, amoxycillin and H2-receptor antagonist therapy for Helicobacter pylori peptic ulcer disease in Korea

OBJECTIVE: To compare the efficacy of fallopian tube sperm perfusion utilizing a Foley catheter technique with standard IUI. DESIGN: Randomized controlled study. SETTING: The infertility units of the University Central Hospital and the Family Federation of Finland, Oulu, Finland. PATIENT(S): One hundred infertile women with unexplained factor, minimal to mild endometriosis, mild male factor, or ovarian dysfunction, undergoing 50 IUI and 50 fallopian tube sperm perfusion cycles stimulated by clomiphene citrate and hMG. INTERVENTION(S): Thirty-six hours after hCG administration, patients were randomized to either the IUI group (group 1, 50 patients and cycles) or the fallopian tube sperm perfusion group (group 2, 50 patients and cycles). Intrauterine insemination was performed using a standard method and fallopian tube sperm perfusion with a pediatric Foley catheter, which prevents the reflux of sperm suspension. MAIN OUTCOME MEASURE(S): Number of clinical pregnancies. RESULTS(S): The fallopian tube sperm perfusion method using a Foley catheter technique was easy to perform and convenient for the patients. The overall pregnancy rate per cycle was 8% for fallopian tube sperm perfusion and 20% for IUI, a difference that was not significant. CONCLUSION(S): The fallopian tube sperm perfusion method using a Foley catheter offers no advantage in comparison with the conventional IUI technique.     

Approaches for obtaining sperm in patients with male factor infertility

OBJECTIVE: To describe methods of sperm retrieval for intracytoplasmic sperm injection (ICSI) in patients with male factor infertility and to review the clinical results using sperm from the different sources. DESIGN: The literature on sperm-obtaining methods and ICSI was reviewed. Studies related to this topic were identified through MEDLINE. RESULTS(S): This review describes the evolution of sperm retrieval methods. Sperm can be obtained by microepididymal sperm aspiration (MESA), percutaneous sperm aspiration (PESA), and testicular sperm extraction (TESE), from patients with congenital absence of the vas deferens or acquired vas obstruction. When ICSI is performed with ejaculated, epididymal, or testicular sperm, good fertilization and pregnancy rates are achieved without significant differences among the various sperm sources. The original percutaneous sperm aspiration method has been modified slightly and yields successful results. CONCLUSION(S): Viable pregnancies can be achieved with ICSI by using not only ejaculated sperm, but also epididymal and testicular sperm. Microepididymal sperm aspiration, percutaneous sperm aspiration, modified percutaneous sperm aspiration, and testicular sperm extraction can be considered standard procedures to treat male factor infertility.     

Ultradian, circadian, and stress-related hypothalamic-pituitary-adrenal axis activity--a dynamic digital-to-analog modulation

PURPOSE: We evaluated the safety and efficacy of percutaneous sperm aspiration from the epididymis or testicle as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest sperm for use in intracytoplasmic sperm injection. MATERIALS AND METHODS: We present our experience with 69 sperm aspiration procedures in men considered to have nonreconstructible obstructive azoospermia. This short outpatient procedure was performed using a butterfly needle with the patient under intravenous sedation and local anesthesia. RESULTS: Of the 32 diagnostic aspirations 20 demonstrated mature and motile sperm, 9 maturation arrest and 3 germ cell aplasia. In 35 of 37 therapeutic sperm aspirations (95%) adequate samples of sperm after processing (mean of 5.4 million) were obtained. Of 24 epididymal aspirations 13 (54%) had sufficient residual sperm for cryopreservation of 1 to 5 vials (mean 2.5) containing an average of 170,000 sperm per vial. In the 32 intracytoplasmic sperm injection cycles 221 of 392 eggs (56.3%) fertilized (2PN) and 6 resulted in ongoing pregnancies (21.4% per transfer). There have been no acute or chronic complications in this patient population. Ten men underwent a second successful aspiration procedure for intracytoplasmic sperm injection and 3 underwent a third aspiration without added difficulty. CONCLUSIONS: Percutaneous epididymal or testis sperm aspiration is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive, costly and technically difficult.     

Antiovarian antibodies and their effect on the outcome of assisted reproduction

PURPOSE: To compare the presence in levels of antiovarian antibodies (AOAb) in the pre- and postovulatory stage from serum of infertile patients undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF) with outcome of the procedures. RESULTS: Serum from 36 women undergoing IUI, 36 women undergoing IVF and 25 fertile, healthy controls were assayed for the presence of AOAb by a commercially available ELISA kit. AOAb was positive in 59.7% of infertile women, while none of the fertile controls were positive for AOAb. The levels of these antibodies increased as the patient age and the number of treatment attempts increased. Though the presence of AOAb did not affect oocyte recovery rate, it resulted in decreased fertilization rate, cleavage rate, and pregnancy rate in infertile women. CONCLUSIONS: Our studies suggest that AOAb may be a cause of infertility and presence of these antibodies could have adverse effects on the outcome of assisted reproductive techniques.     

Characterization of cDNAs representing five abscisic acid-responsive genes associated with somatic embryogenesis in Picea glauca, and their responses their responses to abscisic acid stereostructure

During the period January 1, 1991 through December 31, 1995, 258 patients, in whom motile sperm counts for insemination (postwash, processed) were 10.0 million motile sperm or less were seen in the andrology unit for sperm washing and intrauterine insemination (IUI). No significant female factors were noted on history; all female partners had patent Fallopian tubes and were ovulatory spontaneously or were treated by the referring gynecologist with clomiphene citrate, human menopausal gonadotropin (hMG), or follicle-stimulating hormone (FSH) ovulation induction in both anovulatory or ovulatory women. Of the total of 258 patients, 15 achieved a pregnancy in 284 cycles of IUI in which the inseminating motile-count was < 1.0 million motile sperm, resulting in a monthly fecundity (f) of 5.3%. The mean (+/-SD) motile count for IUI in this group was 0.61 (+/-0.29) million sperm, with a range of 0.19-0.95 million motile sperm. The initial motile count was 2.97 (3.2) million sperm, with a range of 0.2-12.81 million sperm. With inseminating motile counts of 1.0-10.0 million motile sperm, there were 83 pregnancies after 467 cycles of IUI, resulting in a monthly f of 17.8%. The mean (+/-SD) motile count for IUI in this group was 4.9 (+/-2.7) million motile sperm with a range of 1.0-9.9 million motile sperm. The initial sperm count in this group was 10.9 million (+/-7.1), with a range of 1.1-23.7 million motile sperm. These data suggest that acceptable pregnancy rates can be achieved with IUI, even in severely oligozoospermic specimens. Intrauterine insemination is less invasive and less costly than other assisted reproductive techniques. These data are supportive of IUI prior to attempting other more invasive and potentially costly reproductive technologies.     

Physical activity in usual occupation and risk of breast cancer (United States)

OBJECTIVE: To identify whether the cause, site of ductal obstruction, and characteristics of fluid aspirates are associated with the cryosurvival and fertility after thawing of sperm obtained during reconstruction of the excurrent ducts with microsurgical epididymal sperm aspiration, vasal sperm aspiration, or both. DESIGN: Prospective study. SETTING: Andrology center at a tertiary care institution. PATIENT(S): Men undergoing reconstruction of the excurrent duct and sperm aspiration (n = 42) or microsurgical epididymal sperm aspiration (n = 11). INTERVENTION(S): Sperm were tested for an association with the cause and site of obstruction. Fertilization and pregnancy rates after sperm aspiration and intracytoplasmic sperm injection (ICSI) were evaluated for fresh and frozen aspirates. MAIN OUTCOME MEASURE(S): Motile sperm count and percentage motility after thawing. RESULT(S): The motile sperm count before freezing was significantly higher in the caput epididymis than in the corpus. The motile sperm count before freezing was related inversely to the distance from the caput where the sperm were aspirated. Sperm from clear and opaque fluid aspirates had better percent motility than those from cloudy and creamy fluid aspirates. High fertilization and pregnancy rates were achieved using both fresh and frozen epididymal sperm. CONCLUSION(S): None of the factors studied was associated with cryosurvival of aspirated epididymal or vasal spermatozoa. Because motility is low after thawing, these specimens are best used with ICSI.     

Low spinal and pelvic bone mineral density among individuals with Down syndrome

The efficacy of intrauterine insemination with husband's semen (AIH) is well established for some types of infertility. Results that had been reported previously were Dwing difficult to assess owing to the low number of patients or treatment cycles as well as an inadequate definition of the indications in most cases. In this study, we report our experience with intrauterine insemination (IUI) using post-treated sperm suspension from husband's semen in the treatment of infertility. A total of 328 treatment cycles were completed from January to December in 1991. The indications for AIH/IUI were male infertility (130 cycles), unexplained infertility (87 cycles), sex selection (72 cycles) and anovulatory disorder (39 cycles). Sixty-eight pregnancies were achieved. The clinical usefulness of AIH/IUI with or without concomitant hMG regimens were established according to diagnostic subgroups. In our results, the cycle fecundity of pregnancy was higher in patients with ovulatory disturbance. The importance of sperm motility confirmed by our results that have compared by the serial sperm parameters. The motile sperm count may appear to be a highly consistent parameter that serves as a sensitive indicator of sperm function and correlation of successful pregnancy in our results. In conclusion, this study indicates that AIH with controlled ovarian hyperstimulation can result in higher viable pregnancy rate, and it is also a non-invasive and relatively easy procedure. We believe that this is a transient useful method for the treatment of non-organic infertility, prior to any attempt of aggressive assisted reproductive procedures.     

The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis. Half-Fourier acquisition single-shot turbo SE

OBJECTIVE: To investigate the incidence of complications in the use of assisted reproductive technology in the management of infertile couples. DESIGN: Retrospective study. SETTING: The Egyptian IVF & ET Center, Maadi, Cairo, Egypt. PATIENT(S): Two thousand nine hundred twenty-four patients underwent IVF-ET or intracytoplasmic sperm injection (ICSI) in 3,500 cycles. INTERVENTION(S): IVF-ET, ICSI, ejaculate sperm, epididymal sperm aspiration, and testicular sperm extraction. MAIN OUTCOME MEASURE(S): Complications of the procedure and complications of pregnancy in 702 patients. RESULT(S): Fifteen hundred ovum pickups for IVF-ET and 2,000 ovum pickups for ICSI were performed. Clinical pregnancy occurred in 1,078 patients (30.8%). Four groups of complications were identified. Complications of the procedure occurred in 291 patients (8.3%). Complications of pregnancy included ectopic pregnancy in 1.9%, heterotopic pregnancy in 0.2%. abortion in 20.6%, multiple pregnancy in 28%, pregnancy-induced hypertension in 10%, preterm labor in 21.5%, low birth weight in 30.5%, and intrauterine death in 2%. Coincidental complications occurred in five patients (0.15%). Other complications that were difficult to measure included psychological breakdown and socioeconomic problems. CONCLUSION(S): Assisted reproductive technology is effective for the management of infertility and has an acceptable incidence of complications. Complications rarely endanger the life of the patient. When this line of treatment is offered, the indications should be definitive. Patients should be monitored properly and measures should be taken to minimize the incidence of complications.     

Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia

The efficiency of testicular sperm retrieval by testicular fine needle aspiration (TEFNA) was compared with open biopsy and testicular sperm extraction (TESE), in 37 rigorously selected patients with non-obstructive azoospermia. All patients underwent TEFNA and TESE consecutively. Thus, each patient served as his own control. The case was regarded as successful if at least one testicular spermatozoon was found allowing intracytoplasmic sperm injection (ICSI) of at least one oocyte. The mean age of the male patients was 32.7 years (range 24-47). Whereas by TEFNA spermatozoa enabling performance of ICSI were found in only four patients out of 37 (11%), open biopsy and TESE yielded spermatozoa in 16 cases (43%). The negative predictive value of high serum follicle stimulating hormone (FSH) concentrations (> or =10 IU/l) (predicting failure to find spermatozoa for ICSI) was low (38.4%). The positive predictive value (predicting the chance to find spermatozoa for ICSI) of normal-sized testicle was not different from that of small-sized (<15 ml) testicle (50%). Complications included one case of testicular bleeding following fine needle aspiration, treated locally, and two cases of extratunical haematomata following TESE requiring no intervention. In patients with non-obstructive azoospermia, TEFNA has a significantly lower yield compared to TESE. Performance of ICSI with testicular sperm in these cases resulted in satisfactory fertilization and high embryo transfer rates. The implantation and pregnancy rates per embryo transfer were 13 and 29% respectively. Neither serum FSH values nor testicular size were predictive of the chances to find spermatozoa for ICSI. Some complications may occur even following TEFNA.     

Controlled hyperstimulation in intra-uterine inseminations: hMG-hCG protocol (204 cycles)

OBJECTIVE: to evaluate the results of superovulation, protocol hMG-hCG, associated to IUI for treatment of infertility. PATIENTS AND METHODS: this prospective study, includes 77 couples who underwent 204 consecutive cycles of homologous IUI. The same protocol was applied for all the couples. hMG was administrated from cycle days 2 to 5 (3 then 2 ampuls per day). Patients were monitored daily, by evaluation of serum oestradiol. Insemination was done 36 to 38 hours after hCG injection. RESULTS: 2.6 cycles were done per couple. We observed 16.2% pregnancy per cycle. The best results were obtained in female indications, in the first cycle, with more than 500,000 spermatozoide and with a level of E2 between 500 and 1500 pg/ml. Multiple pregnancy was observed in 18.2%. CONCLUSION: controlled ovarian stimulation should be associated to all IUI.     

Implications of complete fertilization failure after intracytoplasmic sperm injection for subsequent fertilization and reproductive outcome

With the introduction of intracytoplasmic sperm injection (ICSI), couples with severe male factor infertility have achieved fertilization and clinical pregnancy rates comparable to other in-vitro fertilization (IVF) patients. However, failure of fertilization still occurs in some patients despite the utilization of microsurgical sperm injection techniques. How such fertilization failure after ICSI might impact later ICSI treatment(s) is unknown. In this investigation, couples with complete fertilization failure after ICSI treated from August 1993 to August 1996 were identified (index cycle, n = 21). Additionally, fertilization data from any previous or subsequent infertility treatments were evaluated. Seven patients (33%) had at least one IVF treatment before the index cycle, although no deliveries occurred. Of patients with complete fertilization failure in the index cycle, 48% (n = 10) underwent at least one subsequent ICSI cycle which proceeded to oocyte retrieval. The remainder (n = 11) elected to discontinue treatment. Although six subsequent cycles were cancelled due to poor follicular response (< or = 2 mature oocytes), all patients electing to continue treatment eventually achieved a subsequent embryo transfer. The clinical pregnancy rate per transfer was 45.4% for this group; the delivery and ongoing pregnancy rate per transfer was 36.3%. Review of semen parameters, superovulation characteristics or other clinical parameters during the three study cycles (pre-index, index, and post-index) was not prognostic of fertilization success or reproductive outcomes in later treatments. Fertilization failure with ICSI therefore could not be predicted by prior cycle performance, although total immotility of spermatozoa at time of oocyte retrieval, total teratozoospermia, and low oocyte yield were common characteristics of couples experiencing complete fertilization failure with ICSI. These findings suggest that fertilization failure in one ICSI cycle does not preclude successful fertilization and delivery in a later ICSI treatment.     

Initial experience with the MESA and TESE techniques in the treatment of infertile men with azoospermia

The authors evaluate their initial experience and results of the technique of microsurgical aspiration of epididymal sperm (MESA) and extraction of testicular sperm (TESE) combined with intracytoplasmic sperm injection into the oocyte (ICSI) in men with azoospermia. The above methods were used in 16 patients with repeatedly assessed azoospermia. Epididymal sperm was obtained in six instances, testicular sperm in 10 instances. With epididymal sperm after ICSI 50% fertilization was achieved after ICSI, with testicular sperm 51% fertilization of oocytes.     

Porcine islet preservation during isolation in University of Wisconsin solution

OBJECTIVE: To report a triplet pregnancy that occurred after intracytoplasmic injection of sperm into cryopreserved oocytes. DESIGN: Case report. SETTING: Instituto de Ginecología y Fertilidad (IFER), Buenos Aires, Argentina. PATIENT: A 36-year-old infertile patient with premature ovarian failure and a previous term pregnancy with fresh donated oocytes. INTERVENTION(S): We administered leuprolide acetate for pituitary down-regulation followed by E2 valerianate in incremental doses until an endometrial lining of >8 mm was observed by ultrasound. Thawing of frozen donated oocytes, intracytoplasmic sperm injection (ICSI), and translaparoscopic fallopian tube ET also were performed. Natural micronized progesterone was administered intravaginally (600 mg/d) before ET. MAIN OUTCOME MEASURE(S): Ultrasound at the 8th week of gestation revealed a triplet pregnancy with active fetal heartbeats. RESULT(S): A triple intrauterine gestation was achieved with the use of microinjection into cryopreserved oocytes. CONCLUSION(S): This case illustrates the feasibility of oocyte cryopreservation for clinical use in the era of ICSI.     

Modern fertilization techniques

In Germany, some 17.2% of married couples are unintentionally childless. Of these, about one-third have a male factor infertility (with disordered spermatogenesis), which in part is unresponsive to drug treatment. In such cases, assisted reproductive techniques are giving childless couples new hope. The techniques are based on two principles: 1) in vitro improvement in semen quality in the laboratory, and 2) the overcoming of natural barriers to fertilization. The latter includes intra-uterine insemination (IUT), in vitro fertilization and embryo transfer (IVF/ET), gamete intrafallopian transfer (GIFT), subzonal sperm insemination (SUZI), zona pellucida drilling, and intracytoplasmatic injection of sperm (ICSI). ICSI has also used epididymal spermatozoa obtained by microsurgical aspiration (MESA) and sperm extracted from testicular biopsies (TESA). These methods have their own specific indications, contraindications and pregnancy rates. However, assisted conception techniques should not be considered outside the overall situation of the couple, including ethical, sociological, physiological and general medical problems.     

Comparison of sperm separation methods: effect on recovery, motility, motion parameters, and hyperactivation

OBJECTIVE: To compare the Enhance (Percoll; Conception Technologies, San Diego, CA) and PureSperm (Gen X International, Madison, CT) sperm preparation methods with respect to recovery (percentage of motile sperm), motility (%), path and progressive velocities (microm/s), and hyperactivation (%). DESIGN: Comparison of sperm processing methods. SETTING: University medical center-based clinical andrology laboratory and infertility program. PATIENT(S): Twenty-five men who presented for semen analysis. INTERVENTION(S): Each of 25 semen specimens were divided and each aliquot was prepared using two different density gradient centrifugation methods. MAIN OUTCOME MEASURE(S): The motile sperm recovery, percent motility, motion parameters, and percent hyperactivation were measured for each semen specimen (n=25) before and after separation with the use of the two methods. RESULT(S): There was no difference in the percent motility and motile count between specimens prepared with Enhance (Percoll) and PureSperm and fresh specimens. Statistically significant differences were found (fresh versus test) in the velocities and in hyperactivation (PureSperm only), and no differences were found between the processing methods. CONCLUSION(S): PureSperm appears to be as effective as Percoll (Enhance) for the recovery of good, progressively motile sperm for use in IUI or other assisted reproductive techniques.     

An interview with Sue Hall Esleck. Interview by Connie R. Curran

The present report covers the results of a 38-month period in which 2853 consecutive intracytoplasmic sperm injection (ICSI) cycles were performed in 1953 couples. These couples were afflicted with male factor infertility and had at least one previous failed conventional in vitro fertilization (IVF) treatment cycle. In other couples, the husband had semen parameters incompatible with conventional IVF or suffered from excretory or secretory azoospermia where it was possible to recover spermatozoa by microsurgical epididymal sperm aspiration (mesa) or by testicular sperm extraction (tese) procedure. Overall, the 2-PN fertilization rate was 62% per retrieved metaphase II oocyte and 70% per successfully injected metaphase II oocyte. Embryo transfer was performed in 91% of started cycles. The cumulative pregnancy rate (positive HCG) was 34% per started ICSI treatment and 37% per embryo transfer.     

Electroejaculation and assisted fertility in men with psychogenic anejaculation

OBJECTIVES: To evaluate sperm characteristics and fertility potential in ejaculates obtained after electroejaculation in men with psychogenic anejaculation. DESIGN: Retrospective clinical study. SETTING: In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS: Twenty men with psychogenic anejaculation who underwent 55 sessions of electroejaculation and their spouses. INTERVENTIONS: Electroejaculation, assisted reproduction technologies. MAIN OUTCOME MEASURES: Semen analysis, IVF, intracytoplasmic injection (ICSI), fertilization rates, and pregnancy rates. RESULTS: In all patients, sperm density and motility rates were unsatisfactory (98 +/- 127 x 10(6) with 14.6% +/- 15% motility in the antegrade portions and 42 +/- 42 x 10(6) with 9.7% +/- 15.6% motility in the retrograde samples). Intrauterine inseminations performed in eight couples did not result in a pregnancy. Four couples underwent IVF-ET treatments. Two pregnancies were achieved with overall success rates of 22% per cycle. Five couples were treated using the ICSI procedure. Although good quality embryos were transferred, none of the treatments resulted in a pregnancy. CONCLUSIONS: Psychogenic failure to ejaculate may be treated by electroejaculation. However, the average motility of the sperm obtained is diminished. The combination of electroejaculation with IVF, including the ICSI procedure, should improve chances of fertilization and pregnancy in these cases.     

The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters

High success rates have been reported for the use of intracytoplasmic sperm injection (ICSI) in alleviating essentially andrological infertility. However, neither the relationship between any of the sperm parameters and the result of ICSI nor the minimal sperm requirements for ICSI have been investigated so far. In this paper, our objective was therefore to study the relationship between three basic sperm parameters (total sperm count, sperm motility and morphology) and the outcome of ICSI by retrospective analyses of fertilization, embryo development and pregnancy rates in 966 micro-injection cycles, performed with ejaculated semen. The results showed that there was no important influence from either the type or the extent of sperm impairment on the outcome of ICSI. Even in the most extreme cases of male-factor infertility, where cryptozoospermia or total astheno- or total teratozoospermia was diagnosed in the initial semen sample, high fertilization and pregnancy rates were obtained by ICSI. Only one condition had a strongly negative influence on the result of ICSI: where an immotile (presumably dead) spermatozoon was injected into the oocyte. Thus the only ultimate criterion for successful ICSI is the presence of at least one living spermatozoon per oocyte in the pellet of the treated semen sample used for micro-injection.     

The effect of combined laser and electropuncture on the bioelectrical potentials and skin temperature of patients with gastroesophageal reflux

We determined the intrauterine insemination (IUI) pregnancy outcome in the same group of patients when applying different methods of ovulation induction. A group of patients with unexplained (no. 46) and male factor infertility (no. 101) consented to have the following treatment protocol at the American University of Beirut-Infertility Center: IUI to be performed in three natural ovulatory cycles in all patients, then in three clomiphene citrate (CC) stimulated cycles in the remaining non-pregnant patients, and then three cycles with controlled ovarian hyperstimulation (COH) in the remaining group. Of the total 147 patients 130, 138 and 123 underwent 273 natural, 278 CC and 266 COH IUI cycles, respectively. Semen processing for IUI was done by washing the sperm twice and using the swim-up technique. The chi-square test was used for statistical analysis. Pregnancy rate per cycle of IUI with COH (9.8%) was significantly higher than that of IUI in natural cycles (3.3%) but approached significance when compared to IUI with CC cycles (5.4%). Also unexplained infertility cases had a significantly higher pregnancy rate (58.7%) when compared to that of male factor cases (22.8%). IUI still has a place in the treatment of infertility due to selective causes. Combined with COH, IUI gives the best pregnancy rate although its benefit with natural or CC cycles remains obvious.