Intracervical versus intrauterine insemination: correlation of outcome with antecedent postcoital testing

Thirty-four infertile women alternated cycles of intracervical insemination (ICI) with whole ejaculate homologous semen (mean, 3.2 cycles/patient) versus intrauterine insemination (IUI) with washed sperm (mean, 3.4 cycles/patient). Twenty of the 34 women had prior postcoital tests consistently demonstrating less than or equal to 3 motile sperm per high-powered field (HPF). Six of those 20 conceived during IUI cycles (30.0%); 0 conceived during ICI cycles (P = 0.06, Mantel-Haenszel chi-square test). The pregnancy rate per IUI cycle was 6/72 (8.3%), compared with 0/66 (0.0%) per ICI cycle, a statistically significant difference (P = 0.04, Fisher's exact chi-square test). Fourteen of 34 women had prior postcoital tests consistently demonstrating greater than or equal to 5 motile sperm per HPF. One of the 14 conceived during an IUI cycle (7.1%), and 2 conceived during ICI cycles (14.3%), a difference that was not significant. The pregnancy rate per IUI cycle was 1/42 (2.4%), compared with 2/42 (4.8%) per ICI cycle (not significant). IUI may be helpful in the management of infertility associated with relatively poor postcoital tests (less than or equal to 3 motile sperm per HPF) but not with relatively good postcoital tests (greater than or equal to 5 motile sperm per HPF).