Prospective randomized comparison of intrauterine and intracervical insemination with donor spermatozoa

From March 1990 to September 1993, 20 women underwent a total of 89 cycles of intracervical inseminations with donor semen (ICI) and 23 women underwent 67 cycles of intrauterine inseminations with donor semen (IUI). The women were assigned to the two groups randomly, but ensuring that the ages of the women and pathologies of the male partner (azoospermia or severe oligozoospermia) were similar in the two groups. There was no significant difference between the characteristics of the two groups and the method used to induce ovulation (HMG/HCG) was identical. Two semen straws were used for each insemination cycle. Semen was prepared for IUI on a Percoll gradient. Thirteen clinical pregnancies were obtained in the IUI group (19.4% of the attempts) and six in the ICI group (6.75%). After six cycles of insemination, 75.4% of the women of the IUI group obtained a pregnancy, as compared to 35% in the ICI group. These good results may be due to the method of induction of ovulation, but also to the technique itself, increasing the number of motile spermatozoa at the site of fertilization. The time taken to obtain a pregnancy is thus shorter with IUI than with ICI, and the number of semen straws required is smaller. In-vitro fertilization (IVF) should be proposed after six failures by IUI.