Abstract:

Objective To investigate the timing and outcome of artificial insemination with donor sperm(AID) after failure in intracytoplasmic sperm injection (ICSI) in patients with severe oligoasthenospermia or obstructive azoospermia. Methods The cycle pregnancy rates of AID (93 treatment circles) after failure in ICSI in 46 infertile couples with severe oligoasthenospermia or obstructive azoospermia were retrospectively analysed, and were compared with those directly undergoing AID during the same period (AID group, n=74). Besides, 1 007 patients undergoing ICSI during the same period (1 128 treatment cycles) were selected, and were divided into ejaculated sperm group and epididymal sperm group according to different sources of sperm, and were also divided into mild oligoasthenoteratozoospermia group (group A, n=157), severe oligoasthenoteratozoospermia group (group B, n=305), testicular or epididymal aspiration group (group C, n=110) and the other aspiration group (group D, n=435) according to sperm parameters. The fertility rate, cleavage rate, excellent embryo rate and pregnancy rate were compared among group A, B, C and D, and the fertility rate, cleavage rate, excellent embryo rate and pregnancy rate of the first to fourth cycle of ICSI in group B were compared. Results The cumulative pregnancy rate of 46 patients who failed in multi-cycle ICSI treatment and transferred to 1 to 4 cycles of AID reached 52.2%, and the cycle pregnancy rate was 25.8%, which was not significantly different from the cycle pregnancy rate of AID control group (27.6%)(P>0.05). The fertility rate (75.3%) and pregnancy rate (28.7%) of group C were significantly lower than those of group A, B and D (P<0.01), the excellent embryo rate of group B (40.7%) were lower than group A, C and D, and the pregnancy rate of group B (35.1%) were significantly lower than those of group A (P<0.01) and group D (P<0.05). The pregnancy rates of the third cycle and fourth or above cycle of ICSI were 15.4% and 0 in group B, which were significantly lower than those of the first cycle and second cycle (P<0.05). Conclusion AID can be performed after informed consent in patients with failure in more than 3 cycles of ICSI or with severe asthenozoospermia and obstructive azoospermia whose sperm is few, and a high pregnancy rate can be achieved.

Key words: intracytoplasmic sperm injection, artificial insemination with donor semen, pregnancy rate