A Plea for a More Scientific Approach in the Treatment of Male Infertility

Washed Intrauterine Insemination in the Treatment of Oligospermic Infertility

“…In cases of infertility in which the only cause is impairment of semen quality due to a reduction in normal sperm number (oligopsermia), a reduction in normal motility and/or normal morphology (asthenospermia), or a combination of these three factors, it would seem logical to attempt: (1) to concentrate the fraction of morphologically normal spermatozoa with a high progressive motility as atraumatically as possible; (2) to place these highquality sperm accurately and atraumatically at the top of the uterine cavity, adjacent to the medial ends of the fallopian tubes, thereby reducing the distance that the sperm have to travel to the oocyte; and (3) to SEMINARS IN REPRODUCTIVE ENDOCRINOLOGY Volume 5, Number 1 February 1987 inseminate within hours of ovulation, as the endometrial cavity appears hostile to sperm longevity. It is important for these sperm to evacuate the uterus and reach the site of fertilization in the ampullary portion of the fallopian tube and attach to the zona pellucida of the oocyte within a short time.…”

“…An appeal was made for the incorporation of control groups in future studies. A further plea for a more scientific approach to the assessment of male factor infertility was made by Dubin and Amelar, 2 and it serves to underline the degree of empiricism and lack of scientific principles that have commonly applied to methods of treatment for male infertility. In a more recent review on the therapeutic value of IUI by Allen and associates 3 it was emphasized that (1) treatment should be reserved for couples with clear indications, (2) couples should be well informed of the success rates, (3) risks such as sperm sensitization in the woman should be considered, and (4) the emotional impact of being involved in a relatively expensive and technically demanding procedure should be conveyed and appropriate support given.…”

“…However, the principles outlined for designing a prospective and controlled study for evaluation of the efficacy of IUI for other infertility categories also apply. The rationale for pericervical insemination or IUI about the time of ovulation in cases of (1) anatomic defects of the penis, such as severe hypospadias, which make intravaginal intercourse difficult or ineffectual; (2) psychogenic, drug-related, or organic impotence; and (3) retrograde ejaculation, is easily understood and the treatment is effective, provided the semen quality is acceptable and the woman is potentially fertile.…”