Fifty-seven cases of homologous artificial insemination (AIH) were reviewed as well as the reason for performing the insemination. Three patients had AIH because of impotence, and two conceived. Twenty-nine patients whose husbands had sperm counts of less than 40 million/ml had AIH combined with split ejaculates, and seven (24.1%) became pregnant. Twenty-five patients had AIH because of persistent, unexplained, poor postcoital tests despite a normal semen picture, and eight (32%) became pregnant.

PIP: 57 cases of homologous artificial insemination (AIH) among patients with at least 2 years of involuntary infertility and a minimum of 4 treatment cycles were reviewed. Patients were classified into 4 groups by indication for AIH: 1) faulty delivery with a fertile semen specimen; 2) oligospermia (sperm count 20 million/ml); 3) subfertile semen (sperm count 20-40 million/ml with at least 35% motility after 6 hours); and 4) persistent, unexplained, poor postcoital tests with a negative spermagglutination test and husbands with a fertile semen specimen. Female partners were further classified according to whether another infertility related factor was (group B) or was not (group A) present. 17 patients (29.8%) conceived, for a total of 18 pregnancies. There were 15 term deliveries and 3 spontaneous abortions. An average of 3.8 treatments was required to achieve pregnancy. Overall, 52.9% of the pregnancies were achieved by the 4th treatment cycle and 76.4% by the 5th. 8 (27.5%) of the 29 women in group A and 9 (32.1%) of the 28 women in group B became pregnant. 2 of the 3 cases receiving AIH because of faulty delivery of semen conceived. In cases in which there was oligospermia and no female factor, 4 of 12 women (33.3%) became pregnant when split ejaculate was used. 3 of the remaining 8 patients had artificial insemination with donor semen and all conceived. No pregnancies occurred among 5 group A women in whom AIH split ejaculate was performed due to subfertile semen; however, 2 of 2 group B patients in this category conceived. If all patients with sperm counts 40 million/ml are combined, 4 of 17 patients (23.5%) in group A and 3 of 12 patients (25%) in group B became pregnant. 3 of 10 (30%) group A women and 5 of 15 (33.3%) group B women became pregnant where there were unexplainedly poor postcoital tests. Overall, 5 of 22 (22.7%) normal and abnormal women whose partners had oligospermia and 2 of 7 (28.5%) whose husbands had sperm counts between 20-40 million/ml conceived, for a total rate of 24.1%. On the basis of these pregnancy rates, AIH with split ejaculates appears to be a worthwhile procedure in oligospermia and subfertility. The overall 32% pregnancy rate in patients with poor postcoital tests but normal sperm counts suggests that AIH is a useful mode of treatment in these cases as well.