Methods to increase the success rate of artificial insemination with donor semen.

Donor insemination was performed in two fertility clinics using cryopreserved semen from the same sperm bank. Donors were selected in agreement with American Fertility Society recommendations. In the first clinic, cup insemination was combined with intra-uterine insemination in 321 cycles. Follicular development was closely monitored with vaginal echography and serum hormonal measurements. In the second clinic, 1287 insemination cycles were performed using intra-cervical insemination, timed only on basal body temperature. In the first clinic, a total of 53 pregnancies were obtained, of which seven were in 55 unstimulated cycles (12.5%), 21 in 159 cycles with clomiphene citrate stimulation (13.1%, P > 0.1), and 25 in 107 cycles stimulated with clomiphene plus human menopausal gonadotrophin (HMG) (23.9%, P < 0.03). No multiple pregnancies were observed in the latter group. In the second clinic, 159 pregnancies occurred during 1287 insemination cycles (12.4%). It is concluded that neither intra-uterine insemination, nor hormonal and echographic cycle monitoring, nor clomiphene citrate enhances the success rate of artificial insemination with donor semen, but HMG treatment probably exerts a favourable effect.