A randomized, prospective analysis of five sperm preparation techniques before intrauterine insemination of husband sperm.

Objective: To evaluate pregnancy rates (PRs) in women undergoing artificial insemination with sperm alternately prepared by one of five techniques: sperm washing, Percoll gradient centrifugation, swim-up, swim-down, or refrigeration/heparin treatment.
Design: Each treatment group alternated in a different order through the five sperm preparations. Pregnancy rates were compared for each sperm preparation.
Setting: Two infertility centers, one located in an academic institution and the other a regional hospital.
Patient(s): Three hundred sixty-three women undergoing 898 artificial inseminations with husband semen with a progressive motile sperm count of >20 million sperm per mL were randomly placed in the five treatment groups.
Main Outcome Measure(s): Pregnancy rates.
Result(s): The overall ongoing PR per insemination was 9.7% (87/898), including 6.12% for natural cycles (n = 196), 12.8% for clomiphene citrate-stimulated cycles (n = 101), and 10.3% for gonadotropin-stimulated cycles (n = 601). The highest ongoing PRs for sperm preparations followed the swim-up technique (13.2%, 26/197) and the Percoll gradient centrifugation technique (12.7%, 26/204).
Conclusion(s): These data suggest that the swim-up and Percoll gradient preparations result in higher PRs than the wash, swim-down, and refrigeration/heparin techniques.