Optimizing success with donor insemination.

Artificial insemination with donor sperm yields pregnancy rates similar to the general fertile population with the woman's age being the best predictor for success. This article reviews the indications for donor insemination and the current American Society for Reproductive Medicine guidelines for screening both the donors and recipients. For most women, timing the insemination the day after detecting the LH surge with a urinary ovulation predictor kit gives the best results. The addition of clomiphene or letrozole provided no benefit in women with regular menstrual cycles. Superovulation with FSH or hMG did significantly increase the fecundity rate but at a much greater cost and risk of multiple pregnancy and ovarian hyperstimulation syndrome. Intrauterine insemination has been shown to be superior to intracervical insemination in most studies. Adding a second insemination doesn't appear to significantly improve upon the pregnancy rates to justify the additional cost and inconvenience. Fallopian sperm perfusion has shown promise in preliminary studies. The different techniques of sperm processing are reviewed but no technique was clearly better.