Introduction

Insemination technique has changed greatly during the past 40 years, from a simple vaginal technique that was little different than that used by John Hunter in 1785 to intracervical (ICI), intrauterine (IUI), fallopian tube sperm perfusion (FSP) and direct intraperitoneal insemination (DIPI) techniques. When Nachtigall et al. reviewed the status of artificial insemination in 1979, nearly all inseminations were vaginal and pregnancy rates were generally satisfactory when donor sperm was used or insemination with partner sperm was performed because of physical problems, but very poor when insemination with partner sperm was performed because of low sperm count. The semen specimen was usually fresh for both donor and partner insemination, except in rare cases where multiple samples of poor-quality sperm were cryopreserved in the hope that sufficient “good” sperm would be available when the accumulated specimens were thawed. Those cases were nearly always unsuccessful.

Successful pregnancies following intrauterine insemination of 10 minims (0.6 mL) of fresh unprocessed sperm were reported in 1920, but the procedure was abandoned because of concern about infection. Furthermore, the amount inseminated had to be kept small to reduce uterine cramping, so it was not helpful in cases where the sperm count was low. When insemination techniques were compared in 1957, pregnancy rates for IUI were worse than when the entire sperm specimen was placed in a cervical cup applied to the cervix, or simply deposited in the vagina.

In the present day, insemination with both donor and partner semen is nearly always performed by the intrauterine insemination (IUI) technique.