A controlled assessment of direct intraperitoneal insemination.

OBJECTIVE: To test the efficacy of direct intraperitoneal (IP) insemination and its effect on cell-mediated immunity. DESIGN: A prospective trial with each couple having one treatment (insemination) cycle and one control (timed intercourse) cycle performed in random order with the same ovulation stimulation in both cycles. SETTING: Secondary and tertiary referral fertility clinics; university teaching hospital. PATIENTS: Twenty-six infertile couples. Excluding pregnancy, only one couple did not complete the two cycles. INTERVENTIONS: Ovulation induction in both cycles. Intraperitoneal insemination in the insemination cycles. MAIN OUTCOME MEASURES: These were pregnancy rate (treatment versus control) and mixed lymphocyte response (MLR) sensitivity (before and after direct IP insemination treatment). RESULTS: There were four control and no treatment pregnancies. This was not a significant difference (odds ratio). Mixed lymphocyte responses in fertile subjects did not change during the menstrual cycle (Wilcoxon). There was no significant increase in MLR sensitivity to partner's cells after direct IP insemination treatment. CONCLUSIONS: This controlled study found no benefit from direct IP insemination in terms of pregnancies over control cycles. There was no evidence that direct IP insemination had increased cell-mediated immune response sensitivity to husband's cells.