Semen preparation techniques for intrauterine insemination

Cochrane Database of Systematic Reviews

Volumn 2019, Issue 10, 2019, Pages

  Boomsma, Carolien M ^a   Cohlen, Ben J ^b   Farquhar, Cindy ^c  

^a Bariatric Centre South West Netherlands   (Netherlands)

^b ISALA HOSPITAL   (Netherlands)

^c UNIVERSITY OF AUCKLAND   (New Zealand)

Author keywords

[No Author keywords available]

Indexed keywords

CENTRIFUGATION; COMPARATIVE EFFECTIVENESS; FEMALE; HUMAN; INTRAUTERINE INSEMINATION; MALE; MEDICAL PROCEDURES; MULTIPLE PREGNANCY; PREGNANCY RATE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SEMEN PREPARATION TECHNIQUE; SPONTANEOUS ABORTION; SYSTEMATIC REVIEW; TREATMENT OUTCOME;

EID: 85073543455     PISSN: 14651858     EISSN: None     Source Type: Journal    
DOI: 10.1002/14651858.CD004507.pub4     Document Type: Review

References (102)

1. Carrell DT, Kuneck PH, Peterson CM, Hatasaka HH, Jones KP, Campbell BF. A randomized, prospective analysis of five sperm preparation techniques before intrauterine insemination of husband sperm. Fertility and Sterility 1998;69(1):122-6.
2. Dodson WC, Moessner J, Miller J, Legro RS, Gnatuk CL. A randomized comparison of the methods of sperm preparation for intrauterine insemination. Fertility and Sterility 1998;70(3):574-5.
3. Grigoriou O, Makrakis E, Konidaris S, Hassiakos D, Papadias K, Baka S, et al. Effect of sperm treatment with exogenous platelet-activating factor on the outcome of intrauterine insemination. Fertility and Sterility 2005;83(3):618-21.
4. Karamahmutoglu H, Erdem A, Erdem M, Mutlu MF, Bozkurt N, Oktem M, et al. The gradient technique improves success rates in intrauterine insemination cycles of unexplained subfertile couples when compared to swim-up technique; a prospective randomized study. Journal of Assisted Reproduction and Genetics 2014;31(9):1139-45.
5. Posada MN, Azuero AM, Arango AM, Raigosa GC, Cano JF, Perez AL. Sperm washing with swim-up versus gradients in intra uterine insemination (IUI): results of a prospective randomized study comparing pregnancy rates and costs. Fertility and Sterility Abstract book 61st ASRM meeting. 2005; Vol. 84 Suppl 1:361.
6. Soliman S, Goyal A. RCT comparing two different sperm preparations for intrauterine insemination. Fertility and Sterility, Abstractbook 61st ASRM meeting. 2005; Vol. 84 Suppl 1:156.
7. Xu L, Lu RK, Chen L, Zheng YL. Comparative study on efficacy of three sperm-separation techniques. Asian Journal of Andrology 2000;2(2):131-4.
8. Abed F, Zadehmodarres S. A comparative study of swim-up and upstream methods for isolating sperm cell for intra uterine insemination. International Journal of Women's Health and Reproduction Sciences 2015;3(2):103-6.
9. Almagor M, Benbenishti D, Rosenak D, Mogle Y, Yaffe H. Simultaneous swim-up/swim-down of sperm in assisted reproduction procedures. Journal of Assisted Reproduction and Genetics 1993;10(4):261-5.
10. Aribarg A, Sukcharoen N. Intrauterine insemination of washed spermatozoa for treatment of oligozoospermia. International Journal of Andrology 1995;18 suppl 1:62-6.
11. Bajamonte M, Ruvolo G, Cimino C, Cittadini E. Advantages of treatment with human follicular fluid in the management of severely dyspermic patients in human in vitro fertilization programs. Acta Europaea Fertilitatis 1994;25(2):87-92.
12. Baka S, Grigoriou O, Hassiakos D, Konidaris SW, Papadias K, Makrakis E. Treatment of sperm with platelet activating factor does not improve intrauterine insemination outcomes in unselected cases of mild male factor infertility: a prospective double blind randomized crossover study. Urology 2009;74(5):1025-8.
13. Berteli TS, Da Broi MG, Martins WP, Ferriani RA, Navarro PA. Magnetic-activated cell sorting before density gradient centrifugation improves recovery of high-quality spermatozoa. Andrology 2017;5(4):776-82.
14. Bhakta R, Kumar P, Adiga SK, Kalthur G. A randomized controlled study to evaluate the cost-effectiveness in sperm extraction using carbon dioxide and carbon dioxide free system in relation to intrauterine insemination pregnancy. Journal of Human Reproductive Sciences 2010;3(1):8-10.
15. Butt F, Arshad Chohan M. Comparative efficacy of density gradient and swim-up methods of semen preparation in intrauterine insemination cycles. Journal of the Pakistan Medical Association 2016;66(8):932-7.
16. Byrd W, Drobnis EZ, Kutteh WH, Marshburn P, Carr BR. Intrauterine insemination with frozen donor sperm: a prospective randomized trial comparing three different sperm preparation techniques. Fertility and Sterility 1994;62(4):850-6.
17. Caccamo A, Scarduelli C, Tesoriere G, Giametta P, Lombroso GC. Comparison of the Percoll and swim-up methods for sperm preparation for normal semen samples. Human Reproduction 1995;10(Abstractbook 2):114.
18. Chan P, Tredway D, Su B, Corselli J, Pang S. A double method sperm wash for artificial insemination. Archives of Andrology 1992;29(1):43-8.
19. Cimino C, Cittadini E, Gattuccio F. New developments in the treatment of male sub-fertility by means of assisted fecundation techniques. Acta Europaea Fertilitatis 1990;21(6):281-8.
20. Depypere H, Milingos S, Comhaire F. Intrauterine insemination in male subfertility: a comparative study of sperm preparation using a commercial percoll kit and conventional sperm wash. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1995;62(2):225-9.
21. Fazaeli H, Davoodi F, Kalhor N, Tabatabaii Qomi R. The effect of supernatant product of adipose tissue derived mesenchymal stem cells and density gradient centrifugation preparation methods on pregnancy in intrauterine insemination cycles: An RCT. International Journal of Reproductive Biomedicine (Yazd, Iran) 2018;16(3):299-308.
22. Fleming SD, Ilad RS, Griffin AM, Wu Y, Ong KJ, Smith HC, et al. Prospective controlled trial on an electrophoretic method of sperm preparation for assisted reproduction: comparison with density gradient centraifugation. Human Reproduction (Oxford, England) 2008;23(12):2646-51.
23. Gentis RK, Siebert I, Kruger TF, de beer-Windt ML. Implementation of an office-based semen preparation method (SEP-D Kit) for intra-uterine insemination (IUI): A controlled randomised study to compare the IUI pregnancy outcome between a routine (swim-up) and the Sep-D Kit method. South African Journal of Obstetrics and Gynaecology 2012;18(2):54-5.
24. Guerin JF, Mathieu C, Lornage J, Pinatel MC, Boulieu D. Improvement of survival and fertilizing capacity of human spermatozoa in an IVF programme by selection on discontinuous Percoll gradients. Human Reproduction 1989;4(7):798-804.
25. Butt F, Chohan MA. Comparative efficacy of density gradient and sim-up methods of semen preparation in intrauterine insemination cycles. Journal of the Pakistan Medical Association 2016;66(8):932-7.
26. * Hammadeh ME, Kuhnen A, Amer AS, Rosenbaum P, Schmidt W. Comparison of sperm preparation methods: effect on chromatin and morphology recovery rates and their consequences on the clinical outcome after in vitro fertilization embryo transfer. International Journal of Andrology 2001;24(6):360-8.
27. Heidari M, Darbandi M, Darbandi S, Shani S, Lakpour N, Sadeghi MR. Comparative study of sperm quality on swim up and upstream processing techniques. ISERB conference abstract. Journal of Reproduction & Infertility 2016;17:110-1.
28. Huang HY, Lai YM, Lee CL, Chang MY, Chang SY, Soong YK. Improved sperm recovery rate with Percoll gradient method in intrauterine insemination. Chang Gung Medical Journal 1996;19(1):24-9.
29. Inaudi P, Petrilli S, Joghtapour A, Trusso P, Petraglia F. Reduction of steps in the preparation of motile sperm for intra uterine insemination does not reduce efficacy of the procedure: Simplified one-step swim-up method versus classic swim-up. Human Reproduction 2002;17(5):1288-91.
30. Jalilian N, Bakhtiyari M, Keshavarzi F, Nankali A, Rezavand N, Veisi F, et al. Improvement in sperm quality and increased pregnancy rate after intrauterine insemination. Acta Medica Mediterranea 2016;32:941-5.
31. Jaroudi KA, Carver-Ward JA, Hamilton CJCM, Sieck UV, Sheth KV. Percoll semen preparation enhances human oocyte fertilization in male-factor infertility as shown by a randomized cross-over study. Human Reproduction 1993;8(9):1438-42.
32. Karlström PO, Bakos O, Bergh T, Lundkvist Ö. Intrauterine insmeination and comparison of two methods of sperm preparation. Human Reproduction 1991;6(3):390-5.
33. Kücük T, Sozen E, Buluç B. Effect of heat-induced hypermotility on pregnancy rate in intrauterine insemination for male factor infertility associated with asthenospermia: a prospective, randomized, controlled study. Journal of Assisted Reproduction and Genetics 2008;25(6):235-8.
34. Leonetti T, Causio F, Cagnazzo G. Techniques of sperm selection and in vitro fertilization results. Acta Europaea Fertilitatis 1995;26(1):31-4.
35. Levay PF, Fourie FR, Bezuidenhout C, Koch A. Effectiveness of various sperm processing methods in removing seminal plasma from insemination media. Human Reproduction 1995;10(8):2056-60.
36. Mathieu C, Guerin JF, Gille Y, Pinatel MC, Lornage J, Boulieu D. Isolation of spermatozoa using Percoll gradients; it's value for in vitro fertilization (IVF) [Separation des spermatozoides en gradient de Percoll: interet pour la fecondation in vitro (FIV)]. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 1988;17(2):237-41.
37. Menge AC, Hurd WW, Randolph JF, Ansbacher R, Hiner MR, Grady E, et al. The effect of TEST-Yolk buffer on intrauterine insemination pregnancy rates. Fertility and Sterility. Abstracts from the Meeting of the American Society for Reproductive Medicine. 1992; Vol. 58 Suppl 155:P140.
38. Monqaut AL, Zavaleta C, Lopez G, Lafuente R, Brassesco M. Use of high-magnification microscopy for the assessment of sperm recovered after two different sperm processing methods. Fertility and Sterility 2011;95(1):277-80.
39. Morshedi M, Duran HE, Taylor S, Oehninger S. Efficacy and pregnancy outcome of two methods of semen preparation for intrauterine insemination: a prospective randomized study. Fertility and Sterility 2003;79(Suppl 3):1625-32.
40. Morshedi M, Taylor S, Duru K, Montgomery C, Barroso G, Oehninger S. A prospective randomized study comparing Isolate™-processed versus washed semen in intrauterine insemination (IUI) therapy using husband's sperm: efficiency and pregnancy outcome. Fertility and Sterility. 1999; Vol. 72 Suppl 1:217.
41. Oguz Y, Guler I, Erdem A, Mutlu MF, Gumuslu S, Oktem M, et al. The effect of swim-up and gradient sperm preparation techniques on deoxyribonucleic acid (DNA) fragmentation in subfertile patients. Journal of Assisted Reproduction and Genetics 2018;35(6):1083-9.
42. Ohashi K, Saji F, Wakimoto A, Kato M, Tsutsui T, Tanizawa O. Preparation of oligozoospermic and/ or asthenozoospermic semen for intrauterine insemination using the Spermprep semen filtration column. Fertility and Sterility 1992;57(4):866-70.
43. Ord T, Patrizio P, Marello E, Balmaceda JP, Asch RH. Mini-Percoll: a new method of semen preparation for IVF in severe male factor infertility. Human Reproduction 1990;5(8):987-9.
44. Ozturk TN, Pekel A, Arikan OY, Bayrak O, Kafali H. One wash or two washes: effects of sperm wash processing by density gradient centrifugation on intrauterine insemination outcomes. Abstract. Human Reproduction 2008;23(Suppl 1):i119.
45. Paul JB, Seidemann EL, Wbster BW, Cochran RA. Influence of different gradient separation protocols on percent motile spermatozoa recovery. Fertility and Sterility. 2004; Vol. 82 Suppl:268.
46. Ragni G, De Lauretis L, D'Ambrogio G, Pellegrini S, Maggioni P, Vegetti W, et al. Prospective randomized comparison of test yolk buffer preincubation and swim-up standard preparation in intrauterine insemination. Human Reproduction. 1996; Vol. Abstract book 12th Annual Meeting of the ESHRE:122.
47. Ragni G, De Lauretis L, D'Ambrogio G, Pellegrini S, Maggioni P, Vegetti W, et al. Semen preparation by standard swim-up versus swim-up with test yolk buffer incubation in intrauterein insemination: a randomized study. Human Reproduction 1998;13(7):1859-63.
48. Remohi J, Gastaldi C, Patrizio P, Gerli S, Ord T, Asch RH. Intrauterine insemination and controlled ovarian hyperstimulation in cycles before GIFT. Human Reproduction 1989;4(8):918-20.
49. Ren SS, Sun GH, Ku CH, Chen DC, Wu GJ. Comparison of four methods for sperm preparation for IUI. Archives of Andrology 2004;50(3):139-43.
50. Ricci G, Perticarari S, Boscolo R, Montico M, Guaschino S, Presani G. Semen preparation methods and sperm apoptosis: swim-up versus gradient-density centrifugation technique. Fertility and Sterility 2009;91(2):632-8.
51. Romany L, Rivera Egea R, Meseguer M, Aparicio-Ruiz B, Remohi J, Garrido N. Magnetic activated sorting selection (MACS) of non-apoptotic sperm (NAS) improves ongoing pregnancy rates in homologous intrauterine insemination (IUI). ASRM conference abstract. Fertility and Sterility 2017;108(Suppl 1):e128-e129.
52. Roth F, Wusk B, Redolfi R, Haeberlin F. Semen processing-simultaneous swim-up vs swim-down technique: Re-evaluation of the benefits. Journal of Assisted Reproduction and Genetics 2018;35:2099.
53. Sapienza F, Verheyen G, Tournaye H, Janssens R, Pletincx I, Derde M, et al. An auto-controlled study in in-vitro fertilization reveals the benefit of Percoll centrifugation to swim-up in the preparation of poor-quality semen. Human Reproduction 1993;8(11):1856-62.
54. Siam EM. Pregnancy outcome after IUI for male and idiopathic infertility using a new simplified method for sperm preparation. Middle East Fertility Society Journal 2012;17(1):30-6.
55. Su BC, Chan PJ, Tredway DR, Pang SC. Clinical pregnancy rate after the double method wash and intrauterine insemination. Archives of Andrology 1993;31(1):63-7.
56. Tanphaichitr N, Agulnick A, Seibel M, Taymor M. Comparison of the in vitro fertilization rate by human sperm capacitated by multiple-tube swim-up and Percoll gradient centrifugation. Journal of in Vitro Fertilization and Embryo Transfer 1988;5(3):119-22.
57. Tomari H, Honjo K, Nagata Y. Evaluation of a new sperm density gradient and sperm wash for assisted reproductive technology. ASRM conference abstract. Fertility and Sterility 2017;108:e243.
58. Tsai YC, Lin MY, Chen SH, Kang CY, Tsai YT, Lin YT, et al. Comparing the clinical outcomes of intrauterine insemination by two different density gradient preparation methods. Journal of the Chinese Medical Association: JCMA 2004;67(4):168-71.
59. Urry RL, Middleton RG, Jones K, Poulson M, Worley R, Keye W. Artificial insemination: a comparison of pregnancy rates with intrauterine versus cervical insemination and washed sperm versus swim-up sperm preparations. Fertility and Sterility 1988;49(6):1036-8.
60. Van Der Zwalmen P, Bertin-Segal G, Geerts L, Debauche C, Schoysman R. Sperm morphology and IVF pregnancy rate: comparison between Percoll gradient centrifugation and swim-up procedures. Human Reproduction 1991;6(4):581-8.
61. Werlin L, Mayer J, Kramer T, Le N, Elwood V, Westerhout S, et al. A prospective randomized study of two methods of semen preparation for intrauterine insemination (IUI): a significant difference in the clinical pregnancies between Percoll (PW) and sperm wash (SW). Fertility and Sterility. Abstracts from the American Society for Reproductive Medicine. 1992; Vol. 58: Suppl 108. P215.
62. Zarmakoupis-Zavos PN, Zavos PM. Can the method of sperm preparation for intrauterine insemination affect subsequent pregnancy rates? Comparison between the SpermPrep (TM) and the traditional double wash method. Middle East Fertility Society Journal 1998;3:2.
63. Zavos PM, Centola GM. Methods of semen preparation for intrauterine insemination and subsequent pregnancy rates. Tohoku Journal of Experimental Medicine 1992;168(4):583-90.
64. Zech H, Moschig M, Weiss P, Zech J. Comparison of sperm preparation techniques with regard to sperm recovery, sperm survival and fertilization rate in vitro in normal and pathological ejaculates [Vergleich von praparationstechniken in bezug auf die spermatozoen-endkonzentration und-uberlebenszeit sowie die fertilisierungsrate in vitro bei normalen und pathologischen ejaculaten]. Geburtshilfe und Frauenheilkunde 1993;53(10):715-20.
65. Aitken J, Fisher H. Reactive oxygen species generation and human spermatozoa: the balance of benefit and risk. BioEssays 1994;16(4):259-67.
66. Berg U, Brucker C, Berg FD. Effect of motile sperm count after swim-up on outcome of intrauterine insemination. Fertility and Sterility 1997;67(4):747-50.
67. Byrd W. Processing of human semen for insemination: comparison of methods. In: GM Centola, K Ginsburg editor(s). Evaluation and treatment of the infertile male. Cambridge: Cambridge University Press, 1996:89-107.
68. Campana A, Sakkas D, Stalberg A, Bianchi PG, Comte I, Pache T, et al. Intrauterine insemination: evaluation of the results according to the woman's age, sperm quality, total sperm count per insemination and life table analysis. Human Reproduction 1996;11(4):732-6.
69. Canale D, Giorgi PM, Gasperini M, Pucci E, Barletta D, Gasperi M, Martino E. Inter and intra-individual variability of sperm morphology after selection with three different techniques: layering, swimup from pellet and Percoll. Journal of Endocrinological Investigation 1994;17(9):729-32.
70. Centola GM, Herko R, Andolina E, Weisensel S. Comparison of sperm separation methods: effect on recovery, motility, motion parameters, and hyperactivation. Fertility and Sterility 1998;70(6):1173-5.
71. Cho CL, Agarwal A. Role of sperm DNA fragmentation in male factor infertility: a systematic review. Arab Journal of Urology 2017;16(1):21-34.
72. Daya S. Pitfalls in the design and analysis of efficacy trials in subfertility. Human Reproduction 2003;18(5):1005-9.
73. De Jonge C. The clinical value of sperm nuclear DNA assessment. Human Fertility 2002;5(2):51-3.
74. Delhanty JDA. Preimplantation genetics: an explanation for poor human fertility?. Annals of Human Genetics 2001;65(Pt 4):331-8.
75. Evers JL. Female subfertility. Lancet 2002;360(9327):151-9.
76. Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet 2018;391(10119):441-50.
77. Goldenberg, M, Rabinovici J, Bider D, Lunenfeld B, Blankstein J, Weissenberg R. Intra-uterine insemination with prepared sperm vs. unprepared first split ejaculates. A randomized study. Andrologia 1992;24(3):135-40.
78. Henkel RR, Schill WB. Sperm preparation for ART. Reproductive Biology and Endocrinology: RB&E 2003;1:108.
79. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
80. Huang HY, Lee CL, Lai YM, Chang MY, Wang HS, Chang SY, et al. The impact of the total motile sperm count on the success of intrauterine insemination with husband's spermatozoa. Journal of Assisted Reproduction and Genetics 1996;13(1):56-63.
81. Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstetricia et Gynecologica Scandinavica 2001;80(1):74-81.
82. Lemmens L, Kos S, Beijer C, Braat DD, Nelen WL, Wetzels AM. Techniques used for IUI: is it time for a change?. Human Reproduction 2017;32(9):1835-45.
83. Lemmens L, Kos S, Beijer C, Braat DD, Jonker MA, Nelen WL, Wetzels AM. Optimization of laboratory procedures for intrauterine insemination: survey of methods in relation to clinical outcome. Andrology 2018;6(5):707-13.
84. Madbouly K, Isa A, Habous M, Almannie R, Abu-Rafea B, Binsaleh S. Postwash total motile sperm count: should it be included as a standard male infertility work up. Canadian Journal of Urology 2017;24(3):8847-52.
85. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Medicine 2012;9(12):e1001356.
86. Ng FL, Liu DY, Baker HW. Comparison of Percoll, mini-Percoll and swim-up methods for sperm preparation from abnormal semen samples. Human Reproduction (Oxford, England) 1992;7(2):261-6.
87. Nice: National Institute for Health and Care Excellence. Fertility problems: assessment and treatment [Clinical guideline [CG156]]. 2013, update 2017.
88. Niederberger C, Pellicer A, Cohen J, Gardner DK, Palermo GD, O'Neill CL, et al. Forty years of IVF. Fertility and Sterility 2018;110(2):185-324.
89. Oguz Y, Guler I, Erdem A, Mutlu MF, Gumuslu S, Oktem M, et al. The effect of swim-up and gradient sperm preparation techniques on deoxyribonucleic acid (DNA) fragmentation in subfertile patients. Journal of Assisted Reproduction and Genetics 2018;35(6):1083-9.
90. Ombelet W. The revival of intrauterine insemination: evidence-based data have changed the picture. Facts, Views & Vision in ObGyn 2017;9(3):131-2.
91. Parinaud J, Le Lannou D, Vieitez G, Griveau JF, Milhet P, Richoilley G. Enhancement of motility by treating spermatozoa with an antioxidant solution (Sperm-Fit) following ejaculation. Human Reproduction 1997;12(11):2434-6.
92. [Computer program] Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
93. Swan SH, Elkin EP. Declining semen quality: can the past inform the present?. BioEssays 1999;21(7):614-21.
94. Templeton A, Fraser C, Thompson B. The epidemiology of infertility in Aberdeen. BMJ 1990;301(6744):148-52.
95. Vail A, Gardener E. Common statistical errors in the design and analysis of subfertility trials. Human Reproduction 2003;18(5):1000-4.
96. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertility and Sterility 2001;75(4):661-8.
97. Wang FN. Assisted Human Reproductive Technology. Washington DC: Hemisphere Publishing Co, 1991.
98. World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge: Cambridge University Press, 1992.
99. World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge: Cambridge University Press, 1999.
100. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th Edition. WHO press, 2010.
101. Yan RY. Practical Eugenics. 2nd Edition. Beijing: People Health Publishing House, 1998.
102. Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C. Semen preparation techniques for intrauterine insemination. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2007, issue 4. [DOI: 10.1002/14651858.CD004507.pub3; CD004507]