Sex preselection through albumin separation of sperm.

OBJECTIVE: To determine if passage of sperm through columns of liquid albumin before their use in artificial insemination could affect the sex ratio at birth. DESIGN: Sperm were isolated by layering over columns of liquid albumin. The isolated fractions were inseminated into the uterus on the presumptive day of ovulation. SETTING: Patients were treated in 65 clinical practices (Sperm Centers) located both in this country (57) and abroad (8). PATIENTS: Individuals were self-selected by their desire to have a child of a specified sex. MAIN OUTCOME MEASURE: The sex of offspring resulting from the insemination of isolated sperm. RESULTS: Insemination with sperm isolated to enhance male sex preselection produced 71% and 76% males depending on the technique. Use of isolated sperm in women who were taking clomiphene citrate was associated with a 69% birth of females. CONCLUSIONS: Separation of sperm on columns of liquid albumin can affect the sex ratio at birth.

PIP: Fertility specialists examined data on 1407 births resulting from artificial inseminations with sperm separated on albumin columns and occurring at 59 sperm centers in the US and at 8 sperm centers in other countries to determine whether albumin separation can effectively affect the sex ratio. The patients had already had at least 2 children of the same sex and wanted a child of the opposite sex and consciously opted to use sex preselection techniques. Male newborns predominated (72% vs. 28%). The modified protocol 3 resulted in a higher percentage of male births than did protocol 3 (76% vs. 71%), but the difference was insignificant. Both protocols significantly influenced the sex ratio (71% vs. 29% for protocol 3, and 76% vs. 24% for modified protocol 3; p .0001). For female sex preselection, protocol 2 included administration of clomiphene citrate to the woman to induce ovulation and less complete sperm separation. It resulted in a significantly higher percentage of female births than male births (69% vs. 31%; p .0003). 5.7% of a representative sample (sperm centers in Dallas, Texas, and Lathrup Village, Michigan) were lost to follow-up, but these 547 couples were apparently the same as the entire sample. These findings indicated that the albumin separation method does influence the sex ratio at birth, but its use is likely limited since it is not 100% effective.

Uterus unicornis with uterus solidaris.

Five patients are presented who manifested a heretofore unreported uterine anomaly: uterus unicornis with uterus solidaris. The condition is illustrated and described in detail. Patients with this anomaly have a good fertility potential, although they may expect a high fetal wastage, frequent premature labor and delivery, increased complications of pregnancy and delivery, and an increased incidence of infants that are small for the pregnancy duration. The importance of laparoscopy in diagnosing this anomaly is emphasized.