(326) Intrauterine Insemination: A Story of Husbandry and Husbands
Authors: Werner Z , O'connor L , Barnard J 
Published: February 2024

Abstract

Introduction
Intrauterine insemination (IUI) is one of the most common methods of reproductive assistance in the modern era. As most female mammals have an estrous cycle, IUI as a procedure can be broadly applied to a wide array of species.

Objective
We sought to explore the history of IUI from its origins to modern application in assisted human reproduction.

Methods
We reviewed articles from Google Scholar, PubMed, and MedLine.

Results
Unverified accounts of the artificial insemination of an Arabian Mare can be traced back to the French translation of a 14th century equine veterinary textbook. A century later, King Henry IV of Castile, given the unfortunate nickname the Impotent, holds the first unsubstantiated claim of successfully using IUI. However, subsequent accounts dispute the paternity of the princess. It was not until the 18th century that Italian scientist Lazzaro Spallanzani would successfully conduct canine IUI with the birth of three puppies. Concurrently, famed surgeon John Hunter advised an impotent hypospadias patient to collect his post-coital semen. Hunter would subsequently instill it into the wife’s vaginal vault with reported successful pregnancy. Jumping forward to the mid 1800s J. Marion Sims, the so-called Father of Gynecology, instilled semen in six enslaved African American women, unfortunately time with their menstrual cycles, resulting in one pregnancy and subsequent miscarriage. In 1884 Dr. William Pancoast successfully performed IUI using a medical student’s semen, unbeknownst to the husband and wife. The results were published 25 years after the procedure. Human artificial reproduction had gained enough notoriety at the time to attract the attention of the Catholic Church. Pope Leo XIII condemned the practice as illicit. The majority of IUI research would then be largely conducted in Europe for the purpose of superior dairy cattle and stallions. In 1938 New Jersey dairy farm operator EJ Perry was the first American to institute cattle artificial insemination using Danish practices. Just one year later Gregory Pincus at Harvard University would remove and fertilize the egg of a female rabbit. Implantation into a second donor female resulted in a successful litter. Vast improvements in sperm preservation were made utilizing bull semen, egg yolks, sodium citrate, and glycerol. Contamination rates were reduced with the invention of the reputed Cornell Extender, and by 1953 Dr. Jerome Sherman was able to freeze, thaw, and successfully fertilize a human oocyte. Although the first successful pregnancy using frozen spermatozoa was reported in 1953, a conception rate of 3.4% reported by Mastriani et al led them to conclude the practice should be abandoned if no improvements made. The introduction of in-vitro fertilization in 1978 by Steptoe and Edwards effected subsequent improvements in sperm washing techniques, sperm selection and use of adjunctive hormones for induction of ovulation. IUI would go on to become one of the most common assisted reproduction techniques world-wide.

Conclusions
IUI has undergone numerous, major breakthroughs across several species with, at times, questionable ethical practices. Nonetheless, it provides an additional option to couples globally and appears here to stay

Disclosure
No.