The development of a clinical test of sperm migration to the site or fertilization.

In those patients whose infertility is unexplained after routine investigations, it is likely that there are defects of gamete transport, fertilization, or implantation. This paper describes the development of a test of sperm migration to the site of fertilization. A method of laparoscopic sperm recovery from the peritoneal cavity and fimbrial rinsings following insemination at midcycle is described. In all, 47 patients were studied, and spermatozoa were recovered in 55%. There was no difference in the success rate following artificial insemination or coital insemination. Successful sperm recovery could not be attributed to better semen quality or better timing of the procedure in the menstrual cycle. The spontaneous pregnancy rate in the positive sperm recovery group was significantly higher than in the negative group. A comparison was made between the results of the postcoital test and the results of laparoscopic sperm recovery. There was a poor correlation between the two tests. It is suggested that laparoscopic sperm recovery is useful in the investigation of and the further management of that group of patients whose infertility is unexplained.