Role of Semen Preparation Techniques in Success of IUI

Role of Semen Preparation Techniques in Success of IUI – Where and How?

Dr. Aruna Saxena ,Dr. Sharda Jain, Dr. Jyoti Bhaskar, Dr.Jyoti Agarwal, Dr. Abhishek Parihar

Intrauterine insemination is accepted as the most common first therapeutic intervention in Infertile couples. It can be performed with or without ovarian stimulation for treatment of cervical factor, mild to moderate male factor, anovulation and unexplained infertility.

Big part of the success of IUI lies in semen processing. The semen preparation which is offered as IVF services in Delhi to IVF patients is now universally followed for IUI patients too. It has eliminated the risk of pelvic inflammatory disease and uterine cramping.

The aim of semen preparation is to separate the normal sperm from the debris of the ejaculate and in case of IUI, to yield as many normal motile spermatozoa as possible.

It is important to remember that for the best results of IUI, Semen preparation should be done in In house Lab and should not be processed outside – as sperm capacitation process starts immediately and inspite of motile sperms, no pregnancy results.

We are 30 thousand gynaecologists in India and nearly half of them are practising infertility and doing IUI. It is unfortunate that except in IVFcentres in Delhi Ncr– very few gynaecologists in Delhi have In house lab for semen preparation.

As far as the technique of sperm preparation is concerned – it is clear one size does not fit all.
Spermatozoa may be selected by their ability to swim, known as the 'swim-up technique'. This technique is performed by layering culture medium over the liquefied semen. Motile spermatozoa swim up into the culture. The upper part of the layered medium is then carefully removed for further use.

The second method of selecting spermatozoa is by the use of density gradients. The semen sample is pipetted on top of the density column, which is then centrifuged. Density gradient centrifugation separates spermatozoa according to their density. This way we can select the motile, morphologically normal spermatozoa in the solution with the highest concentration of gradient, which is aspirated for further use.

The third method is conventional wash method in combination with centrifugation. The semen sample is diluted with a medium and centrifuged. Subsequently, the pellet (the bottom part after centrifugation) is resuspended in a small amount of medium and incubated until the time of insemination.

It is our experience at Lifecare IVF, a reputed IVF centre in Delhi Ncr, that there is no statistically significant difference between pregnancy rates for swim up versus gradient /wash technique though results from various studies may suggest a preference for gradient technique for most of the samples. Only samples with very good parameters should be prepared by Swim up technique.