SEMEN PREPARATION for IUI Dr Aruna Saxena MD(Obs& Gynae),ARTCE (NUS, Singapore) Director ,Lifecare IVF Pvt Ltd

SEMEN PREPARATION-Why ? Washing removes seminal plasma (prostaglandins) .Prolonged exposure to seminal plasma inhibits capacitation of sperm Dead sperm and pus cells produce harmful ROS (Reactive oxygen species) Selects for motile sperm.

SEMEN COLLECTION AND DELIVERY WHO recommendation 3-5 days of abstinence Masturbation Clean wide mouth sterile container Labeling First portion of ejaculate should not be lost Collection in non spermicidal condom following intercourse  

Normal values for WHO manuals (editions 2-5) 4

Which technique ? GOOD : Parameters normal /> normal BAD : Parameters less than normal UGLY : Parameters severely low, viscous , infected , agglutination NO SPERMS : high speed centrifugation VERY LOW COUNT : Pooling of samples

PELLET - SWIM UP

PELLET - SWIM UP

Density gradient Pellet Semen 45% gradient 90% gradient Media Spin

Migration Media Semen Underlay

INSTRUCTIONS TO BE FOLLOWED WHILE HANDLING SEMEN SAMPLE Clean sterile work area (Laminar air flow) Non-toxic, non-powdered gloves Slow Dilution Pre warm media and disposables Preparation performed at 37`c Thorough identification protocol Damage to the sperm from dilution, temperature change.centrifugation,and exposure to potentially toxic material must be minimised

Semen préparation techniques for intrauterine insémination (Review) Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C The Cochrane Library 2009, Issue 1 Five RCTs, including 262 couples in total, were included in the meta-analysis No trials reported the primary outcome of live birth. There was no evidence of a difference between pregnancy rates (PR) for swim-up versus a gradient or wash and centrifugation technique, Nor in the multiple PR in two studies comparing a gradient technique versus wash and centrifugation. There was no evidence of a difference in the miscarriage rate in two studies comparing swim-up versus a gradient technique.

Authors’ conclusions There is insufficient evidence to recommend any specific preparation technique. Large high quality randomised controlled trials, comparing the effectiveness of a gradient and/ or a swim-up and/ or wash and centrifugation technique on clinical outcome are lacking. Further randomized trials are warranted.

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