Best sperm preparation technique in IUI Novita Prasetiawati Senior Embryologist Melati Clinic RSAB Harapan Kita

Introduction Semen contains of: Sperm + Seminal plasma Should it be separated ?? - Diagnostic test - Therapeutic recovery (IUI and ART)

Before Treatment Cycle 1x semen analysis Preparation must be with in 1 hour after ejaculation

Sperm Separation Aims to: Eliminates seminal plasma, debris and contaminants Concentrate progressively motile sperm Select morphologically normal sperm

Semen Analysis (WHO 2010) Volume (≥1,5 ml) Morphology ≥ 4% Concentration ≥ 15x106 /ml Σ Motile Sperm ≥ 39x106/ ml Morphology ≥ 4%

Sperm preparation Method Simple Washing Direct Swim Up Density Gradien

Incubator Incubator Non CO2 Incubator CO2 the medium must be added buffer with hepes or similar Caps tubes tightly closed Incubator Non CO2 Medium buffered with sodium bicarbonate Caps tubes should be loosed to allow gas exchange Incubator CO2

Simple Washing Centrifugation Diluting semen + Medium culture High yield sperm, but debris & cells including in pellet

Swim Up Technique Sperm swim up to medium Normozoospermia Clean but < sperm yield (<20%) > zinc concentration IVF & ICSI

Discontinuous Density-gradients Best selection of good-quality spermatozoa (>20%) Good separation from other cell & debris Easier Used for IUI, IVF & ICSI

Normozoospermia VS OAT in 2016-2017

Gradien vs Swim up in 2016-2017

Pregnancy rates of IUI base on Sperm count (ASRM 2015)

Conclusion For treatment cycle (TC) sperm must be separate from seminal plasma Semen Analysis must be performed at least once before TC Semen analysis should be performed according WHO 2010 Density Gradien gives more advantages than other techniques

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